Abstract
THE ACTION of tamoxifen in increasing the risk of benign and malignant disease has been attributed to its partial oestrogen agonist activity. We ha.ve investigated whether these endometrial changes are modified by the addition of sequential oestrogen/progestogen HRT. 100 postmenopausal ‘women with climateric symptoms and early stage breast cancmer were randomised to receive HRT (Nuvelle, Schering Healthcare) or no HRT for 6 months. 60 women had an intact uterus; 29 were current tamoxifen users (median duration of use 24 months, range 5-54 months) and 16 of these were randomised to receive Nuvelle. 3 1 (n = 17), were not using tamoxifen or ex-tamoxifen users (n = 14) and 16 received Nuvelle. Endometrial thicknes8s (ET) and uterine vascular resistance were measured pretreatment and at 6 months. At baseline, current tamoxifen users had a greater ET (median 6.7mm, range 2.5-42 versus 3.0mm, range 1.3-14.0, P 8 mm (11 were current tamoxifen users) and were referred for hysteroscopy and D&C. No hyperplasia, atypia or carcinoma was diagnosed but 6 women were found to have benign polyps. The use of HRT did not reduce ET in current tamoxifen users and the uterine vascular resistance was also not reduced in this group. These observations suggest that the activity of tamoxifen may be independent of and more potent than that of the oestrogen, oestradiol valerate 2mg/day, used in Nuvelle.
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