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Endometrial ablation for refractory postmenopausal bleeding with continuous hormone replacement therapy
1Department of Obstetrics and Gynecology, St. Joseph Hospital, Denver, Colorado.
Fertility and Sterility
|December 1, 1994
Summary
Continuous hormone replacement therapy (HRT) effectively manages menopausal bleeding for many women. For persistent cases, adjusting progestin dosage or endometrial ablation can resolve refractory bleeding caused by uterine pathology.
Area of Science:
- Gynecology
- Reproductive Medicine
- Menopause Management
Background:
- Refractory bleeding is a common concern for menopausal women using hormone replacement therapy (HRT).
- Identifying underlying benign uterine pathology is crucial for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of endometrial ablation and identify benign uterine pathology in menopausal women with refractory bleeding despite continuous HRT.
- To determine the role of escalating progestin dosage in managing persistent bleeding.
Main Methods:
- A prospective study involving 171 menopausal women treated with continuous HRT.
- An algorithm of endometrial biopsy, hormone manipulation, hysteroscopy, and endometrial resection-ablation for refractory bleeding was employed.
Main Results:
- 65.4% of women achieved amenorrhea with initial continuous HRT.
- Increasing progestin dosage resolved bleeding in 87% of remaining cases.
- Endometrial resection-ablation successfully treated refractory bleeding in 13% of patients, revealing polyps, leiomyomas, and adenomyosis in 85.7%.
Conclusions:
- Initial continuous HRT is effective for many menopausal women with bleeding.
- Doubling progestin dosage is effective for most remaining cases.
- Endometrial resection-ablation is a successful treatment for refractory bleeding caused by benign uterine pathology.