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The influence of hormone replacement therapy on the ultrasound features of the endometrium: a prospective study
Author(s) -
Van Den Bosch T.,
Timmerman D.,
Van Schoubroeck D.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.abs14-2.x
Subject(s) - medicine , progestogen , tibolone , endometrium , estrogen , ultrasound , gynecology , menopause , hormone replacement therapy (female to male) , menstrual cycle , urology , obstetrics , hormone , radiology , testosterone (patch)
Purpose: To evaluate the thickness and the sonographic features of the endometrium in postmenopausal women on hormone replacement therapy (HRT). Methods: A total of 485 vaginal ultrasound examinations were performed in 239 consecutive postmenopausal women on HRT. Endometrial thickness (ET) was measured and other sonographic features were recorded. Endometrial sampling was performed if indicated. Results: Mean age was 55.1 years (SD 5.7) with an average parity of 1.8 (SD 1.0). The mean age at menopause was 49.7 years (SD 3.6). Sixty‐four percent of women were on sequential estro‐progestogen therapy, 23.7% on continuous estro‐progestogen, and 22% took tibolone. The average ET was 5.2 mm (SD 2.7), 5.7 mm (SD 2.7) in women taking sequential HRT, vs. 4.3 mm (SD 2.3) in the continuous estro‐progestogen schemes, and 4.6 mm (SD 1.3) in the tibolone group. In the sequential schemes mean ET measured 5.7 (SD 2.6) in the first estrogen‐alone phase of cycle vs. 5.8 mm (SD 2.9) in the estro‐progestogen phase. Polyps were diagnosed by ultrasound in 12.1% of patients: more than half of them (54.5%) were asymptotic. In sequential HRT, a three‐layer ultrasound pattern of the endometrium was seen in 49.4% of women in the estrogen‐alone phase of cycle vs. 13.3% in the estro‐progestogen phase. About 3.5% of women on continuous estro‐progestogen and 13.8% of the tibolone group showed a three‐layer pattern. Conclusions: 1 The same cut‐off values for endometrial thickness proposed in postmenopausal women without HRT cannot be used in patients on HRT. 2 A sonographic evaluation performed in the estrogen‐alone phase of cycle may optimize the accuracy for focal lesion detection in women on sequential HRT. 3 The issue of the relatively high incidence of polyps in asymptotic women on HRT has to be addressed in order to avoid overtreatment.