Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler sonography: the effect of hormone replacement therapy.

Abstract

We used transvaginal color Doppler sonography to study the effect of hormone replacement on the uterine arterial blood flow of 203 postmenopausal women. The regimens studied involved estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by combined estrogen-progestogen. The mean pulsatility index fell to 65% ± 9% and the mean resistive index fell to 87% ± 4% of baseline during E pidemiologic data indicate that HRT has a protective effect against coronary artery disease in postmenopausal women. It has been suggested that HRT has a "nonmetabolic or direct vascular effect" on arterial tone.t The mechanism by which HRT might influence arterial tone remains uncertain. Although there is some evidence that estrogens have such an effect,2· the vascular effects of HRT have not been well defined. In addition, although some studies have addressed the influence of progestogens on the beneficial vascular effects of estrogens, the effects on vascular flow of adding progestogens to HRT have not yet been determined objectively in humans. We found no reports in the literature on whether there was a difference in vascular response to HRT if progestogens were added to estrogen at the onset of therapy or if they were added sequentially.PI and RI are indicators of resistance to flow distal to the point of measurement. The higher the value of these indices, the greater the resistance to flow, and vice versa. The ability to measure PI and RI with great accuracy using color imaging has made possible a more thorough and systematic evaluation of the vascular response to HRT in humans. Preliminary reports6 indicate that the vascular benefits of HRT remain effective during several months of treatment, but the overall impact of long-term hormonal use is still unknown.

Randomized Comparison of Oral and Transdermal Hormone Replacement on Carotid and Uterine Artery Resistance to Blood Flow

“…17,19 We found no effect of norethisterone acetate on uterine artery impedance to flow in agreement with previous data obtained during oral HRT. 20 As a whole, our results and those of others 10,17,20 indicate that the estrogen-induced drop in vascular impedance is not eliminated by sequential progestin administration.…”

Three‐dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding

“…Consequently, the prevalence of endometrial cancer in the present study is high (together with the older age of 61.3 ± 4.4 years and high BMI of 36.4 ± 4.3) and is therefore not representative of the general population. We also did not include patients who received tamoxifen or hormone replacement therapy because it is well known that they have increased endometrial vascularization, which may be a potential biasing factor …”

Quantification of ovarian stromal Doppler signals in postmenopausal women receiving hormone replacement therapy

“…4, 2003 ler ultrasonography. Previous observational studies have demonstrated a beneficial effect on the arteries, using Doppler parameters, after HRT in postmenopausal women, with either a reduction in the pulsatility index or an increase in peak flow velocity [7][8][9][10] . However, in most of these studies, there was a lack of controls.…”

“…6 Several methods have been used to measure the changes in blood flow after the administration of HRT, one of which is the measurement of the pulsatility index using Doppler ultrasound. With this method, significant reductions in the pulsatility index have been observed in the internal carotid arteries, 7,8 the cerebral arteries, 8 peripheral arteries, 9 and especially the uterine arteries, 10 where estrogen receptors are more highly concentrated. 11 However, there is only limited information on the effect of HRT on the ovarian stromal blood flow changes.…”