Ultrasonographic and morphological studies of the postmenopausal endometrium using unopposed estrogen replacement therapy with regular pause: a prospective preliminary study

Hormone replacement therapy with progestogen is known to have severe side e ffects or complications in certain patients. Objective: The goal of this st udy is to evaluate the safety and efficacy of an alternative treatment regi men with a mensal pause using both transvaginal sonography (TVS) and endome trial biopsy to follow patients. Methods: A total of 30 postmenopausal wome n were treated with unopposed estrogen for 21 days each month followed by a regular pause of 9-10 days, and were studied prospectively for 18 months. The TVS measurements of endometrial thickness and biopsy of the endometrium were done on the 21 st day of treatment and the 7th day of the pause at 6- month intervals throughout the study. Results: There was a significant decr ease of proliferative activity at all three time points during the study (6 , 12 and 18 months) when tested on the 7th pause day (PD7). The percentage of patients with hyperplasia without nuclear atypia and endometrial thickne ss greater than or equal to8 mm was 32% at 6 months, but decreased to 22 an d 19% at 12 and IS months, respectively. All cases of hyperplasia regressed after the hormonal pause throughout the treatment period. Conclusions: Thi s study presents an alternative treatment regimen for select patients havin g side effects or complications from progestogen administration; however, s tudies evaluating the safety and efficacy of this regimen over longer time periods are necessary. (C) 2001 Elsevier Science Ireland Ltd. All rights re served.