HORMONE REPLACEMENT THERAPY AFTER TRANSCERVICAL RESECTION OF THE ENDOMETRIUM

Objective: To determine if women who have undergone transcervical rese ction of the endometrium can be treated safely with estrogens alone. M ethods: Sixty-two postmenopausal women who had undergone endometrial r esection were recruited into a double-blind, randomized study. Twenty- one had menopausal symptoms at the primary operation and were recruite d at the time of the surgery, and 38 were recruited an average of 20 m onths (range 8-42) after the primary endometrial resection and underwe nt a second resection to remove any residual endometrium before enteri ng the study. Three patients were excluded from the study. Subjects we re allocated randomly to one of two hormone replacement therapy (HRT) regimens: 17-beta-estradiol 2 mg alone or combined with norethisterone 1 mg. Clinical and ultrasound data were collected every 3 months. Hys teroscopically standardized endometrial biopsies were taken after 1 ye ar. Results: In the single-agent therapy group, endometrial hyperplasi a without atypia was found in six subjects and proliferative endometri um in eight after 1 year. No such cases occurred among women receiving combined therapy. Endometrial thickness and menstrual bleeding were s ignificantly greater in the single-agent therapy group than in those r eceiving combined therapy. These differences between single-agent and combined therapy were statistically significant. Conclusion: Postmenop ausal HRT in patients who have undergone transcervical resection of th e endometrium should include progestagen for protection of the endomet rium.