ENDOMETRIAL THICKNESS ASSESSED BY TRANSVAGINAL ULTRASOUND INSUFFICIENTLY PREDICTS OCCURRENCE OF HYPERPLASIA DURING UNOPPOSED ESTROGEN USE

In the present study, unopposed oestrogens were given to 184 non-hyste rectomized women, for a duration varying from four weeks to 24 months, while the endometrial responses were monitored by transvaginal sonogr aphy (TVS) and backed up by endometrial sampling (conducted when the e ndometrial thickness reached 8 mm (double layer) or more, vaginal blee ding occurred during oestrogen administration, or after one year of un opposed oestrogen use). In cases where the endometrial thickness reach ed 8 mm or more, progestogens were administered for 12 days. In 64% of the women, administration of progestogen could be postponed until at least the fourth month of treatment under the pre-defined decision cri teria. Eleven percent of the patients used oestrogens continuously dur ing the two year study period, without any need of additional progesto gen. In total, 338 endometrial biopsies were performed; 16 cases of hy perplasia were detected. In three cases,the corresponding endometrial thickness was below 8 mm (in one case, 5 mm). Endometrial thickness co uld not consistently predict occurrence of hyperplasia. In eight cases , hyperplasia occurred within 4 months of treatment, and in four cases , within only 2 months (of which only one case could possibly be attri buted to previous hormone use and none to endogenous oestrogen product ion). The rapid occurrence of hyperplasia should be taken into account in studies of quarterly progestogen administration with hormone repla cement therapy. It is concluded that postponement of progestogen admin istration with hormone replacement therapy under guidance of TVS only (without biopsies) would not be adequately safe to be recommended for clinical practice.