Register for |
The First World Congress On:
Controversies in Obstetrics, Gynecology & Infertility |
|
Asymptomatic Endometrial and Ovarian Findings in
Post Menopausal Women
|
| The leading rational for periodic gynecologic “check-up” of women is to identify premalignant or suspicious lesions, provide prompt evaluation and treatment thus resulting in reduced mortality from malignant gynecologic diseases. In the post menopausal years this effort is being directed in the past decade, to sporadic “screening” of the endometrium and ovaries with Transvaginal Ultra sonography (TVS). Although there is no data to support TVS screening of low risk asymptomatic women, in practice, it is extremely common for women to be referred to TVS annually or semi annually by their physician. As a result of this practice, a variety of “abnormal” lesions are visualized by TVS and promote further evaluation procedures by imaging, invasive tests and ultimately surgical management. Of the common Endometrial lesions we should mention: 1) “Thick” Endometrium 2) Endometrial Polyps, Fibroids 3) Endometrial Fluid Collection 4) Tamoxifen Effect Of the ovarian lesions, the common findings include various cystic formations whether simple, solid, or complex with a wide range of sizes. As a result of these positive findings, a “second-line” of “Sonography” and minimally invasive techniques, are implemented to further evaluate these findings and rule out a malignant lesion. Specifically the use of endometrial biopsy techniques (Pipelle), office hysteroscopy and hysteroscopic surgery (In and Out patient) are utilized. In addition, 3D and power Doppler sonography technologies associated with measurements of tumor markers (CA-125) and minimally invasive surgery (i.e. 3 mm and 5 mm Laparoscopy) are used for diagnosis and treatment. The efficacy of the initial screening methodology and the cost effectiveness of the management of positive findings are an issue of controversy and major concern. Women are exposed to the risks associated with the variety of tests, examination and surgical procedures joined by a significant period of anxiety during the evaluation and follow-up. There is desperate need for prospective studies to analyze our practice from all medical aspects. It is our duty and the purpose for presenting this topic in this meeting to: One) Review current Data Two) Provide guidance for current screening strategies Three) Define the “Very Low Risk” lesions, which require no further evaluation. Four) Define the proper stepwise evaluation of asymptomatic lesions and the indications for the various therapeutic approaches. It is our responsibility to safely raise the “threshold” of positive TVS findings without compromising women’s health, thus reducing the costs and the morbidity. A critical presentation will be followed by an open discussion and a proposed consensus will be offered. |
