• All women should be able to access advice on how they can optimise their menopause transition and the years beyond.

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We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.

Objectives To investigate the association between previous large loop excision of transformation zone (LLETZ) and risk for subsequent spontaneous preterm delivery (sPD) and whether this effect is reflected in the measurement of cervical length at midgestation.Design and setting A secondary analysis of data from women recruited for clinical trials of interventions to prevent preterm labour.Population A total of 26 867 women with singleton pregnancies attending for routine antenatal care.Methods Transvaginal sonographic measurement of cervical length was carried out at 20 +0 to 24 +6 weeks. Logistic regression analysis was used to determine the significant predictors of sPD among maternal characteristics, obstetric history, previous history of LLETZ and cervical length.Main outcome measures Spontaneous preterm delivery.Results In the 473 women who had undergone LLETZ, compared with the 25 772 without a history of LLETZ, the rate of sPD before 34 weeks of gestation was higher (3.4 versus 1.3%, P = 0.0002) and the median cervical length was shorter (32 mm versus 34 mm, P < 0.0001). Regression analysis demonstrated that in the prediction of sPD there were significant contributions from racial origin, cigarette smoking, previous preterm delivery and LLETZ and the detection rate of sPD was 29.8%, at a falsepositive rate of 10%. However, after addition of cervical length, LLETZ did not remain a significant predictor in the model, which detected 52.6% of sPD, at a false-positive rate of 10%.Conclusions LLETZ increases the risk of sPD, even after adjustment for maternal risk factors. The effect of a previous LLETZ on sPD in a subsequent pregnancy is reflected in the measurement of cervical length at mid-gestation.Keywords Cervical length, large loop excision of the transformation zone, screening, spontaneous preterm delivery.Please cite this paper as: Poon L, Savvas M, Zamblera D, Skyfta E, Nicolaides K. Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG 2012;119:692-698.

Objective To investigate the effect of subcutaneous oestradiol and testosterone on the proportion of type III collagen in the skin of postmenopausal women. Design A cross sectional comparison. Setting Dulwich Hospital menopause clinic. Subjects Fourteen untreated women and 11 women who had received subcutaneous oestradiol and testosterone for a median 8.0 years (range 3–14). Ten of the untreated women received subcutaneous hormone implants and the effect on skin collagen was studied prospectively. Measurements The proportion of type III collagen in skin biopsies taken from the lateral aspect of the thigh. Results The median type III collagen content in the skin of the women who had received hormone replacement therapy (25.4%, range 21.4–30.2) was significantly higher (P<0.01) than in the untreated women (19.6%, range 18.2–28.8). The proportion of type III collagen in the skin of 10 untreated women increased significantly (P<0.01) from a median of 19.9% (range 18.2–23.9) to 22.4% (range 20.5–31.5) following 6 months of treatment with hormone implants. Conclusion This study indicates an increase in the proportion of type III collagen in women receiving hormone replacement therapy.

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Study objective-To compare oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis.Design-Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls.Setting-Gynaecological endocrine clinic in tertiary referral centre.Patients-Oral treatment group of 37 postmenopausal women (mean age 57*5 years, median 8-75 years from last menstrual period), compared with 41 women given oestrogen implants (mean age 56-2 years, median 9-5 years from last menstrual period) and 36 controls (mean age 51-8 years, median 2.0 years from last menstrual period). Weight was not significantly different among the groups.Interventions-Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycloprogynova) for a median of 8-0 years. Implant group was given subcutaneous implants of oestradiol 50 mg combined with testosterone 100 mg, on average six monthly for a median of 8 5 years. Controls were not treated.End point-Significant increase in bone density. Measurements and main results-Bone density measured by dual beam photon absorptiometry was 1*02 (SD 0-13) g hydroxyapatite/cm2 in implant group versus 0-89 (0-11) in oral group (p<001) and 0-87 (0-14) in controls (p<0.01). Serum oestradiol concentration in implant group was (median) 725 pmolIl versus 170 pmolIl in oral group (p<001) and 99 pmol/l in controls (p<0-01). Serum follicular stimulating hormone was median 1 IU/I (range 1-11) in implant group (equivalent to premenopausal values) versus 43 (4-94) IU/I in oral group (p<0-01) and 72 (28-99) IU/I in controls (p<0-01).Conclusions-Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved. It also avoids problems of compliance that occur with oral treatment. IntroductionPeak bone mass is achieved in the fourth decade of life in both men and women, after which it decreases with age. The rate at which bone is lost accelerates in women after the menopause to the extent that they have lost half of their skeletal calcium by the age of 70. This leads to the excess of osteoporotic fractures in

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