The endometrial status of women on longterm continuous combined hormone replacement therapy

Hawthorn, Robert; Spowart, Keith; Walsh, David; Hart, D. M.

doi:10.1111/j.1471-0528.1991.tb13519.x

Cited by 20 publications

(10 citation statements)

References 9 publications

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“…7 – 10 12 13 17 19 This study confirms that long term treatment for up to five years with a continuous combined hormone replacement therapy regimen of oestradiol 2 mg and norethisterone acetate 1 mg daily was associated with neither endometrial hyperplasia nor malignancy and that it converted the endometrium to normal in women in whom complex hyperplasia arose during previous sequential or unopposed oestrogen regimens.…”

Section: Discussionsupporting

confidence: 66%

“…16 17 24 25 A separate study of 40 postmenopausal women treated with the same drug at one of the participating sites confirmed that the Pipelle method of sampling was effective and that an unassessable specimen was associated with endometrial atrophy 26…”

Section: Discussionmentioning

confidence: 92%

“…In many cases, the endometrium cannot be assessed because biopsy specimens contain insufficient tissue. 2 8 17 Continuous combined hormone replacement therapy stops bleeding in most postmenopausal women, 2 14 – 16 and it may transform hyperplastic endometrium into states of atrophy after three to nine months. 2 8…”

Section: Introductionmentioning

confidence: 99%

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Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up study

Wells

Sturdee²,

Barlow³

et al. 2002

BMJ

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Objective To determine effects of five years of treatment with an oral continuous combined regimen of 2 mg 17 -oestradiol and 1 mg norethisterone acetate on endometrial histology in postmenopausal women. Design Follow up study in postmenopausal women. Setting 31 menopause clinics in the United Kingdom. Participants 534 postmenopausal women, all with an intact uterus, who had completed nine months of treatment with oral continuous combined 2 mg 17 -oestradiol and 1 mg norethisterone acetate agreed to take part in a long term follow up study. Women were assigned to different groups on the basis of the treatment status immediately before entering the original study: 360 women had taken sequential oestrogen-progestogen hormone replacement therapy, 164 had taken no hormone replacement therapy, and 10 had taken unopposed oestrogen therapy. Methods Endometrial aspiration specimens were taken before the women started the continuous combined regimen, after 9 and 24-36 months, and at the end of the five year treatment period or on withdrawal from the study. Main outcome measure Results of endometrial histology. Results The duration of treatment with continuous combined hormone replacement therapy was 4.4 (range 1.1-5.9) years. Data on endometrial specimens were available for 526 women after nine months of treatment, 465 women after 24-36 months of treatment, and 398 women who completed the five years treatment (345 women) or were withdrawn between the two latter visits for biopsies (53 women). No cases of endometrial hyperplasia or malignancy were detected at biopsy; 69% of women had an endometrium classified as atrophic or unassessable on completion of the study or withdrawal from it. Before the continuous combined therapy was started, complex hyperplasia was detected in 21 women who had taken sequential hormone replacement therapy before the study and in one who had taken unopposed oestrogen. All of these women had normal results on histological examination of endometrial tissue after nine months of treatment with continuous combined hormone replacement therapy, and hyperplasia did not recur after up to five years of treatment. Conclusions Long term treatment (for up to five years) with continuous combined hormone replacement therapy containing oestradiol 2 mg and norethisterone 1 mg daily was associated with neither endometrial hyperplasia nor malignancy. In women who had complex hyperplasia during previous sequential or unopposed regimens, the endometrium returned to normal during treatment with continuous combined hormone replacement therapy. These findings provide reassurance about the long term safety of this continuous combined regimen in terms of the endometrium.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up study

Wells

Sturdee²,

Barlow³

et al. 2002

BMJ

View full text Add to dashboard Cite

show abstract

“…All these regimens tend to produce an atrophic endometrium in the short term 54,60 ; we do not yet have information on effects on the endometrium in the long term. It is, however, reassuring that in women who develop complex endometrial hyperplasia after taking standard combined sequential regimens for a mean of 2–5 years 40 the endometrium is corrected to normal after changing to a continuous combined therapy preparation 61,62 .…”

Section: Continuous Combined Therapymentioning

confidence: 98%

Newer HRT regimens

Sturdee

1997

BJOG

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“…The aim is to achieve amenorrhoea by rendering the endometrium atrophic 7. It is hoped that women who have been postmenopausal for many years and are used to not bleeding regularly will accept continuous combined therapies more readily than sequential ones.…”

Section: Introductionmentioning

confidence: 99%

Fortnightly review: Management of abnormal bleeding in women receiving hormone replacement therapy

Spencer

Cooper²,

Whitehead³

1997

BMJ

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The endometrial status of women on longterm continuous combined hormone replacement therapy

Cited by 20 publications

References 9 publications

Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up study

Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up study

Newer HRT regimens

Fortnightly review: Management of abnormal bleeding in women receiving hormone replacement therapy

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