Endometrial response to unopposed estrogens remains unaltered in patients with chronic renal failure receiving hemodialysis

Most patients with chronic renal failure who are on maintenance hemodialysi s are anovulatory and have menstrual abnormalities. This study was designed to determine the prevalence of organic ca uses of abnormal uterine bleedin g in this group of patients exposed to unopposed estrogens, Eighteen patien ts with chronic renal failure and abnormal uterine bleeding underwent vacuu m curettage. The histopathologic findings were compared with a group of 154 premenopausal women who had abnormal uterine bleeding without detectable o rganic causes. Excluding patients with secretory and atrophic endometrium, only 2 of 8 patients (25%) with chronic renal failure had endometrial lesio ns while 44 of 131 patients (33.6%) had either endometrial polyp, simple or atypical endometrial hyperplasia or endometrial carcinoma (p > 0.05). The uremic environment caused by chronic renal failure does not alter the endom etrial responsiveness to unopposed estrogens and may lead to the developmen t of endometrial lesions.