Diagnosis and treatment of abnormal uterine bleeding in postmenopausal patients using hormone replacement therapy

Abstract

ObjectiveTo investigate the cause of uterine bleeding in menopausal patients using hormone replacement therapy (HRT), and the efficacy of resectoscopic surgery for treatment of irregular vaginal bleeding caused by benign uterine pathology in such patients.DesignRetrospective case series.SettingEndoscopy unit of a private urban hospital.Subjects143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997.InterventionsAll the patients were evaluated using transvaginal sonography, hysteroscopy and endometrial biopsies. A total of 87 patients with polyps, myomas or an atrophic uterine cavity underwent polypectomy (n = 64) and myomectomy (n = 19) in association with endometrial resection (n = 87).ResultsEndometrial polyps and submucous myomas were the most frequent cause of uterine bleeding in postmenopausal women using HRT. These conditions could be treated effectively using the resectoscope. The failure rate of resectoscopic surgery for focal lesions in patients receiving HRT was 6%. Adenomyosis and recurrence of endometrial polyps were the most frequent reasons for treatment failure and resumption of vaginal bleeding.ConclusionUterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.