Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease.

Objective: The purpose of this study was to assess postmenopausal women with endometrial fluid collection and the risk of significant endometrial or cervical disease.

Methods: A retrospective chart review was conducted of 343 postmenopausal women with endometrial fluid collection on pelvic sonography. Medical records were reviewed to identify women who underwent an evaluation of the endometrium with endometrial biopsy, hysteroscopy, or hysterectomy after the sonographic examination. Clinical and sonographic characteristics were compared between women with diagnoses of cervical or endometrial cancer or hyperplasia (nonbenign group) and women with benign conditions (benign group).

Results: The endometrium was significantly thicker in the nonbenign group compared with the benign group (mean +/- SD, 9.9 +/- 7.4 versus 5.9 +/- 4.1 mm; P = .016). None of the patients with adenocarcinoma of the endometrium had endometrial thickness of 3 mm or less, but 2 with endocervical cancer did. Echogenic fluid in the endometrial cavity was significantly more likely to be found in the nonbenign group compared with the benign group (45.8% versus 4.8%; P < .01). Multivariate logistic regression analysis revealed that echogenic fluid in the endometrial cavity was the only significant risk factor for nonbenign conditions (odds ratio, 10.94; 95% confidence interval, 2.67-44.84; P < .01).

Conclusions: Postmenopausal women with endometrial fluid collection on sonography should undergo endometrial sampling if the endometrial lining is thicker than 3 mm or the endometrial fluid is echogenic. If the lining is 3 mm or less and the endometrial fluid is clear, endometrial sampling is not necessary, but we recommend endocervical sampling to rule out endocervical cancer.