Endometrial evaluation with transvaginal ultrasound during hormone therapy: a prospective multicenter study.
OBJECTIVE
To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium.


METHODS
Prospective multicenter study.


METHODS
University and general hospitals outpatient centers.


METHODS
Postmenopausal women (702) on HT.


METHODS
Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding.


METHODS
Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness >4.5 mm (precision scale 0.5 mm).


RESULTS
Endometrial thickness >4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding.


CONCLUSIONS
Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium.
Omodei
Umberto
U
Clinica Ostetrica e Ginecologica, Universitá degli Studi di Brescia, Brescia, Italy. omodeiu@tin.it
Ferrazzi
Enrico
E
Ramazzotto
Francesca
F
Becorpi
Angela
A
Grimaldi
Eva
E
Scarselli
Gianfranco
G
Spagnolo
Daniele
D
Spagnolo
Luigi
L
Torri
Walter
W
D001706:Biopsy; D003430:Cross-Sectional Studies; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D015907:Hysteroscopy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014591:Uterine Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology