ENDOMETRIAL THICKENING IN PATIENTS ON TAMOXIFEN: CURRENT INSIGHTS AND MANAGEMENT STRATEGIES

Tamoxifen, a selective estrogen receptor modulator (SERM), remains a cornerstone adjuvant treatment for hormone receptor positive breast cancer because of its anti-estrogenic effects on breast tissue. However, its partial estrogen-like activity on the endometrium raises concerns about endometrial thickening and related pathologies. Recent data indicate that up to 66% of women receiving tamoxifen show an endometrial thickness of 8 mm on ultrasound. According to several studies, about 50 60% of women on tamoxifen have an endometrium measuring 8 mm on imaging, yet more than half of these cases reveal a benign or atrophic endometrium on biopsy, highlighting that routine invasive investigations may be unnecessary in asymptomatic patients. This mismatch between imaging findings and histology calls into question the value of systematic invasive evaluation in women without symptoms.A review of recent clinical and imaging studies, predictive models incorporating machine learning, and updated clinical guidelines suggests that risk stratification could be improved through nomograms that integrate both clinical and radiologic data