Menopausal therapy and endometrial pathology

The value of endometrial cell sampling in the management of post-menopausal women

The value of performing endometrial cytology on women receiving hormonal replacement therapy is discussed. Evidence is presented which shows that when this is routinely performed prior to beginning therapy, some 2% of women are found to have an abnormality ranging from polyps to carcinoma. When minimal dose combined oestrogen plus progestogen replacement therapy is used together with a monitoring procedure which involves routine annual Mimark endometrial sampling and curettage for abnormal cytology or bleeding, the risk of endometrial abnormality is reduced to a minimum. The benefits to be gained and the problems which detract from the use of endometrial cytology are discussed. It is recommended that every woman should have a routine cytological endometrial screening performed by a doctor experienced in the use of endometrial sampling equipment when she receives hormonal replacement therapy in the post-menopausal phase.

Minimal dose combined hormonal replacement therapy for menopausal women

The problem of managing postmenopausal women with hormonal replacement therapy is reviewed. A case is clearly made for using progestogen in every instance when women receive oestrogen in the menopause. By this means the incidence of carcinoma is reduced to at least the rate found in non-treated patients and perhaps even lower. The biochemical changes leading to this reduction are summarized, and a suggestion is made regarding the optimal dosage of progestogen. This paper presents evidence to suggest that minimal doses of progestogen given for at least ten days in each month will protect endometrial target cells.

Value of cytology for detecting endometrial abnormalities in climacteric women receiving hormone replacement therapy

Over six months 113 endometrial specimens from 110 menopausal women receiving hormone replacement therapy were examined by two cytologists and two histopathologists. Specimens were obtained by aspiration with the Isaacs cell sampler immediately before Vabra suction curettage, both procedures being performed in the outpatient department without anaesthetic. The histologists agreed with each other on the classification of 85 specimens (75.2%) and the cytologists agreed on the classification of 44 (38.9%). In only 15 cases (13.3%) did all four observers agree. Of the three cases of cystic or adenomatous hyperplasia detected histologically, only one was diagnosed by cytology. Furthermore, both cases of adenocarcinoma escaped detection by cytology, though a third case--later confirmed-"was suspected by one cytologist alone. Use of the Isaacs endometrial cell sampler cannot be advocated for routine screening of women with climacteric symptoms receiving hormone replacement therapy. Efforts should be made to establish the correct dose and duration of treatment with an oestrogen-progestogen preparation in order to avoid over-stimulating the endometrium and the need for regular screening for endometrial abnormalities.