Objective  To analyze the risk factors of asymptomatic endometrial thickening after menopause and construct a prediction model.

Methods  A retrospective study was conducted on postmenopausal women who visited the Department of Gynecology, the Zhangjiagang First People's Hospital from March 2022 to February 2024. Patients were divided into a test set and a validation set at a ratio of 7 ∶ 3. Patients in the test set were further divided into an endometrial thickening group (endometrial thickness ≥5 mm) and a normal group (endometrial thickness < 5  mm) based on ultrasound results. Multivariate Logistic regression analysis was performed to analyze the risk factors for asymptomatic endometrial thickening in postmenopausal women, and a predictive model was constructed. The predictive efficacy of the model was evaluated using the receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curve, and decision curve.

Results  A total of 410 patients were enrolled, with 287 in the training set and 123 in the validation set. Multivariate Logistic regression analysis revealed that high BMI [OR=2.71, 95%CI (1.30, 5.67)], longer duration of menopause [OR=7.17, 95%CI (3.27, 15.75)], presence of hypertension [OR=3.05, 95%CI (1.43, 6.50)], elevated fasting blood glucose level [OR=3.10, 95%CI (2.23, 4.32)], and high estradiol level [OR=1.22, 95%CI (1.11, 1.35)] were independent risk factors for asymptomatic endometrial thickening in postmenopausal women. The calibration curves for both the training and validation sets demonstrated high consistency with the ideal curve and exhibited significant net benefit. The AUC were all 0.88 for the training and validation sets, respectively.

Conclusion  BMI, menopausal years, hypertension, fasting blood glucose, and estradiol are all independent risk factors for asymptomatic endometrial thickening after menopause. The prediction model constructed based on these factors shows a high level of predictive and clinical decision-making effectiveness, which helps to evaluate the risk of asymptomatic endometrial thickening after menopause and guide the development of targeted intervention strategies accordingly.

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