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Abstract
Objectives: To evaluate, in women with postmenopausal bleeding, the effect of hormonal replacement
(HRT) therapy on the endometrial thickness as measured by transvaginal sonography
in relation to endometrial histology. Methods: 1110 women with sequential/progestin treatment (E + P) (n = 202), with Estriol treatment (n = 149) or without HRT (n = 759) and postmenopausal bleeding were examined by transvaginal sonography (TVS)
prior to curettage, with special reference to the relation of endometrial thickness
to its histopathology. Results: The distribution of endometrial pathology was different in those women with E +
P and Estriol compared with those without HRT. Endometrial pathology was found most
frequently in women with an endometrium exceeding 8 mm in thickness. Furthermore,
the incidence was found to increase with increasing endometrial thickness in all treatment
groups. Atrophy was found significantly more often in women without HRT. Hormonal
effects on the endometrium were found significantly more often in women with E + P
and Estriol. Endometrial hyperplasia was found most commonly in women with Estriol
in the thickness group 5–8 mm (P < 0.001) as compared to those with HRT and without HRT. Endometrial cancer occurs
most in women without HRT, in those women with an endometrium exceeding 8 mm in thickness
as compared both to the E + P (P < 0.001) group and to the Estriol (P < 0.001) group. Endometrial cancer did not occur in any woman (with E + P, Estriol
or without HRT) with an endometrial thickness of ≤ 4 mm. Conclusions: TVS is of value for excluding endometrial pathology in women with HRT and postmenopausal
bleeding. The distribution of endometrial findings and histopathological diagnosis
in women ith abnormal postmenopausal bleeding was different in women with E + P than
in women without HRT. Furthermore, the cut-off for excluding endometrial abnormalities
is the same in both groups i.e. ≤ 4 mm.
Keywords
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Article info
Publication history
Accepted:
January 2,
1997
Received in revised form:
December 23,
1996
Received:
January 11,
1996
Identification
Copyright
© 1997 Published by Elsevier Inc.
