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

Abstract

Objective To 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. Design Retrospective case series. Setting Endoscopy unit of a private urban hospital. Subjects 143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997. Interventions All 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). Results Endometrial 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. Conclusion Uterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.

Hysteroscopic findings in postmenopausal patients using tibolone

“…The high incidence of endometrial polyps in tibolone users which was seen in the present study confirms previous observations carried out with hysteroscopy; these revealed that the presence of uterine intracavitary lesions accounts for a large number of the bleeding episodes reported during tibolone treatment 5,6 . The higher incidence of endometrial polyps in menopausal patients using HRT has also been observed in previous studies 8,10 …”

“…The discrepancy between biopsy and hysteroscopic findings may be caused by the inability of blind endometrial biopsies to correctly identify polyps and submucous myomas in the majority of patients 7 . In fact, in menopausal patients who were experiencing abnormal uterine bleeding during HRT, the diagnosis of endometrial polyp was missed by endometrial biopsy in most cases 8 …”

Do we really need to hysteroscope all the women who have irregular bleeding on hormone replacement therapy?

“…Irregular bleeding associated with the use of a combination of oestrogens and progestogens is considered as an unacceptable side effect of HRT [7]. In continuous combined regimens, oestrogens and progestogens are administered together daily, and such treatment should produce an atrophic endometrium and amenorrhoea.…”