Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy

Abstract

Objective This study correlates the transvaginal ultrasound findings with histopathology results in women who present with unscheduled bleeding on hormone replacement therapy. Study design Retrospective analysis of 469 consecutive cases with unscheduled bleeding on hormone replacement therapy (203 patients on sequential hormone replacement therapy (seq-HRT) and 266 patients on continuous combined hormone replacement therapy (con-HRT)). Main outcome measures Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy. Results Normal appearance of the endometrium on pelvic ultrasound was seen in 62% patients on seq-HRT and 43% of women on con-HRT. These women required no further assessment and were discharged. Histological assessment showed normal endometrial tissue in 22% of women on seq-HRT and 22% of con-HRT group. Benign endometrial polyps were noted in 8% of women on seq-HRT versus 18% of women on con-HRT. Hyperplasia without atypia was noted in 0.5% of woman on seq-HRT versus 0.4% of women on con-HRT while atypical hyperplasia/endometrial cancer was noted in 2% of women on seq-HRT versus 1% of women on con-HRT. Conclusion Women who present with unscheduled bleeding on hormone replacement therapy both on sequential and continuous combined regimens can be reassured that the risk of pathology is low.