Can endometrial protection be inferred from the bleeding pattern on combined cyclical hormone replacement therapy

Citation
D. Burch et al., Can endometrial protection be inferred from the bleeding pattern on combined cyclical hormone replacement therapy, MATURITAS, 34(2), 2000, pp. 155-160
Citations number
17
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Reproductive Medicine","Medical Research General Topics
Journal title
MATURITAS
ISSN journal
0378-5122 → ACNP
Volume
34
Issue
2
Year of publication
2000
Pages
155 - 160
Database
ISI
SICI code
0378-5122(20000215)34:2<155:CEPBIF>2.0.ZU;2-P
Abstract
Objective: To investigate the relationship between the timing of withdrawal bleeding on hormone replacement therapy and the state of the endometrium. Design: Double-blind, prospectively randomised dose-ranging study. Setting: Menopause clinics in the UK and the Netherlands. Subjects: Two hundred and seventy one postmenopausal women aged 40-60. Interventions: Administration of six 28-day treatment cycles of a continuous daily dose of 2 mg of micro nised 17 beta oestradiol with a randomly allocated dose of 5-20 mg of dydro gesterone added for the last 14 days of each. Methods: Comparison of the ti ming of the withdrawal bleed recorded in subject-held diaries with an endom etrial biopsy obtained toward the end of the last cycle. Results: There was a trend towards later withdrawal bleeding with secretory endometrium and e arlier bleeding with inactive or atrophic endometrium, but with too much ov erlap for this to be of clinical relevance. There were two cases of prolife rative and one of hyperplastic endometrium, with no characteristic bleeding pattern. Conclusion: Combined sequential HRT with progestogen given for 12 -14 days very rarely fails to protect the endometrium. Such failures can no t be detected by noting the bleeding pal:tern. The only suspicious pattern is non-cyclic bleeding, but this will not detect every case of hyperplasia or persistent proliferative endometrium. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.