Volume 4, Issue 6, November 2016, Page: 38-43
Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women
Sidharth Srinivas, Manchester Medical School, University of Manchester, Manchester, United Kingdom
Sachchidananda Maiti, Obstetrics & Gynaecology, The Pennine Acute NHS Hospitals, Crumpsall, United Kingdom
Perunkulam Jothilakshmi, Obstetrics & Gynaecology, The Pennine Acute NHS Hospitals, Crumpsall, United Kingdom
Received: Sep. 4, 2016;       Accepted: Sep. 21, 2016;       Published: Oct. 15, 2016
DOI: 10.11648/j.jgo.20160406.12      View  7396      Downloads  169
Abstract
Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.
Keywords
Post-Menopausal Bleeding, Proliferative Endometrium Without Atypia, Progesterone Therapy
To cite this article
Sidharth Srinivas, Sachchidananda Maiti, Perunkulam Jothilakshmi, Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women, Journal of Gynecology and Obstetrics. Vol. 4, No. 6, 2016, pp. 38-43. doi: 10.11648/j.jgo.20160406.12
Copyright
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
UK CR. Cancer Statistics: Registrations Series. 2011.
[2]
McBride. The normal post-menopausal endometrium. J Obstet Gynaecol Br Emp 1954;61 (5):691-7.
[3]
Noer T. The histology of the senile endometrium. Acta Pathologica Microbiologica Scandinavica 1961;51 (3):193.
[4]
Korhonen MO, Symons JP, Hyde BM, Rowan JP, Wilborn WH. Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study). American Journal of Obstetrics and Gynecology 1997; 176 (2): 377.
[5]
Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J Ultrasound Med 2001; 20 (10): 1025-36.
[6]
SIGN. Investigation of Post-Menopausal Bleeding. 2002.
[7]
Paley PJ. Screening for the major malignancies affecting women: Current guidelines. American journal of obstetrics and gynecology 2001; 184 (5): 1021.
[8]
NICECG27. Referral Guidlines for Suspected Cancer. 2005.
[9]
Nand SL, Webster MA, Baber R, O'Connor V. Bleeding pattern and endometrial changes during continuous combined hormone replacement therapy. The Ogen/Provera Study Group. Obstet Gynecol 1998; 91 (5 Pt 1): 678-84.
[10]
Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North Am 2003;41 (4):769-80.
[11]
Gupta JK, Chien PFW, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (9): 799.
[12]
Dijkhuizen FPHLJ, BrÖLmann HAM, Potters AE, Bongers MY, Heintz APM. The Accuracy of Transvaginal Ultrasonography in the Diagnosis of Endometrial Abnormalities. Obstetrics & Gynecology 1996;87 (3):345-349.
[13]
Ciatto S, Cecchini S, Gervasi G, Landini A, Zappa M, Crocetti E. Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment. Br J Cancer 2003; 88 (8): 1175-9.
[14]
Weber G, Mere E, Bahlmanw E, Riisch B. Evaluation of different transvaginal sonographic diagnostic parameters in women with postmenopausal bleeding. Ultrasound in Obstetrics and Gynecology 1998; 12 (4): 265.
[15]
Gruboeck K, Jurkovic D, Lawton F, Savvas M, Tailor A, Campbell S. The diagnostic value of endometrial thickness and volume measurements by three-dimensional ultrasound in patients with postmenopausal bleeding. Ultrasound in Obstetrics and Gynecology 1996; 8 (4): 272.
[16]
Dijkhuizen FPHLJ, Mol BWJ, Brölmann HAM, Heintz APM. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia. Cancer 2000; 89 (8): 1765.
[17]
Van den Bosch T, Vandendael A, Van Schoubroeck D, Wranz PA, Lombard CJ. Combining vaginal ultrasonography and office endometrial sampling in the diagnosis of endometrial disease in postmenopausal women. Obstet Gynecol 1995; 85 (3): 349-52.
[18]
Curtis RE, Boice JD, Shriner DA, Hankey BF, Fraumeni JF. Second Cancers After Adjuvant Tamoxifen Therapy for Breast Cancer. Journal of the National Cancer Institute 1996; 88 (12): 832-835.
[19]
Karlsson B, Granberg S, Wikland M, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding — a Nordic multicenter study. American Journal of Obstetrics and Gynecology 1995; 172 (5): 1488.
[20]
Lacey JV, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas 2009; 63 (1): 39.
[21]
Lacey JV, Sherman ME, Rush BB, Ronnett BM, Ioffe OB, Duggan MiA, et al. Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia. Journal of Clinical Oncology 2010; 28 (5): 788-792.
[22]
Silverberg. Tumors of the Uterine Corpus and Gestational Trophoblastic Disease. AFIP Atlas of Tumor Pathology 1995.
[23]
Balk JL, Whiteside DA, Naus G, DeFerrari E, Roberts JM. A pilot study of the effects of phytoestrogen supplementation on postmenopausal endometrium. J Soc Gynecol Investig 2002; 9 (4): 238-42.
[24]
Pathology FG. http://library.med.utah.edu/WebPath/FEMHTML/FEMIDX.html#2.
[25]
Sivridis E, Giatromanolaki A. Proliferative activity in postmenopausal endometrium: the lurking potential for giving rise to an endometrial adenocarcinoma. J Clin Pathol 2004; 57 (8): 840-4.
[26]
Baak JP, Wisse-Brekelmans EC, Fleege JC, van der Putten HW, Bezemer PD. Assessment of the risk on endometrial cancer in hyperplasia, by means of morphological and morphometrical features. Pathol Res Pract 1992; 188 (7): 856-9.
[27]
Wan YL, Holland C. The efficacy of levonorgestrel intrauterine systems for endometrial protection: a systematic review. Climacteric;14 (6): 622-632.
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