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Hysteroscopy and transvaginal sonography in menopausal women receiving hormone replacement therapy
H Maia1, I C Barbosa, D Marques
1Centro de Pesquisas e Assistencia em Reproducao Humana, Salvador, Bahia, Brazil.
Study Objective:
To evaluate the endometrial cavity of menopausal women with irregular bleeding while receiving hormone replacement therapy.
Design:
Comparative evaluation of hysteroscopic and biopsy findings.
Setting:
A center for reproductive studies.
Patients:
Forty-one patients receiving different regimens of hormone replacement therapy.
Interventions:
Hysteroscopy, endometrial biopsy, and transvaginal sonography were performed in all 41 women. In 10 patients, endometrial polyps were removed with the resectoscope.
Measurements And Main Results:
Irregular bleeding during hormone replacement therapy was associated with atrophic endometrium whenever transvaginal sonography showed endometrial thickness to be less than 4 mm. In patients who developed increased endometrial thickness after hormone replacement therapy, hysteroscopy revealed the presence of endometrial polyps in the uterine cavity. Histopathologic examination of excised polyps revealed cystic or adenomatous hyperplasia confined to these lesions.
Conclusions:
Endometrial polyps can appear in menopausal women receiving hormone replacement therapy despite the presence of progestins to oppose the action of estrogens.