Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study

Omodei, U.; Ferrazzia, E.; Ruggeri, C.; Palai, N.; Fallo, L.; Dordoni, D.; Peruginoa, G.

doi:10.1046/j.1469-0705.2000.00091.x

Cited by 30 publications

(10 citation statements)

References 20 publications

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“…In women on sequential combined therapy, the false-positive rate might be reduced by measuring the endometrial thickness within a week after the last progestin pill. This is supported by the findings of Omodei et al, who showed that endometrial thickness did not differ in women on sequential or continuous combined HRT (3.6 mm vs. 3.2 mm) if the measurement in question were taken on about the fifth day following the last progestin pill (15).…”

Section: Discussionsupporting

confidence: 74%

Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy

Epstein

2003

Acta Obstet Gynecol Scand

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Link to publicationCitation for published version (APA): Epstein, E. (2004). Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy. Acta Obstetricia et Gynecologica Scandinavica, 83(1), 89-95. DOI: 10.1111/j.1600-0412.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background. The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence-based algorithm for the management of PMB. Methods. A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden.Results. Fifty-nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always (n ¼ 54, 92%) or most commonly (n ¼ 5, 8%) used in the diagnostic work-up of PMB. In women with endometrial thickness 4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow-up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow-up). In women with endometrium !5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium !5 mm, endometrial biopsy was obtained routinely by Endorette 1 /Pipelle 1 in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed. Conclusion. More than one-third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.

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Section: Discussionsupporting

confidence: 74%

Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy

Epstein

2003

Acta Obstet Gynecol Scand

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“…Endometrial thickness did not differ in women on sequential or continuous combined HRT (3.6 mm versus 3.2 mm) if measured at about the fifth day after taking the last progestogen pill …”

Section: Investigationmentioning

confidence: 85%

“…Among women with postmenopausal bleeding, a thin endometrium (<5 mm) safely excludes endometrial pathology and may not require any further investigation unless recurrent/persistent bleeding or any high‐risk factors are present …”

Section: Investigationmentioning

confidence: 99%

Unscheduled bleeding with hormone replacement therapy

Dave

Adedipe

Disu

et al. 2019

The Obstetric & Gynaecologis

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Menopause is now considered as a mid-life event. Hormone replacement therapy (HRT) is justified when menopausal symptoms adversely affect the quality of life of the individual woman. Management of unscheduled bleeding with HRT remains a clinical challenge and leads to pressure on resources. The aim should be to exclude endometrial pathology and to regulate the bleeding pattern so that the woman's concerns are addressed and compliance maintained. The mechanisms which underlie this unscheduled bleeding are poorly understood. Appropriate counselling should be offered at the outset. Learning objectivesTo gain knowledge of the most appropriate HRT regimens used in perimenopausal, postmenopausal and hysterectomised women to minimise unscheduled bleeding. To learn how to tailor the treatment regimen to the individual woman's situation. Ethical issuesThe lack of clinical evidence for managing unscheduled bleeding should be acknowledged. Should clinicians initiate expensive and invasive investigations in all women with unscheduled bleeding on HRT or only select those with significant risk factors?

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“…No difference in the incidence of endometrial cancer was identified between the two groups, however it concluded that women with unscheduled bleeding on HRT require further investigation by hysteroscopy and biopsy if the endometrial thickness was greater than 8 mm . Comparing combined HRT to sequential HRT, the likelihood of identifying an endometrial pathology was significantly higher in patients with endometrial thickness >4 mm than the incidence observed in patients with unscheduled bleeding …”

Section: Endometrial Hyperplasiamentioning

confidence: 86%

Endometrial pathology in the postmenopausal woman – an evidence based approach to management

Otify

Fuller

Ross

et al. 2014

The Obstetric & Gynaecologis

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This article outlines how to identify the symptoms and signs associated with endometrial pathology and how these correlate with the final diagnosis. The evidence for and against intervention in asymptomatic women with a coincidental finding of endometrial pathology is discussed. This article looks at how best to investigate symptomatic women on hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs). Screening for endometrial pathology is discussed. Learning objectivesTo be able to identify risk factors associated with postmenopausal endometrial pathology, as well as symptoms and signs.To learn about the models of care for different endometrial pathology. To understand the contentious issues and the risk-benefit profile of different strategies for the management of asymptomatic women. Ethical issuesDoes an incidental finding of a thick endometrium in asymptomatic postmenopausal women warrant further investigation? Should asymptomatic women receiving HRT or SERMs be routinely screened and investigated?

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Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study

Cited by 30 publications

References 20 publications

Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy

Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy

Unscheduled bleeding with hormone replacement therapy

Endometrial pathology in the postmenopausal woman – an evidence based approach to management

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