Monitoring Hormone Replacement Therapy

Abstract

Transvaginal ultrasonography (TVS) provides a valuable tool for the diagnosis of a wide range of gynaecological disorders, including those of the endometrium and the myometrium.1 The ability of TVS to show changes of endometrial thickness in abnormal endometrium has been well established. The Nordic trial2 and the Italian multicentre trial3 provided independent evidence that in patients with postmenopausal bleeding without hormone replacement therapy (HRT) - 787 and 930 patients, respectively - an endometrial thickness ≤ 4 mm safely excludes endometrial cancer as a possible cause of bleeding and accurately predicts atrophy in more than 80% of cases. According to Osmers,4 endometrial lesions and thickenings that turned out to be asymptomatic cancers were of a lower stage than cancers diagnosed in symptomatic postmenopausal women. The effects of drugs known to cause proliferative changes of the endometrium, such as tamoxifen, can be monitored by TVS.5 The use of intracavity instillation of saline allows accurate diagnosis of polyps already suspected by simple transvaginal scanning.6 There is therefore considerable potential for the use of TVS examination of the endometrium in patients taking HRT.