Hormone replacement therapy after transcervical resection of the endometrium

To determine if women who have undergone transcervical resection of the endometrium can be treated safely with estrogens alone.

Sixty-two postmenopausal women who had undergone endometrial resection were recruited into a double-blind, randomized study. Twenty-one had menopausal symptoms at the primary operation and were recruited at the time of the surgery, and 38 were recruited an average of 20 months (range 8-42) after the primary endometrial resection and underwent a second resection to remove any residual endometrium before entering the study. Three patients were excluded from the study. Subjects were allocated randomly to one of two hormone replacement therapy (HRT) regimens: 17-beta-estradiol 2 mg alone or combined with norethisterone 1 mg. Clinical and ultrasound data were collected every 3 months. Hysteroscopically standardized endometrial biopsies were taken after 1 year.

In the single-agent therapy group, endometrial hyperplasia without atypia was found in six subjects and proliferative endometrium in eight after 1 year. No such cases occurred among women receiving combined therapy. Endometrial thickness and menstrual bleeding were significantly greater in the single-agent therapy group than in those receiving combined therapy. These differences between single-agent and combined therapy were statistically significant.

Postmenopausal HRT in patients who have undergone transcervical resection of the endometrium should include progestagen for protection of the endometrium.