Interactive Transcript
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So, endometrium, when you're thinking about
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that, you have to take all of these factors
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into account when you're evaluating whether the
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thickness of the endometrium is normal or not.
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So, the important things are going to be the age
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of the patient, whether they are pre-menopausal,
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post-menopausal, or within a menstrual cycle.
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It's also important to note at what stage
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they are within a menstrual cycle because it's
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going to vary depending on where they are.
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And then, of course, the pregnancy
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status that's going to affect what
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the endometrium should look like.
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So, let's talk about the cycle and
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let's talk about premenopausal
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and postmenopausal endometrium.
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So, at birth, the uterus is, in general,
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the similar size to the cervix itself.
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It may have a little bit of fluid
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in the endometrium at that point.
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And then, with age, the endometrium
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and the uterus are going to grow.
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The endometrium, at that point, starts
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to appear as a thin echogenic line.
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And then you reach the age of menstruation.
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So, at menstruation, in general, at the very
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beginning, right after the period ends, so maybe
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day three, day four, day five, you're going to
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have a thin echogenic line, as we can see here
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in this retroverted retroflex uterus, generally
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going to be around one to four millimeters.
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It's going to be thin.
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And it's going to be echogenic.
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Next, you have your proliferative
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phase, that's around day 6 through 14.
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You're going to range there
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from around 5 to 7 millimeters.
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At this point, it's going to become even
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more echogenic compared to the myometrium.
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So, you can see right here, we have
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a little bit of fluid in this one,
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but echogenic compared to the
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myometrium and a little bit thicker.
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That's the proliferative phase.
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Your late proliferative phase is
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going to look a little bit different.
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That measures up to around 11 millimeters
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and will have this trilaminar
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appearance that you can see here.
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And then you get the secretory phase.
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The trilaminar phase itself will resolve
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after ovulation, and that's when you're
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going to convert into the secretory phase.
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It's going to be the thickest, ranges
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from around 7 to 16 millimeters, and
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that's when it's very echogenic, as
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you can see in this example right here.
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It's important to note that when you're in
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secretory phase, the endometrium could obscure
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small or subtle findings such as an echogenic
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polyp because polyps are echogenic, sitting
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in a background of thickened endometrium,
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may be a little bit difficult to find those.
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So, if you're not sure that you may or may
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not see one, if you have vascularity, for
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example, you might want to re-image when
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they're in the menstruation or just post
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menstruation or early proliferative phase.
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And then postmenopausal.
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So, in postmenopausal patients, you're going
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to see a thin homogeneous echogenic line in
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general, less than five millimeters and no focal
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thickening of greater than five millimeters.
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That's going to be considered
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normal in all comers.
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It's important to note that atrophy
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is the most common cause of bleeding.
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But you can also have polyps, hyperplasia,
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and carcinoma, and you can't tell by physical
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exam which one it is, so you're going to
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come to ultrasound to evaluate them more.
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Polyp, in general, you're going to look for
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a focal echogenic structure, often has a
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single feeding vessel, they can have cystic
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change, and that overlaps, therefore, with
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hyperplasia, which can be thick with cystic
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change and may or may not be vascular.
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That also overlaps with carcinomas, which
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can be thick and have cystic change.
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One other thing to think
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about is a submucosal fibroid.
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In those cases, they're going to
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distort the cavity but not expand it.
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They're often going to have a broader base
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than a polyp or hyperplasia would.
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So let's talk a little bit more
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about the postmenopausal endometrium.
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That's going to change depending on if they
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are bleeding or if they're not bleeding.
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So I made this little diagram
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here that you can follow.
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If they are less than five
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millimeters all comers, this is
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going to be due to vaginal atrophy.
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They're done.
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They don't need a biopsy.
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However, if it's thicker than five millimeters,
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you need to know whether they are bleeding or
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not bleeding in their postmenopausal status.
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If they are bleeding and it's greater than five
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millimeters, they need to go for DNC or biopsy
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if something's more focally thickened there.
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However, if they're not bleeding,
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you go down this column here.
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If they're not bleeding and it is less than
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about eight millimeters and not focally thick,
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this is again, most likely due to atrophy
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and you can just kind of watch them and wait.
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However, if they're greater than eight
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millimeters, either overall thickness or
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focal, then you go back down to this DNC
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or biopsy category for further evaluation.92 00:03:21,130 --> 00:03:22,260 In those cases, they're going to
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distort the cavity but not expand it.
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They're often going to have a broader base
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than a polyp or hyperplasia would.
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So let's talk a little bit more
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about the postmenopausal endometrium.
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That's going to change depending on if they
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are bleeding or if they're not bleeding.
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So I made this little diagram
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here that you can follow.
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If they are less than five
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millimeters all comers, this is
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going to be due to vaginal atrophy.
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They're done.
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They don't need a biopsy.
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However, if it's thicker than five millimeters,
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you need to know whether they are bleeding or
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not bleeding in their postmenopausal status.
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If they are bleeding and it's greater than five
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millimeters, they need to go for DNC or biopsy
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if something's more focally thickened there.
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However, if they're not bleeding,
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you go down this column here.
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If they're not bleeding and it is less than
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about eight millimeters and not focally thick,
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this is again, most likely due to atrophy
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and you can just kind of watch them and wait.
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However, if they're greater than eight
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millimeters, either overall thickness or
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focal, then you go back down to this DNC
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or biopsy category for further evaluation.
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