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Ultrasonographic and morphological studies of the postmenopausal endometrium using unopposed estrogen replacement
M T Patriarca1, G R de Lima, J N Stavale
1Department of Gynecology of the Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
Unlabelled:
Hormone replacement therapy with progestogen is known to have severe side effects or complications in certain patients.
Objective:
The goal of this study is to evaluate the safety and efficacy of an alternative treatment regimen with a mensal pause using both transvaginal sonography (TVS) and endometrial biopsy to follow patients.
Methods:
A total of 30 postmenopausal women were treated with unopposed estrogen for 21 days each month followed by a regular pause of 9-10 days, and were studied prospectively for 18 months. The TVS measurements of endometrial thickness and biopsy of the endometrium were done on the 21st day of treatment and the 7th day of the pause at 6-month intervals throughout the study.
Results:
There was a significant decrease of proliferative activity at all three time points during the study (6, 12 and 18 months) when tested on the 7th pause day (PD7). The percentage of patients with hyperplasia without nuclear atypia and endometrial thickness > or =8mm was 32% at 6 months, but decreased to 22 and 19% at 12 and 18 months, respectively. All cases of hyperplasia regressed after the hormonal pause throughout the treatment period.
Conclusions:
This study presents an alternative treatment regimen for select patients having side effects or complications from progestogen administration; however, studies evaluating the safety and efficacy of this regimen over longer time periods are necessary.