Management of the menopause and HRT by ultrasound

Recent improvement of the transvaginal grey-scale and colour Doppler ultrasound scanning permits to investigate the morphology and the perfusion parameters of the female pelvic organs in the menopause. Data from detailed scanning of the ovaries and the uterus reflect the hormonal status, but the menopausal age from the last menstrual bleeding (LMB) and the sequence of the HRT given must be taken into consideration. Screening for endometrial pathology is advisable in the days after the withdrawal bleeding in women taking HRT. The positive vascular changes and increased peripheral perfusion in women with HRT detected by Doppler ultrasound are due to the oestrogen's vasodilator effect, which leads to cardiovascular and cerebrovascular protection. Changes of the uterine perfusion during the combined sequential HRT cycle doesn't seem to reflect the reverse effect of the progestin to oestrogen on the general vasculature, but correlates to the vascular changes of the normal menstrual cycle. The disappearing uterine notch in the menopause suggests decreasing vessel compliance. In women taking HRT the uterine notch persists or even may reappear years after the LMB, as a sign of the vessel compliance reserve probably activated by oestrogen and may act also as an indicator of the effect of HRT on arterial status.