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CARS Archives



Ultrasound versus endometrial biopsy to evaluate the endometrium in HRT
Title: A comparative study of transvaginal uterine ultrasound and endometrial biopsy for evaluating the endometrium of postmenopausal women taking hormone replacement therapy
Author: D. Archer, et al.
Address: Norfolk, VA
Source: Menopause: The Journal of The North American Menopause Society 6: 201-208 (Fall) 1999
Summary: To compare transvaginal uterine ultrasound (TVS) and endometrial biopsy for the evaluation of the endometrium of postmenopausal women taking estrogen replacement therapy (ERT) or hormone replacement therapy (HRT), a prospective study was conducted. Participants included 148 healthy women with an intact uterus. Of these, 121 used oral hormone preparations and regimens prescribed by their physicians. Endometrial biopsy samples were taken within 3 days of transvaginal ultrasound measurement. The uterus was scanned transversely and longitudinally, with endometrial thickness measured at the thickest part of the longitudinal plane. The thickness range in 126 women with a normal endometrium was 1.0 to 25.0 mm. In 15 women with an abnormal endometrium, the range was 2.8 to 23.0 mm. A significant difference in endometrial thickness was seen between the 38 subjects taking ERT and HRT with unexpected bleeding or spotting and the 26 untreated women in the control group. Results of ultrasound as a screening technique in postmenopausal women who were taking ERT or HRT did not correlate well with results of endometrial biopsy. These results indicate that endometrial thickness determined by TVS is not a reliable indicator of normal endometrium and cannot be used to rule out pathology.
Comment: It is an important issue and confirmation is needed. It would be interesting to confirm this in a situation of excluding pathology rather than in a clinical trial routine investigation. These women did not present with post-menopausal bleeding. The are reports on the lack of sensitivity of endometrial biopsy. With such a variety of strengths and combinations of replacement regimens, I had hoped that in ultrasound, we had a less painful and more sensitive tool.

 

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