阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

Sonography and hysteroscopy for endometrial carcinoma and its precursors

The transvaginal sonography is a non invasive diagnostic method to evaluate the endometrium. It has a high reliability in the diagnosis of endometrial carcinoma, in the assessment of the depth of myometrial invasion as well as in preoperative staging.Patients with an episode of postmenopausal vaginal bleeding and an endometrial thickness (double layer) less-than-or-equal 4 mm should be controlled by transvaginal ultrasound examination after 3 month. In case of a endometrial thickness > 4 mm or in case of a persistent bleeding a histologic assessment should be obtained. Because of the highest sensitivity and specificity a hysteroscopic biopsy or a diagnostic hysteroscopy with subsequent D & C should be performed.Vaginal bleeding under hormonal replacement therapy should not be regarded to have more importance than vaginal bleeding in patients without HRT.After the current consensus hysteroscopy causes only a slightly increase in the rate of positive peritoneal cytology. This phenomenon seems to be of no influence on the disease free survival rate.     

Diagnostic and preoperative staging of endometrial carcinoma with transvaginal sonography--a review

Endometrial carcinoma is the most common malignant tumor of the female genital tract. The major non-invasive diagnostic method is ultrasound. Endometrial thickness (double layer) is measured by transvaginal sonography. The cut-off value in patients with postmenopausal bleeding is still controversial, although in patients with endometrial thickness below 4 mm (or 5 mm respectively), malignancy can be excluded with high probability. If the endometrium measures more than 4 mm (or more than 5 mm respectively) or the patient presents with continuous bleeding, hysteroscopy and curettage should be performed in order to obtain histologic diagnosis. Sonographic findings like structure and demarcation of the endometrium increase diagnostic specificity only when combined with the measurement of endometrial thickness. Measuring the fluid within the uterine cavity does not seem to be useful in differentiating malignant from benign disorders. The extent of surgery depends on the preoperative estimation of the tumor stage which is particularly important for elder patients with increased morbidity. Transvaginal sonography has not been widely accepted to predict the depth of myometrial invasion or cervical infiltration. Although promising studies exist, additional examinations have to be done in order to determine the role of transvaginal sonography beside other methods (CT, MRT). This article on transvaginal ultrasound reviews current data on the method's capacity to identify endometrial cancer and to diagnose the depth of invasion.     

Hormonal replacement therapy and evaluation of intrauterine pathology in postmenopausal women: a ten-year study

BACKGROUND: To evaluate the role of hormonal replacement therapy (HRT) in determining: a) abnormal uterine bleeding (AUB); b) increased endometrial thickness at transvaginal sonography (TVS); c) the correct indication for outpatient hysteroscopy (HS) and biopsy in diagnosing intrauterine pathology. METHODS: Between April 1991 and April 2001 a group of 3,400 postmenopausal women was referred to the Department of Obstetrics and Gynecology of Rome University "La Sapienza"; 16.7% of them had received HRT. 587 out of the 3,400 women were recruited for a comparative study, including four groups. To assess statistical significance of HRT in determining AUB, and/or endometrial thickness related to malignant disease the chi-square test was used; p < 0.05 was considered significant. Histology was considered the true result (control). RESULTS: An increase in the endometrial thickness occurred significantly more often in women on HRT (p < 0.03); as well as the percentage of AUB (p < 0.0001). No difference in the incidence of endometrial adenocarcinoma was reported between the HRT and the non HRT groups. CONCLUSIONS: In postmenopausal women using HRT we can confirm that a higher incidence of signs (AUB, endometrial thickness > or = 5 mm) does not coincide with a higher incidence of malignant pathology. The data obtained from the recruited patients was arranged and evaluated by the most suitable methods for screening endometrial adenocarcinoma. According to our experience, we believe a cut-off point of 8 mm to be significant (p < 0.001) to perform an hysteroscopy and biopsy except for asymptomatic patients on HRT.     

Transvaginal sonography and sonohysterography as screening tools for postmenopausal bleeding

The number of postmenopausal women in the United States is rapidly increasing, and the benefits of hormone replacement therapy (HRT) for the prevention of menopausal syndromes such as osteoporosis, coronary heart disease, and urogenital atrophy are documented. Accordingly, the number of patients using HRT constitutes an increasing percentage of obstetrician/gynecologist and other primary care physician practices. The risk of estrogen-stimulated endometrial hyperplasia and carcinoma in postmenopausal women with uteri in situ using HRT is effectively counteracted by progesterone, thereby making combined estrogen-progesterone HRT regimens safer than estrogen-only regimens. Bleeding, however, continues to be a common complaint among postmenopausal HRT users and nonusers. Despite recent research on the use of transvaginal sonography (TVS), with and without sonohysterography, as a screening tool for the diagnosis of the causes of postmenopausal bleeding, practitioners continue to rely on aspiration endometrial biopsy, hysteroscopy, and dilatation and curettage as the primary methods of evaluating such postmenopausal bleeding. This article evaluates the advantages of TVS, with and without saline infusion sonohysterography (SIS), as a screening tool for postmenopausal bleeding in HRT users and nonusers. Also, the potential of TVS, with and without SIS, to decrease the number of invasive procedures performed is explored.     

TV sonographic assessment in postmenopausal women with bleeding

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women with bleeding. This study involved 275 postmenopausal women aged 47-81 years (median 62). None of them were on hormone replacement therapy and all had had amenorrhea for more than one year. Concerning the age of the study patients, we confirm that endometrial cancer occurs at any age, but more commonly in ages above 58 years. Transvaginal sonography was performed in all women. About 89.2% of malignant diseases were discovered in the study women whose endometrial thickness was above 4 mm, but we also found endometrial cancer in 10.2% of the cases in women whose endometrial thickness was below 4 mm. In postmenopausal symptomatic women premalignant or malignant causes of bleeding can not be excluded with just transvaginal ultrasound.     

Treatment of recurrent bleeding disorders during hormone replacement therapy by transcervical endometrial ablation.

If bleeding disorders, which could not be treated by modification of steroid dosages, occurred during sequential hormone replacement therapy (HRT), most of the patients stopped HRT. In these cases a diagnostic outpatient hysteroscopy with biopsy was carried out. In most of the cases no intrauterine cause for the bleeding disorder was found. In 35 patients we performed an endometrial ablation without intra- or postoperative complications. After this procedure all patients received a combined continuous HRT. In a follow-up of 12 months 34 patients were amenorrheic and satisfied with the treatment. One patient stopped HRT because of suffering from other side effects. Endometrial ablation represents a method of treating patients with bleeding disorders without intrauterine causes with a minimal invasive procedure. A continuous combined HRT is possible after the endometrial ablation in perimenopausal and postmenopausal patients without bleeding disorders. In selected cases endometrial ablation can contribute to the increase of the compliance with HRT.     

The use of hysterosonography and transvaginal sonography in combination with the progesterone test in asymptomatic women in risk groups in the postmenopause

The hysterosonography allows evaluation of the endometrial cavity by endouterine administration of sterile physiologic solution. We wanted to assess the role of the hysterosonography and the transvaginal ultrasonography in asymptomatic women in post-menopause in combination with progesterone test. The progesterone test was performed by border of the endometrial depth of 4 mm, we used progesterone tablets Primolut Nor for 10 days., by depth 5 mm and over. Under the border of 4 mm we assessed the endometrium as atrophic. When bleeding occurred we used transvaginal sonography in combination with hysterosonography and in this way were better visualised the sub-mucous uterine fibroids nodes and also very small lesions., and endometrial cancers. The transvaginal sonography allowed to measure better the endometrial depth and in combination with the hysterosonography provided very good information. One hundred postmenopausal women from the risk groups with diabetes, blood hypertension, obesity and treated with Tamoxiphen were subjected to transvaginal sonography by endometrial depth of 4 mm we used progesterone test. -so it was used by 5 mm and over When bleeding occurred we performed abrasio probatoria separata The hysterosonography was used as additional method for clearing and determining of some polyps and very small lesions. The sensitivity of the transvaginal sonography was compared with the hysterosonography and was nearly the same--91% resp. 94%. The specificity was 31% for the transvaginal sonography. The combining of the transvaginal sonography and hysterosonography increased the sensitivity up to 96% and the specificity up to 98%. The hysterosonography can be additional method for diagnose of focal lesions, because of the good shape and forms of the lesions, especially in some risk groups receiving Tamoxiphen, with diabetes mellitus, blood hypertension and obesity patients.     

Uterine Blutungen bei internistischen Grunderkrankungen

Clinical management of unscheduled uterine bleeds in women using hormone replacement therapy (HRT) involves reconsideration of the selected individual therapy. Special attention should be given to the dose of the estrogen and progestin, the adequacy of both the progestin phase and the regimen – sequential or continuous combined therapy. A progestin should be administered for at least 10 days. It is unknown whether tibolone is an alternative for women with irregular bleeding on continuous combined therapy. These considerations also apply to women with uterine myoma. Transvaginal sonography may help identify women with thickened endometrium demanding histopathological assessment. Various controlled clinical trials suggest different cut-off values for a “normal” endometrial thickness (double-layer). A threshold of 7 mm appears to offer a reasonable compromise between sensitivity and specificity. A single episode of bleeding in the presence of an endometrial thickness ≤ 4 mm may allow for follow-up without endometrial sampling. Adherence to HRT may be enhanced by selecting the lowest doses of estrogens and progestins, including progesterone, achieving alleviation of climacteric symptoms without compromising endometrial safety. Parenteral use of estrogens and progestins is preferable in women with impaired liver function, as this mode of administration avoids the first-pass effect. This relatively small group of women may be eligible for replacement therapy if hepatic function reaches an equilibrium prior to initiation of therapy. Scarce clinical data indicate that systemic lupus erythematosus appears to deteriorate in women using HRT. However, other studies suggest that biliary cirrhosis does not deteriorate in women on HRT. HRT is possible in women with chronic renal and bone diseases. The outlined management of uterine bleeding also applies to these women. Uterine bleeding may occur with use of tamoxifen and less frequently with raloxifene, which is approved for the prophylaxis and treatment of postmenopausal osteoporosis. Transvaginal sonography may identify women with uterine stimulation, as indicated by the presence of subendometrial cysts and thickened endometrium, and preselect patients for endometrial sampling to exclude hyperplasia and cancer. The sensitivity and specificity of a single measurement of endometrial thickness is limited and additional tests such as saline infusion sonography may enhance the predictive value of the ultrasound assessment. The baseline frequency of postmenopausal bleeding does not appear to be increased in women who use raloxifene. Preliminary data suggest that use of raloxifene is not associated with an increased risk of endometrial cancer as is tamoxifen. SERMs constitute a relative contraindication in women with severe impairment of liver function.     

Monitoring of hormone replacement therapy in postmenopausal women by transvaginal sonography and color flow doppler: study in different phases of sequential therapy

OBJECTIVE: To assess uterine artery blood flow and endometrial thickness in postmenopausal patients receiving sequential hormone replacement therapy (HRT) at different phases of the treatment. DESIGN: Prospective controlled study. SETTING: Ultrasound and menopause units of the obstetrics and gynecology department of the University of Tor Vergata, Rome, Italy. PATIENT(S): Forty postmenopausal women were treated with cyclic sequential HRT (transdermal E2, 50 microg/d, days 1-21; and dydrogesterone, 10 mg/d, days 12-24). INTERVENTION(S): All patients underwent transvaginal color Doppler sonography in the estrogen (phase E) and progestogen (phase E/P) phases and after uterine bleeding when no hormone was administered (phase 0). MAIN OUTCOME MEASURE(S): Endometrial thickness; systolic, diastolic, and mean velocities; and pulsatility and resistance indices of the uterine arteries. RESULT(S): No statistically significant difference in endometrial thickness between phase E (6.5+/-1.6 mm) and phase E/P (6.0+/-1.7 mm) was observed. In phase 0, compared with phases E and E/P, a statistically significant decrease in endometrial thickness was found (4.1+/-1.2 mm). Doppler flow impedance parameters of uterine arteries during the different phases of the HRT cycle showed no differences between the phases considered. CONCLUSION(S): The decrease in endometrial thickness in phase 0 suggests a protective effect of our cyclic sequential regimen on the endometrium. Dydrogesterone does not interfere markedly with the vasodilatory effect of estrogen on uterine arteries.     

Transvaginal Sonography of the Endometrium in South Indian Postmenopausal Women

EDITORIAL COMMENT: We accepted this paper because it has a simple important message, namely that postmenopausal women with an endometrial thickness ≤4 mm will not have an endometrial cancer; they are likely to have endometrial atrophy. A vaginal ultrasound examination to measure endometrial thickness is a noninvasive investigation. There are about 100 papers on this subject in the world literature at present, and it appears that this investigation will adequately exclude endometrial malignancy in postmenopausal women. This is especially useful in older, unfit or frail women. However, if bleeding is heavy or persists it would still be recommended that hysteroscopy and/or curettage be performed.
Summary: Endometrial carcinoma is not commonly seen in India as in the West. Nevertheless, the diagnosis has to be entertained in women presenting with postmenopausal bleeding. The aim of the study was to compare die transvaginal sonographically-measured endometrial thickness with the histopathological diagnosis in postmenopausal women. Eighty postmenopausal women were studied prospectively. All of them underwent transvaginal sonography followed by eidier an office dilatation and curettage and/or a hysterectomy. Eight women had endometrial carcinoma and their mean endometrial thickness was 12.6±5 mm (mean ± SD). Taking 4 mm endometrial thickness as cut off the sensitivity of transvaginal scan to detect endometrial pathology was 97%, specificity 98%, positive predictive value 97% and negative predictive value 94%. Hence, we conclude that measurement of endometrial thickness by transvaginal scan is a good screening test in postmenopausal women for differentiating endometrial pathology from those who do not have an endometrial lesion.     

The diagnostic value of power Doppler measurements in the endometrium of women with postmenopausal bleeding

OBJECTIVE:The objective was to evaluate the accuracy of blood flow measurements by power Doppler in endometrial vessels in women with postmenopausal bleeding (PMB). METHODS: Sixty consecutive patients with PMB participated in the study. Endometrial thickness and power Doppler measurements of small vessels in the endometrium and subendometrial tissue were performed prior to dilatation and curettage. Correlation between Doppler indices, endometrial thickness (by transvaginal sonography), and histopathologic examination was performed. A Student t test was used for statistical analysis with P < 0.05 as the level of significance. RESULTS: Fourteen positive cases were found: 11 endometrial cancers, 1 sarcoma, 1 simple hyperplasia, and 1 complex hyperplasia with atypia. Measurements of endometrial thickness using a cutoff point of 5 mm revealed a sensitivity of 78% and specificity of 45.6% (P > 0.05, NS) for detecting endometrial pathology. Power Doppler measurements (pulsatility index cutoff point = 1.0) revealed a sensitivity of 85. 7% and specificity of 89% (P = 0.001) for detecting endometrial pathology. CONCLUSIONS: The noninvasive methods for endometrial evaluation are not sensitive enough to exclude endometrial pathology. When invasive methods could not be performed, the combination of transvaginal sonography and power Doppler imaging provided the best results. When both modalities are negative, the probability of cancer is less than 5%.     

Transvaginal endometrial sonography in postmenopausal women taking tamoxifen

OBJECTIVE: To evaluate sonographic measurements of endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and to correlate sonographic and pathologic findings to symptoms and duration of tamoxifen therapy. METHODS: Medical records and sonograms of 80 postmenopausal women treated for breast cancer with adjuvant tamoxifen therapy were reviewed retrospectively. Endometrial thickness was recorded as a single-layer thickness and considered abnormal when greater than 2.5 mm for postmenopausal women. Sonographic endometrial thickness was correlated to histologic findings, symptoms, and duration of tamoxifen therapy. RESULTS: Fifty-seven of 80 postmenopausal women (69%) had single-layer endometrial thicknesses of 2.5 mm or greater, measured by transvaginal sonography, and 55 of 57 had endometrial biopsies or dilatations and curettage. Biopsies detected 24 cases of abnormal endometria, including endometrial carcinoma (two), breast carcinoma metastatic to the endometrium (one), endometrial polyps (13), tubal metaplasia (three), and benign endometrial hyperplasia (five). Using a single-layer endometrial thickness greater than 2.5 mm by transvaginal ultrasound, 21 of 24 (87.5%) women with abnormal endometria were detected. Women with abnormal pathologic findings had a significantly thicker mean single-layer endometrial thickness than those with normal findings, 7 mm versus 4 mm (P < .01). Twelve women had postmenopausal bleeding, all of whom had a single-layer endometrial thickness greater than 2.5 mm on transvaginal sonography. CONCLUSION: With a sensitivity of detecting endometrial abnormalities of 84%, transvaginal sonography was useful for studying postmenopausal tamoxifen-treated women.     

Comparison of transvaginal ultrasound, saline infusion sonography and hysteroscopy to investigate postmenopausal bleeding and unscheduled bleeding on HRT

A study was conducted to compare transvaginal ultrasound (TVS), saline infusion sonography (SIS) and outpatient hysteroscopy for examining the uterine cavity in women with postmenopausal bleeding and unscheduled bleeding on hormone replacement therapy (HRT). Fourty Subjects agreed to undergo TVS, SIS and hysteroscopy in addition to endometrial sampling. The abnormalities detected by each imaging method were recorded together with the discomfort (visual analogue scale). Thirty women completed all three imaging procedures. In 18 cases TVS suggested an abnormal cavity. SIS and hysteroscopy were of similar efficacy in clarifying the nature of this, and confirmed an abnormality in 12 cases (40%). TVS was significantly less painful than the other procedures (p < 0.001). SIS and hysteroscopy were associated with pain scores similar to endometrial sampling. These findings justify the need for a large randomised trial of TVS, SIS, hysteroscopy and endometrial sampling, in order to develop the most appropriate strategy for investigating postmenopausal bleeding and unscheduled bleeding on HRT.     

Transvaginal ultrasonographic assessment of the endometrium in asymptomatic, postmenopausal women using different HRT regimens containing tibolone or estrogen

OBJECTIVE: To assess the effects of hormone replacement therapy (HRT) on endometrial thickness as measured by transvaginal ultrasonography in asymptomatic, postmenopausal women. STUDY DESIGN: Between 1997 and 2001, 307 women who had no risk factors for endometrial cancer or abnormal vaginal bleeding were enrolled in a study. Patients received 1 of the following HRT modalities: (1) oral equine HRT modalities: (1) oral equine estrogen, (2) oral 17beta-estrogen, (3) transdermal 17beta-estrogen, or (4) oral tibolone. All women taking estrogens were also taking a progestin. Only the patients with endometrial thickness >7 mm underwent endometrial biopsy while taking HRT. RESULTS: Although we observed an increase in serum estrogen levels as compared to the levels before tibolone therapy, changes in endometrial thickness were not statistically significant in patients taking tibolone. CONCLUSION: Endometrial thickness with tibolone closely mimics the naturally atrophic postmenopausal state. Thus, tibolone is suggested for those postmenopausal women who have concerns about HRT.     

Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility

OBJECTIVE: To compare transvaginal sonography with hysteroscopy for the evaluation of intrauterine disorders. DESIGN: Clinical study. SETTING: Academic research environment. PATIENT(S): Patients who were undergoing initial evaluation for primary or secondary infertility or investigation after three failed IVF attempts. INTERVENTION(S): Transvaginal sonography was performed, followed by hysteroscopy, between January 1998 and April 1999. The endometrial findings at sonography were compared with those at hysteroscopy, which served as the gold standard. The characteristic sonographic features of intrauterine adhesions were defined. MAIN OUTCOME MEASURE(S): Intrauterine adhesions, endometrial polyps. RESULT(S): The sensitivity, specificity, and positive and negative predictive values for transvaginal sonography in detecting abnormal uterine cavities were 100%, 96.3%, 91.3%, and 100%, respectively. The corresponding values for the specific diagnoses of intrauterine adhesions and endometrial polyps were 80%, 100%, 100%, and 97%, and 71.4%, 100%, 100%, and 97.1%, respectively. On transvaginal sonography, intrauterine adhesions appeared as hyperechoic endometrial foci and were differentiated from endometrial polyps by their irregular shape and more precise localization. The performance of transvaginal sonography at midcycle (three-layer endometrium) rather than after menstrual cessation (endometrial thickness <3 mm) enabled better imaging of small intrauterine adhesions. CONCLUSION(S): A regular myometrial-endometrial interface and homogeneous endometrial structure on transvaginal sonography congruent with the phase of the menstrual cycle indicated a normal endometrium and precluded the need for diagnostic hysteroscopy. Transvaginal sonography may be used as the initial diagnostic procedure to select patients for hysteroscopy.     

Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?

OBJECTIVE: This study was undertaken to evaluate whether it was possible to abstain from performing an endometrial biopsy when endometrial thickness according to transvaginal ultrasonography was /=50 years who were referred because of postmenopausal bleeding or irregular bleeding during hormone replacement therapy. If endometrial thickness was /=5 mm underwent either curettage or endometrial biopsy. RESULTS: One hundred sixty-three women had an endometrial thickness /=5 mm. The corresponding figure when atypical hyperplasia and endometrial metastases were included was 20. 2%. CONCLUSION: If the false-negative rate of endometrial biopsy techniques is taken into account, then the combination of transvaginal ultrasonography and cervical cytologic examination is an adequate form of management for women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy as long as endometrial thickness is 相似文献   

Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding

OBJECTIVES: The aim of this study was to evaluate whether the efficiency of the current diagnostic work up following postmenopausal bleeding could be improved by diagnostic strategies that take into account characteristics of the women in addition to the currently recommended transvaginal measurement of endometrial thickness to determine for subsequent histological assessment. DESIGN: Multicenter, prospective cohort study. SETTING: A university hospital and seven teaching hospitals in the Netherlands. SAMPLE: Consecutive women not using hormone replacement therapy, presenting with postmenopausal bleeding. METHODS: Five hundred and forty women underwent transvaginal sonography, and in case of endometrial thickness (double layer) above 4 mm, subsequent endometrial sampling was performed. Presence of carcinoma was ruled out by the absence of abnormalities in histological specimen or by an uneventful follow up of at least 6 months. MAIN OUTCOME MEASURES: Probability of endometrial carcinoma was estimated by multivariable logistic regression models. For each diagnostic strategy, we calculated diagnostic accuracy (area under receiver operating characteristic curve [AUC]), negative predictive value (NPV) and the number of diagnostic procedures. RESULTS: A strategy with transvaginal sonography alone with a fixed threshold incorrectly classified 0.7% of the women as nonmalignant (NPV: 99.3% [98.5-100%]), with 97% sensitivity and 56% specificity. A strategy integrating characteristics of the women with transvaginal sonography could result in less false reassurances (NPV: 99.6% [99.2-100%]), with only marginal decrease in diagnostic procedures, or a minor increase in false reassurances (NPV: 99.0% [98.3-100%]), with a substantial reduction (15-20%) in the procedures. AUCs associated with these strategies could improve from 0.76 (0.73-0.79) for transvaginal sonography alone to 0.90 (0.87-0.93) for the integrated strategy. CONCLUSION: Taking into account the characteristics of the women could increase the efficiency of the diagnostic work up for postmenopausal bleeding.     

Transvaginal sonography of the endometrium in postmenopausal women

The purposes of this study were to compare transvaginal sonographic scanning of the uterus and endometrium with histology obtained by endometrial biopsy or curettage and to determine whether the sonographic technique might be useful in the evaluation of postmenopausal women. Eighty postmenopausal women were studied. Of these, 65 were asymptomatic (38 on no hormone therapy and 27 on hormone replacement). Fifteen women underwent evaluation because of postmenopausal bleeding. In both groups, endometrial thickness of 4 mm or less as depicted by sonography correlated well with endometrial characteristics of decreased estrogen stimulation. However, in women with measured endometrial thickness between 5-8 mm, proliferative endometrium could not be distinguished from hyperplastic endometrium or, in one case, low-grade carcinoma. Large polyps and invasive carcinoma with myometrial extension were easily recognized.     

Ultrasonic evaluation of endometrial changes induced by cyclic sequential hormone substitution therapy

BACKGROUND: At present the hormonal replacement therapy on postmenopausal women with uterus needs the use of progestins additionally to estrogens, to eliminate the risk of endometrial hyperplasia and carcinoma connected with the use of estrogens alone. The check of the endometrium during these therapies can be made by transvaginal ultrasound that permits the evaluation of the thickness, structure, and contour of the endometrial rima. The aim of this study was to establish the changes of endometrial thickness during cyclic sequential hormonal replacement therapy on healthy postmenopausal women with transvaginal ultrasound. METHODS: The endometrial thickness with transvaginal ultrasound has been evaluated during the cyclic sequential hormonal replacement therapy on 20 healthy women in physiological menopause before the treatment, during the phase of treatment with estrogens alone and during the phase of treatment with the addition of the progestins. RESULTS: Significant differences during the estrogenic phase compared to before treatment have been underlined (5.7 mm vs 3.5 mm p = 0.002), but not during progestinic phase compared to estrogenic (6 mm vs 5.7 mm p = 0.712). CONCLUSIONS: Transvaginal ultrasound is a useful investigation to evaluate the modifications of the thickness and structure of the endometrium during hormonal replacement therapy and can help early diagnosis of endometrial diseases during these treatments.