COMPARISON OF TRANSVAGINAL ULTRASONOGRAPHY AND ENDOMETRIAL BIOPSY IN ENDOMETRIAL SURVEILLANCE IN POSTMENOPAUSAL HRT USERS

Objectives: To compare transvaginal ultrasonography with histological findings in endometrial evaluation of postmenopausal women using hormo ne replacement therapy and to evaluate endometrial safety of three hor mone replacement therapy regimens. Methods: in a randomized, comparati ve study in postmenopausal women, endometrial safety was evaluated usi ng (1) no hormone replacement therapy, (2) oral micronized 17 beta-est radiol/oral sequential dydrogesterone, (3) transdermal 17 beta-estradi ol/oral sequential dydrogesterone, or (4) oral tibolone, 85 Non-hyster ectomised subjects underwent transvaginal ultrasonography immediately before Pipelle biopsy at baseline and subsequently after 12 and 24 mon ths. Endometrial thickness and uterine dimensions were determined by t ransvaginal ultrasonography and endometrial thickness (double-layer) w as compared with biopsy results. Results: Endometrial evaluation was c onveniently performed by transvaginal ultrasonography, and endometrial thickness correlated well with biopsy findings, If endometrial thickn ess was < 5 mm, the endometrial biopsy sample was either inactive/atro phic or insufficient for histopathological diagnosis. Hyperplastic or malignant changes were not reported. After 24 months, endometrial thic kness was increased both in the oral (P < 0.001) and transdermal (P < 0.001) 17 beta-estradiol/dydrogesterone groups, whereas with tibolone the change in endometrial thickness was not different from controls. C onclusion: transvaginal ultrasonography of the endometrium reliably pr edicts the histological picture in hormone replacement therapy users. Using 5 mm endometrial thickness as cut-off point, more than 75% of bi opsies could be avoided. All three hormone replacement therapies were safe with respect to the endometrium. With sequential 17 beta-estradio l/dydrogesterone the expected progestogen-induced secretory pattern wa s observed, whereas endometrial histology under tibolone closely mimic ked the natural atrophic postmenopausal state. (C) 1997 Elsevier Scien ce Ireland Ltd.