title: Sonographic measurement of endometrial thickness as a predictor of vaginal bleeding in women using continuous combined hormone replacement therapy.
abstract: The development of unpredictable vaginal bleeding is one of the main reasons for the discontinuation of treatment in users of continuous combined hormone replacement therapy (HRT). There is no accurate method of predicting which women will develop bleeding on this regimen. The aim of this study was to determine whether sonographic assessment of the endometrium could be used as a predictor of bleeding after the commencement of this treatment. Sonographic measurements of the endometrium were performed before treatment and then every 3 months for 1 year. Measurements of the endometrium were taken in both the transverse and sagittal planes and a record of the frequency of bleeding was maintained. Pretreatment measurements tended to be greater in those who developed bleeding within 1 month of the commencement of treatment, but the difference in measurements between those who developed bleeding and those who did not was not statistically significant. Endometrial thickness tended to be greater at 3, 6, 9 and 12 months of treatment in those who had bleeding compared with those who did not, but again the difference was not statistically significant. It is concluded that whilst bleeding on continuous combined HRT is more common in women with a thicker endometrium, sonographic assessment of the endometrium is not an accurate enough predictor of bleeding to be used in this clinical setting.
authors.affiliation: Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, N.T.. cjohnhaines@cuhk.edu.hk
authors.forename: C J
authors.initials: CJ
authors.lastname: Haines
authors.forename: T K
authors.initials: TK
authors.lastname: Chung
authors.forename: T K
authors.initials: TK
authors.lastname: Lau
mesh_terms: D004359:Drug Therapy, Combination; D004717:Endometrium / Q000000981:diagnostic imaging*; D004958:Estradiol / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause / Q000187:drug effects; D008875:Middle Aged; D009640:Norethindrone / Q000009:adverse effects; D011237:Predictive Value of Tests; D045167:Progesterone Congeners / Q000009:adverse effects; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging
chemical_list: D045167:Progesterone Congeners; D004958:Estradiol; D009640:Norethindrone