What are the EMAS guidelines on endometrial assessment in perimenopausal and postmenopausal women?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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In 2013, The European Menopause and Andropause Society (EMAS) released a clinical guide that provides recommendations on endometrial assessment in perimenopausal and postmenopausal women. The recommendations also address how to deal with inconclusive evaluations and persistent symptoms, as well as testing in women who use tamoxifen and unopposed estrogen. [81, 82]

The EMAS recommendations include the following [81, 82] :

  • Speculum examination and palpation should always be done first to exclude non-endometrial gynecologic pathology

  • Once speculum examination and cervical cytology have been assessed, transvaginal ultrasound scanning should be performed initially because it is noninvasive and will measure endometrial thickness, as well as detect other pelvic pathology (eg, leiomyomas, ovarian tumors)

  • The primary indication for invasive methods should be to obtain endometrial tissue to diagnose or exclude endometrial cancer or premalignancies

  • Hysteroscopy allows visually guided biopsies and the identification and removal of focal lesions, including endometrial polyps or submucous fibroids in the uterine cavity

  • No single method is perfect, and a combination of methods may be necessary

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