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Normograms of Ovarian Volume, Uterine Size and Endometrial Thickness in Urban Midlife Malaysia Women

Vol. 2 No. 1, 2007

Original article

Author

Adeeb N, Nur Azurah AG, Ong FB, Seri SS, Shamsuddin K, Noor-Aini MY

Abstrak

Kanser ovari dan uterus merangkumi 5.0% dan 3.6% keseluruhan kes kanser wanita Malaysia. Kanser ovari (OC) merupakan ketumbuhan ginekologi pembawa maut yang utama kerana tiada terdapat gejala di peringkat awal sehingga kanser telah merebak. Ultrasonografi membenarkan pengesanan awal memberi peluang bagi pakar perubatan menyediakan rawatan dan kaunseling untuk wanita tersebut. Sebagai teras untuk saringan selektif, satu kajian telah dijalankan merangkumi 517 wanita bandar berusia 45+ tahun bebas penyakit, bukan pengguna HRT dan masih mempunyai uterus. Normogram ovari, uterus dan endometrium yang diperolehi daripada pemeriksaan ultrasound garisdasar dibentang. Sampel kajian terdiri daripada 58% dan 42% wanita pra dan pos-menopos dengan umur purata 51.27 ± 5.35 tahun. Lebih dua pertiga terdiri dari kaum Cina, diikuti oleh Melayu dan India. Kajian menunjukkan saiz purata jasad uterus dan ukuran endometrium (ET) adalah 7.21 ± 1.67x4.36 ± 1.30cm and 6.36 ± 3.73mm masing-masing. Saiz uterus wanita pre-menopos lebih besar berbanding pos-menopos (p<0.0005) dan atrofi uterus berlaku berikutan umur dan menopos. Ukuran ET juga lebih tebal pada wanita pre berbanding pos-menopos (p<0.0005), semakin tipis mengikut usia. Wanita pada awal pos-menopos menunjukkan ET <5mm, mencapai 2mm pada wanita berusia >70 tahun. Dengan demikian, tetapan normal klinikal kesemua wanita pos-menopos tanpa mengira kaum ditetapkan pada ET<5mm. Hampir seperlima wanita (18.9%) didapati mempunyai fibroid uterus, sebanyak sesuku (25.0%) semasa pre berbanding 10% pos-menopos (p<0.0005). Purata isipadu ovari (OV) kanan dan kiri masing-masing adalah 5.48 ± 7.85cm3 and 5.80 ± 16.78cm3. Terdapat pengurangan OV mengikut usia dan menopos, daripada 7cm3 pada usia 45-49 tahun kepada <1.5cm3 pada 70 tahun, menghasilkan tetapan normal klinikal wanita Malaysia pre dan pos-menopos pada OV <7.5cm3 and <3.5cm3. Sista ovari tidak ada bahaya dijumpa pada 2.9% dengan saiz purata 65.14 ± 88.22cm3. Sebagai kesimpulan, normogram ET dan OV harus disediakan bagi populasi Malaysia untuk memudahkan saringan kanser ginekologi.

Kata kunci

isipadu ovari, perimenopos, saiz uterus, ukuran endometrium

Abstract

Cancers of the ovary and corpus uteri afflict 5% and 3.6% Malaysian women respectively. Ovarian cancer (OC) remained the deadliest gynaecological malignancy in perimenopausal women mainly due to the lack of symptoms until the disease had spread. Ultrasonography could provide a preliminary screening allowing the clinician to tailor subsequent management and counselling for these women. To support the basis for selective screening, a study on 517 urban disease free women aged 45 years and above, uterus-intact, non-users of HRT was undertaken. This study presented normograms of ovary, uterus and endometrium derived from entry ultrasound assessment. The sample comprised of 58.0% premenopaused and 42.0% postmenopaused women with an average age of 51.27±5.35 years old. Over two thirds were Chinese followed by Malays and Indians. The findings indicated that the average uterine size and endometrial thickness (ET) was 7.21±1.67x4.36±1.30cm and 6.36±3.73mm respectively. Premenopausal women had larger uterus compared to those postmenopaused (p<0.0005) and atrophy of the uterus with age and menopause was demonstrable regardless of ethnicity. Likewise, mean ET in the premenopaused was thicker than the postmenopaused (p<0.0005), showing a gradual decrease with age. Early postmenopausal women demonstrated ET of <5mm, eventually reaching 2mm in women >70 years old. From these findings, a cut-off of <5.0mm was considered clinically acceptable in normal postmenopaused regardless of ethnicity. Nearly one fifth (18.9%) had uterine fibroids, a quarter (25%) in premenopausal women as compared to 10% postmenopaused (p<0.0005). The mean right and left ovarian volume (OV) was 5.48±7.85cm3 and 5.80±16.78cm3 respectively. There was a gradual decline in OV with age and menopause from about 7cm3 at age 45-49 years to less than 1.5cm3 at 70 years giving a clinical norm OV of <7.5cm3 and <3.5cm3 respectively in pre and postmenopausal Malaysian women. Benign ovarian cysts seen in 2.9% had a mean size of 65.14±88.22cm3. In conclusion, ET and OV normograms should be made available for the Malaysian population to facilitate screening for gynaecological malignancies.