Indications
Include any condition where pathologic evaluation of endometrial tissue will be useful for diagnosis.
Examples include:
Abnormal uterine bleeding (AUB)
Follow-up of endometrial hyperplasia treated medically
Pap smear with atypical glandular cells (AGC) in all women older than 35 years and in women younger than 35 who have higher risk of endometrial cancer (abnormal bleeding, morbid obesity, oligomenorrhea)
Pap smear with cells favoring endometrial origin in a non-menstruating woman
Remember:
EMB should be performed in any peri-menopausal woman who has significant risk factors for endometrial cancer or who does not convert to a more normal bleeding pattern with hormonal therapy.
Understanding the risk factors for endometrial hyperplasia and cancer (which are essentially the same), helps determine the importance of sampling endometrial tissue.
Known risk factors include:
Prolonged exposure to unopposed estrogen (exogenous, hyperandrogenic anovulation or polycystic ovary syndrome, obesity, infertility, estrogen secreting tumors)
Diabetes mellitus (2.8:1)
Tamoxifen use
Hypertension (this is less well established than other risk factors)
History of breast or colon cancer (in some patients)
Early menarche and late menopause
Nulliparity