TRANSVAGINAL SONOGRAPHIC AND HYSTEROSCOPIC FINDINGS IN POSTMENOPAUSALWOMEN RECEIVING TAMOXIFEN

Study Objective. To evaluate the effect of tamoxifen on the endometriu m. Design. Prospective study. Setting. Department of Obstetrics and Gy necology of the University of Rome. Patients. One hundred one postmeno pausal women with breast cancer receiving tamoxifen 20 to 30 mg/day fo r al least 1 year; of these 78 were asymptomatic and 23 had vaginal bl eeding. Interventions. All patients underwent transvaginal color Doppl er sonography. Those with endometrial thickness greater than 5 mm were advised to undergo hysteroscopy and if necessary endometrial biopsy. For women with endometrial thickness less than 5 mm, hysteroscopy was recommended only if irregular endometrial echotexture was observed. Me asurements and Main Results. Eleven (14%) asymptomatic patients and 1 (4.3%) with vaginal bleeding had endometrial thickness less than 5 mm (p = 0.4, NS). Women with vaginal bleeding had a significantly thicker endometrium than asymptomatic patients (15.8 +/- 7.5 vs 11.1 +/- 5.7 mm, p = 0.003). In the asymptomatic group 31 polyps, 15 atrophic endom etria, and 6 hyperplasias were observed. Two endometrial cancers, 13 p olyps, and 3 hyperplasias were detected in patients with vaginal bleed ing. Hysteroscopy did not always allow endometrial biopsy, even in the presence of increased endometrial thickness with or without irregular surface. No statistical differences were found for mean pulsatility a nd resistance indexes of uterine and endometrial arteries between symp tomatic and asymptomatic women, but these indexes were significantly l ower compared with normal postmenopausal values. Conclusion. Women rec eiving tamoxifen, especially those who are asymptomatic, should be clo sely monitored by transvaginal sonography and hysteroscopy to detect e ndometrial pathologies.