title: Endometrial carcinoma on continuous combined HRT: case report and literature review.
abstract: BACKGROUND
  Continuous combined hormone replacement therapy (HRT) has been introduced in an attempt to increase patient compliance by eliminating withdrawal bleeding which is one of the most significant and troublesome side effects of sequential HRT. Moreover, when given on a daily basis, progestin is thought to be more protective against the development of endometrial carcinoma.
  
  
  METHODS
  We describe the case of a 59-year-old woman, diagnosed with endometrial carcinoma while on continuous combined HRT. Her last menstrual period was 7 years ago and she had been on HRT ever since. Initially, she tricycled her preparation using transdermal gel 17beta-estradiol 1.5 mg daily along with vaginal micronised progesterone 200 mg daily from day 1 to 12 every 3 months for the first 5 years and she had regular withdrawal bleeding. She was then moved on to continuous combined HRT (transdermal gel 17beta-estradiol 2.25 mg daily plus dydrogesterone 10 mg per os daily) and started to be amenorrhoeic. A routine transvaginal ultrasound showed an increased endometrial echo (10 mm). She was completely asymptomatic. Further investigations resulted in a report of a well differentiated grade II endometrial carcinoma with squamous differentiation. A review of literature confirms endometrial cancer to be rare while on continuous progesterone and difficulties posed in diagnosing it.
authors.affiliation: University Department of Obstetrics and Gynaecology, Royal Free Hospital Pond Street Hampstead, London NW3 2QG, UK. cdispie@tin.it
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.forename: Sheila
authors.initials: S
authors.lastname: Radhakrishnan
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004394:Dydrogesterone / Q000008:administration & dosage; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D014463:Ultrasonography
chemical_list: D004958:Estradiol; D004394:Dydrogesterone