Endometrial evaluation with transvaginal ultrasound during hormone therapy: a prospective multicenter study

Umberto Omodei, U. Omodei, E. Ferrazzi, Enrico Ferrazzi, Francesca Ramazzotto, Angela Becorpi, Angela Maria Becorpi, Eva Grimaldi, Gianfranco Scarselli, Daniele Spagnolo, Luigi Spagnolo, Valter Torri, Walter Torri
Fertility and sterility · 2004 · vol. 81(6) , pp. 1632–1637 · doi:10.1016/j.fertnstert.2003.10.043 · PMID:15193487 · W2094227767
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This prospective multicenter study evaluated the effectiveness of transvaginal ultrasound for assessing the endometrium in women undergoing hormone therapy.

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Abstract

OBJECTIVE: To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium. DESIGN: Prospective multicenter study. SETTING: University and general hospitals outpatient centers. PATIENT(S): Postmenopausal women (702) on HT. INTERVENTION(S): Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding. MAIN OUTCOME MEASURE(S): Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness >4.5 mm (precision scale 0.5 mm). RESULT(S): Endometrial thickness >4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding. CONCLUSION(S): Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium.

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MeSH descriptors

Endometrium Hormone Replacement Therapy Uterine Diseases Uterine Diseases Biopsy Cross-Sectional Studies Endometrium Endometrium Female Hormone Replacement Therapy Humans Hysteroscopy Predictive Value of Tests Prospective Studies Risk Factors Ultrasonography Uterine Diseases Uterine Diseases Uterine Hemorrhage Uterine Hemorrhage

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