We thank Dr. Goldstein for his deep interest and scholarly comments regarding our recently published article1 and for his pertinent query. We really do appreciate his kind comments.
Effectively, as Dr. Goldstein states, the incidence of endometrial thickening detected by ultrasonography in postmenopausal women without bleeding is approximately 10–15%. In our population, after the current state-implemented, nonselective, opportunistic screening protocols, a Pap test, human papillomavirus test, and transvaginal ultrasound scan are performed every 3 years. This means that we see a higher incidence of endometrial thickening on ultrasonography in asymptomatic patients. Following our protocols,2 diagnostic hysteroscopy is performed in all patients with endometrial thickening greater than 5 mm and in any patient who presents with postmenopausal bleeding.
We are currently in the process of changing the state protocol, modifying it to oppose the implementation of opportunistic ultrasound scans according to new guidelines now available and based on convincing scientific evidence.3 We hope that, in due course, there will be no such interventions in asymptomatic patients—regardless of the endometrial thickness detected—as Dr. Goldstein and the literature rightly suggest is appropriate.
On the other hand, we would also like to underline that, as clearly stated in our article, endometrial biopsies were taken only when apposite: in cases of the presence of benign features such as polyps or leiomyomas or on suspicion of malignancy, in 46% of our cases (63/138).