Long-term outcome of postmenopausal women with proliferative endometrium on endometrial sampling.

Abstract Introduction Proliferative endometrium has been reported in 15% of endometrial biopsies of women 50 and older. In contrary to endometrial hyperplasia, proliferative endometrium has not been associated with risk of endometrial cancer. We sought to report on the long-term outcome of postmenopausal women diagnosed with proliferative endometrium. Methods Retrospective cohort study of 1808 women 55 and older who underwent endometrial sampling between 1/1997-12/2008. Outcome data was available through 2/2018. Women with proliferative endometrium were compared to those with atrophic endometrium for future development of endometrial hyperplasia or cancer. A sub-analysis was performed for those who presented with postmenopausal bleeding. Uni and multivariable logistic regression analysis were used to assess for confounders. Results PE was diagnosed in 297 (16.4%) cases. 962 met inclusion criteria, 278 with proliferative endometrium and 684 with atrophic endometrium. Women with proliferative endometrium were younger (61.2 vs. 64.5,p 60 (OR=1.98, 95%CI=1.03-3.82,p=0.04) and BMI>35 (OR=2.3, 95%CI=1.09-4.83,p Conclusion One in six postmenopausal women who underwent endometrial sampling had proliferative endometrium. 11.9% of them developed endometrial cancer or hyperplasia, a four-fold greater incidence than women with atrophic endometrium. The findings of this study suggest that long-term monitoring is warranted for women with postmenopausal bleeding and a proliferative endometrium histology. Further studies are needed to examine if a treatment is required to negate the risk of unopposed estrogen.