Claudia de Carvalho Ramos Bortoletto

Transvaginal ultrasound, uterine biopsy and hysteroscopy for postmenopausal bleeding

Objectives: To determine the importance of endometrial biopsy and transvaginal ultrasound in patients with postmenopausal bleeding. Methods: Eighty patients with postmenopausal bleeding were submitted to transvaginal ultrasound followed by endometrial biopsy. Hysteroscopy and dilatation and curettage were carried out to confirm normality of the uterine cavity. Results: The endometrial echo could be visualized in all patients with postmenopausal bleeding. The biopsy failed to detect one case (1.38%) of adenocarcinoma and 14 cases (17.5%) of endometrial polyps. The sensitivity in detecting endometrial malignancy was 94.44% for endometrial biopsy and 100% for transvaginal ultrasound, when the endometrial thickness was more than 8 mm. Conclusions: When the thickness of the endometrial echo is less than 3 mm there is no need for anatomopathologic investigation. When this limit was adopted, all cases were associated with endometrial atrophy, and when the limit was 4 mm or more, active endometria were detected, requiring further histopathologic investigation by hysteroscopy and directed biopsies. Above 8 mm, malignancy may be found.

Effects of simple hysterectomy on bone loss

Lumbar spine and proximal femoral bone densities of Caucasian women, aged 35-45, were measured by dual photon densitometry model DPX. The measurement sites were assessed at the lumbar spine (vertebrae L2 to L4) and at the proximal femur (trochanter, femoral neck and Wards triangle). After exclusion of women with climacteric symptoms, sterilized patients or those with menopausal concentrations of gonadotrophins, the study included 22 subjects: 11 menstruant (control group) and 11 hysterectomized. The hysterectomies were without oophorectomy and had been performed during the previous five years. The bone densities of the hysterectomized women were lower than those of the normal ones, but significantly lower at the Wards triangle.

Transvaginal ultrasonography and the progestogen challenge test in postmenopausal endometrial evaluation

Objective: To analyze the morphologic and ultrasonographic aspects of the endometrium of postmenopausal women according to the progestogen challenge test. Methods: The study was conducted on 150 postmenopausal women. Each patient was submitted to transvaginal ultrasonography for measurement of endometrial echo thickness and to endometrial biopsies, followed by the progestogen challenge test. Results: Women with a negative test presented atrophic endometrium in 94% of cases. The other 6% have shown active endometrium, but none had hyperplasia. However, 56% of the patients with a positive test had atrophic endometrium. There was a correlation between endometrial thickness less than 5 mm and endometrial atrophy in patients with either positive or negative tests. Conclusion: Because the progestogen challenge test is cheap and easy to deal with, it can be done as a primary screening method in asymptomatic postmenopausal women. If the test is positive, ultrasonography is required in order to determine who needs a more accurate examination of the endometrium. If the test is negative, ultrasonography is not required due to the great number of women who have atrophic endometrium.

The progestogen challenge test in postmenopausal women: clinical and morphologic aspects

The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.