Objectives: Postmenopausal uterine bleeding is a common presenting medical problem that has an overwhelming impact on these women’s quality of life and the utilization of the health care services. An endometrial thickness of 4-5 mm or less in women with postmenopausal bleeding is highly reliable and a significant tool to exclude cancer. There is no data about how frequently an endometrial echo cannot be visualized due to technical limitations. In this study, we aim to identify the incidence of inability to visualize an endometrial echo and the reason(s) for it and test whether is a significant association between the inability to visualize the endometrial echo and the number of years since menopause, BMI, the current use of hormonal replacement therapy either local or systemic versus no hormonal replacement therapy, and presence of history of any previous abdominal surgery.

Method: A retrospective chart review was done of asymptomatic postmenopausal women who came to NYU Medical center in the period of (01/01/2014 - 12/31/2018)

Results: 472 subjects were enrolled in the study. The incidence rate of the inability to visualize the endometrium was measured as 38.14%, and the most frequent findings among those patients were the presence of fibroids (52.78%), followed by the history of a previous abdominal surgery (49.44%) then the presence of axial uterus (31.67%) and adenomyosis (19.44%) respectively. Also, there was a significant association between the BMI and echo finding while controlling for other variables.

Conclusion: In our sample of 472 asymptomatic menopausal patients, the incidence rate of the inability to visualize the endometrial echo was 38.14%. The most frequent findings among those patients were the presence of fibroids.