Endometrial thickness after menopause: effect of hormone replacement.

Abstract

Ultrasound (US) images of the pelvis were evaluated in 112 asymptomatic postmenopausal women to investigate the normal range of endometrial thickness (double-layer measurement) and the effect of hormone replacement on these measurements. Twenty-one patients (19%) had endometrial thickness greater than 0.8 cm. One patient, with an endometrial thickness of 2.5 cm, had endometrial carcinoma. Consideration of the known actions of estrogen and progestogen on the endometrium led the authors to believe that the clinical significance of an endometrium measuring more than 0.8 cm depends on the patient's hormonal status. Among asymptomatic postmenopausal women with an endometrial thickness between 0.8 and 1.5 cm, those receiving unopposed estrogen or continuous estrogen and progestogen need to undergo dilatation and curettage (D&C) or biopsy and those receiving no hormones or receiving sequential estrogen and progestogen should be encouraged to undergo D&C or biopsy. If a patient in one of the latter two groups is unwilling to undergo an invasive procedure, then US examination at 3-month intervals is acceptable. Any patient with endometrial thickness of at least 1.5 cm should undergo histologic diagnosis, regardless of symptoms or hormone status.

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

“…A limit of M-echo thickness at 8 mm [47] or 10 mm [48] was suggested for this category of patients, as the upper limit for normal thickness was also suggested on a value of 9 mm in women receiving treatments associated with thicker endometria (estrogen alone and cyclical combinations) [49-51]. …”

Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection

“…The increase in ET is most marked with the use of unopposed oestrogen (57%), followed by use of the sequential oestrogen and progesterone (55%), and is least affected by the continuous combined oestrogen -progesterone regimens (Bonila-Musoles et al, 1995). Some authors recommend a higher ET threshold in women taking HRT (8 mm) (Lin et al, 1991), while one study reported that a cutoff value of 4 mm should be used irrespective of whether or not the patient is taking HRT (Holbert, 1997). If TVUS is used as the initial step in the evaluation of PMB, invasive investigations would be avoided in 40% of women (Dijkhuisen et al, 2000).…”

Endometrial assessment re‐visited

“…Sequential forms of hormone replacement therapy increase endometrial thickness; average measurements are from 5–8.5 mm 50,88–93 . With continuous combined hormone replacement therapy endometrial thicknesses are 4.5–7 mm–still above the mean for atrophic endometrium 50,88–91,93–95 . With tibolone endometrial thickness is less than 5mm 96,97 .…”