Endometrial findings in asymptomatic postmenopausal women on exogenous estrogens—A preliminary report

Abstract

Multiple retrospective studies have been done implicating estrogen replacement therapy as a factor in the increasing rise of endometrial cancer. This prospective study consisted of 94 asymptomatic postmenopausal females on exogenous estrogen. Duration of therapy ranged from 1 through 5 and greater than 5 years. All these patients were subjected to endometrial biopsies. We encountered a total of 71 negative biopsies (75.5%) and 23 positive biopsies (24.4%) ranging from cystic hyperplasia, through frank adenocarcinoma. All positive biopsies underwent formal diagnostic curettage. Histologic findings on the dilation and curettage specimens correlated with the original biopsy findings. All histologic slides were reviewed by an independent pathologist without knowledge of history or previous grading. Risk factors in the Positive biopsy group were present in only 17%. Therefore, it is not possible to predict the patient on estrogen who is at a higher risk for developing future hyperplasia, and in order to avoid missing early precursor lesions in endometrial carcinoma all patients must be biopsied. Significant cancer precursor lesions did not appear until after the patients had been on at least 3 years duration of unopposed estrogen replacement therapy. We conclude that postmenopausal patients on estrogen therapy at high risk can not be identified by risk factors alone, and as a minimum their endometrial status should be evaluated at least every 3 years.