title: Endometrial cancer after combined hormone replacement therapy.
abstract: OBJECTIVE
  It has been suggested that exposure to relatively high levels of unopposed estrogen is a risk factor for endometrial cancer. Combined therapy of estrogen with cyclic progestagen was therefore highly recommended for menopausal women with an intact uterus.
  
  
  METHODS
  The cases of two postmenopausal women who developed endometrial cancer after taking continuous sequential HRT for 15 months are reported. Both were without bleeding for more than 2 years and presented with a normal vaginal ultrasound. They had severe menopausal symptoms and asked for HRT.
  
  
  RESULTS
  After 15 months irregular bleeding occurred and a hysterectomy was performed. The pathohistological finding in both cases was endometrial cancer. As we measured the serum estradiol levels 4 h after tablet ingestion supraphysiologic values ranging between 418 and 442 pg/ml were found.
  
  
  CONCLUSIONS
  Our report strengthens the evidence that supraphysiologic estradiol levels despite combination with cyclic progestagen therapy, increase the risk of endometrial cancer.
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, University of Vienna, Austria. Doris.Gruber@akh-wien.ac.at
authors.forename: D M
authors.initials: DM
authors.lastname: Gruber
authors.forename: G
authors.initials: G
authors.lastname: Wagner
authors.forename: C
authors.initials: C
authors.lastname: Kurz
authors.forename: M O
authors.initials: MO
authors.lastname: Sator
authors.forename: J C
authors.initials: JC
authors.lastname: Huber
mesh_terms: D000230:Adenocarcinoma / Q000139:chemically induced*; D016889:Endometrial Neoplasms / Q000139:chemically induced*; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077563:Norethindrone Acetate; D017698:Postmenopause; D012307:Risk Factors; D013997:Time Factors
chemical_list: D004958:Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone