IS BLEEDING A PREDICTOR OF ENDOMETRIAL HYPERPLASIA IN POSTMENOPAUSAL WOMEN RECEIVING HORMONE REPLACEMENT THERAPY

OBJECTIVE: We evaluated bleeding as a predictor of endometrial hyperpl asia in postmenopausal women receiving conjugated estrogens (Premarin) alone or with medroxyprogesterone acetate, STUDY DESIGN: This study w as a retrospective assessment of bleeding and endometrial histologic d ata gathered during the prospective Menopause Study Group trial. RESUL TS: Approximately 20% of women (n = 57) who received unopposed conjuga ted estrogens for 1 year had endometrial hyperplasia. These women (n = 56) had more bleeding days than did women who did not have hyperplasi a (p < 0.001). For users of unopposed conjugated estrogens, the predic tive value of amenorrhea to indicate a nonhyperplasia diagnosis was 95 %. Irregular bleeding did not appear to be indicative of hyperplasia w hen continuous or Cyclic medroxyprogesterone acetate was added to conj ugated estrogens. CONCLUSION: Unanticipated prolonged bleeding in post menopausal women receiving unopposed estrogen is suggestive of endomet rial hyperplasia. Some irregular bleeding is anticipated in women who receive conjugated estrogens plus medroxyprogesterone acetate as they acclimate to therapy, and this was not associated with hyperplasia.