The importance of endometrial fluid collection in postmenopause

Objective: We sought to determine the importance of postmenopausal endometrial fluid collection, which has almost invariably been accepted as a finding of a malignant process. Methods: Out of 1,500 postmenopausal patients admitted to our center mainly for their postmenopausal symptoms, endometrial fluid collection was detected in 15 cases during transvaginal pelvic ultrasonographic evaluations. These patients were evaluated with cervical smears as well as endocervical and endometrial curretages. The fluid collections were aspirated and measured. Results: The mean age and mean menopausal age were 51.7 ± 1.3 and 5.7 ± 9.8 years, respectively. Six of the patients were already on hormone replacement therapy. Nine were asymptomatic and the others had vaginal discharge and pelvic pain. Ten patients had normal findings on pelvic examination, and in the others benign cervical polyps, previous cervical amputation, cervical erosion, and nabothian cysts were detected. The volume of the directly measured fluid was 7.9 ± 4.0 cm3. The cervical smears, the cytological examinations of the fluids, the colposcopic examinations and the endocervical curretages were negative, and the histopathological evaluation of the endometrial curretage specimens revealed no premalignant or malignant disease, but blood and fibrin in 1 patient, inactive endometria in 9 patients, proliferative endometria in 4 patients and senile cystic atrophy in 1 patient. Conclusion: Although there was no malignancy in our series, the conflicting results of the limited number of studies made us cautious and we still consider that postmenopausal patients with endometrial fluid collection may be at risk for gynecologic cancers and that every effort should be made in order to rule out such a condition.