Endometrial pathology in postmenopausal women

Abstract

Vaginal bleeding is the most frequent clinical manifestation of intrauterine pathologies, they are observed in 12% of postmenopausal women and are the main reason for consulting a gynecologist.

Aim - to study the prevalence of gynecological pathology in postmenopausal women and to assess the impact of menopausal hormone therapy (MHT) in the anamnesis on the frequency of its occurrence.

Materials and methods. A retrospective analysis of medical records of 82 postmenopausal patients was conducted, who were divided into two groups: those who received MHT during the menopausal transition (MHT+; n=41), and those who did not receive it (MHT-; n=41). Gynecological complaints, transvaginal ultrasound (TVUS) results, and histological findings from pipet biopsy or hysteroscopy were assessed. Statistical analysis was performed using the chi-square test.

Results. 55 (67,0%) patients had gynecological symptoms such as spotting or bleeding in postmenopause, postcoital bleeding, cramping pain in the lower abdomen, discomfort during intercourse, abnormal discharge, and vaginal dryness. According to TVUS, endometrial thickness of more than 5 mm was detected in 23 patients, and in 4 patients, additionally, multiple blood flow loci and endometrial heterogeneity were detected. According to the results of histological examination, atrophic endometrium and endometrial hyperplasia without atypia were most often detected in the both groups, and less often, endometrial polyps and atypical endometrial hyperplasia.

Conclusions. The most common ultrasound manifestation of endometrial pathology was endometrial hyperplasia, which was detected in 13 (31.7%) women in the MHT+ group and in 10 (24.4%) women in the MHT- group. The most frequent histological findings were atrophic endometrium (34.14% and 39.02%, respectively, in the MHT+ and MHT- groups) and endometrial hyperplasia without atypia (26.82% and 19.51%, respectively, in the MHT+ and MHT- groups), regardless of the history of MHT.

These results indicate the absence of the effect of menopausal hormone therapy on ultrasound and histological changes of the endometrium in postmenopause.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.