@article{3087942,
    title = "EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal women",
    author = "Dreisler, E. and Poulsen, L.G. and Antonsen, S.L. and Ceausu, I. and Depypere, H. and Erel, C.T. and Lambrinoudaki, I. and Pérez-López, F.R. and Simoncini, T. and Tremollieres, F. and Rees, M. and Ulrich, L.G.",
    journal = "Maturitas",
    year = "2013",
    volume = "75",
    number = "2",
    pages = "181-190",
    issn = "0378-5122",
    doi = "10.1016/j.maturitas.2013.03.011",
    keywords = "aromatase inhibitor;  bazedoxifene;  conjugated estrogen;  contraceptive agent;  estrogen;  gestagen;  levonorgestrel;  raloxifene;  tamoxifen;  tibolone, article;  breast cancer;  climacterium;  computer assisted tomography;  consensus;  cost effectiveness analysis;  curettage;  endometrial thickness;  endometrium;  endometrium ablation;  endometrium biopsy;  endometrium cancer;  endometrium hyperplasia;  endometrium polyp;  estrogen therapy;  evidence based practice;  female;  follow up;  gynecological examination;  hereditary nonpolyposis colorectal cancer;  histopathology;  hormonal therapy;  human;  hysterography;  hysteroscopy;  laboratory diagnosis;  long term care;  nuclear magnetic resonance imaging;  ovary tumor;  postmenopause;  practice guideline;  preoperative evaluation;  repeat procedure;  transvaginal echography;  uterine cervix cytology;  uterus cavity;  uterus myoma;  whole body imaging, Endometrial Neoplasms;  Endometrium;  Female;  Humans;  Hysteroscopy;  Perimenopause;  Postmenopause;  Uterine Diseases",
    abstract = "Introduction Invasive as well as non-invasive methods are available for assessment of the endometrium. Aims The purpose of this clinical guide is to provide evidence-based advice on endometrial assessment in peri and postmenopausal women. Material and methods Literature review and consensus of expert opinion. Results and conclusions Presuming speculum examination and cervical cytology are assessed, transvaginal ultrasound should be undertaken initially as it is non-invasive and will not only measure endometrial thickness, but will also detect other pelvic pathology such as leiomyomas and ovarian tumours. The main indication for invasive methods is to obtain endometrial tissue to diagnose or exclude the presence of endometrial cancer or pre-malignancies. Biopsy is mainly undertaken as an outpatient procedure, but sampling is 'blind'. Hysteroscopy is used when focal lesions affecting the uterine cavity are suspected such as endometrial polyps or sub-mucous fibroids. None of the available methods are perfect. Ultrasound evaluation is dependent on the experience of the examiner, the equipment and the quality of visualization. Hysteroscopy too is dependent on the examiner and fibroids may obstruct visualization. Blind endometrial biopsy procedures often miss focal lesions. Thus re-examination is necessary when symptoms persist and no explanation for these has been identified. This clinical guide will evaluate the different methods of endometrial assessment, their indications and limitations. Guidance is also given about dealing with inconclusive investigations and persistent symptoms. © 2013 Elsevier Ireland Ltd."
}