- Email: [email protected]
P223 Endometrial effects during long-term hormonal replacement therapy
P220
P221
ENDOMETRIUM EVALUATION BY MICROHYSTEROSCOPY STUDY IN CLIMATERIC PATIENTS AND ITS CORRELATION BY ULTRASOUND STUDY METHOD.
ASSESSMENT OF ENDOMETRIAL HISTOLOGY WOMEN ON TAM0XIFE.N THERAPY BY ULTRASONOGRAPHY
IN
T Moskovic, Z Neskovic, S Runic, M Labuda, A Markovic, J Lazic, M Djukic, M Bojovic, University Clinic of Obstetric and Gynecology, “Narodni Front”, Department of Menopause and Family Planing. Narodnog fronta 62, 11000 Belgrade, Yugoslavia
J E Dotto, A Vilarifio, A Ferrari, A Tempone, S Wittis, S Vighi, J ltala, B Lema, IADT & LALCEC, Buenos Aires, Argentina. We studied 834 patient by microhysteroscopy study and aspiration of endometrium according to the described technique. Previously, we have studied 602 patients with only cytology aspiration of endometrium, so we included 1436 cases in the new series. Adding the endometrial to the routine vaginal and cervical samples, one can observe endometrial cells in 98% of the cases. The cytohistopathologic correlation of this series of cases is 98. 5%. Up to now, the Ultrastructure shows that it is only possible to distinguish between hyperplasia and adenocarcinoma. The results obtained with endometrial cells aspiration and/or microhysteroscopy in high risk patients lead us to the diagnosis of cancer of the endometrium in a pre-clinical stage nd and the detection of its precursors. The percentage of search of a symptomatic lesion was 4.44%. Confidence interval 95% (1.98%-6.90%). We consider advisable the use of the microhysteroscopic study because by using this method, we have detected local atypical lesions not seen by vaginal A significant difference was seen. ultrasound method. Microhysteroscopy is a simple and reliable method that can be carried out in any consulting room and in an ambulatory way may decrease the need for D&C under general anesthesia.
P222
The study was conducted to evaluate effect of the tamoxifen therapy on endometrium in postmenopausal women with the aim of finding out if uhrasonography could be used to facilitate morphological changes. 72 postmenopausal women were allocated in 3 groups: I group 14 women receiving tamoxifen therapy; II group 36 asymptomatic women; III group 22 with irregular bleeding. We correlated endometrial histology provided by dilatation and curettage with thickness of endometrium as assessed by ultrasound. In the I group 35.7% women has pathological findings (2 cystic hyperplasia, 2 premalignant lesia and 1 has endometrial carcinoma). In the II group only 16.7% women has pathological findings with no endometrial carcinoma. In the III group 3 1.8% women have pathological findings (including 1 endometrial carcinoma). In the endometrium thickness more than 5mm we found pathological findings of endometrium: I group 71.4%; in II group 85.7%; in III group 87.5%. Low dose of tamoxifen therapy has a significant effect on endometrial appearances in postmenopausal women. Transvaginal ultrasonography can be used to monitor these changes.
P223 ENDOMETRIAL EFFECTS DURING LONG-TERM HORMONAL REPLACEMENT THERAPY.
EFFECTS OF CYPROTERONE ACETATE AND MEDROXYPROGESTERONE ACETATE ON ENDOMETRIAL LEVELS OF IGF-IR AND IGFBP-I IN ENDOMETRIAL HYPERPLASIA
Beata S&wankiewic~ Jeqy Stefmachdw I Dept. Obstet. & Gynecol. Warsaw’s University Hospital, Poland
B Baysal, A Turtiznda, d Ya&in, R G Gtilbaba, A BUyBkaren, F Eserol, S Akhan, Istanbul Faculty of Medicine, Department of Gyn and Obstet, Turkey The objective of this study was to evaluate the effects of cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) on endometrial levels of insulin-like growth factor-I receptors (IGF-IR) and insulin-like growth factor binding protein-I (IGFBP-I) of 26 women with simple endometrial hyperplasia. 13 women received estradiol valerate and CPA cyclically, while other 13 women were received MPA for 10 days in each month for six months. While receptor levels of proliferative endometrium showed no statistical difference from hyperplastic endometrium, the IGFJBP-I levels of hyperplasia group showed significantly higher levels than proliferative endometrium (~~0.05). In both of the treatment groups control D&&s revealed normal endometrial findings and statistically significant decrease of IGFBP-I levels (~~0.05). Since unopposed estrogen stimulation is a risk factor for hyperplasia and cancer of the endometrium, it is possible that estrogen induced effects on IGF-IRs and IGFBP-I may play an ,important role in the development of endometrial hyperplasia. Our findings suggest that, endometrial levels of IGFBP-I increase with unopposed estrogen for competing with IGF-IRS for binding and inhibiting of IGF-!, which mediates the mitotic actions of estradiol in this tissue. Cyclical use of est.val and CPA is effective in the treatment of simple hyperplasia.
186
In view of increasing interests in the safety of hormonal replacement therapy (HRT) we assess the endometrial effects of long-term estrogen-progesteron cyclical administration. Our study considered 70 postmenopausal women aged 46 to 56 years who received transdermal 17-beta estradiol treatment (Systen 50) complemented with 5 mg (12 days) of medroxyprogesterone acetate (Provera). At the beginning of the treatment and after two years of its duration each patient underwent hysteroscopy with direct endometrial biopsy. Hysteroscopy (previous to HRT) showed atrophic endometrium in 65,7% of patients, proliferative endometrium in 27,1% of them. In 7,2% of cases endometrial polyps were found and removed by hysteroscope. Results of second-look hysteroscopy (after two years of HRT) presented atrophic endometrium in 3 1,4% of patiens and secretary endometrium in remaining 68,6% of examined women. We concluded that in our material long-term HRT induced a physiological secretory transformation of the endometrium in greater part of patients.
P221
ENDOMETRIUM EVALUATION BY MICROHYSTEROSCOPY STUDY IN CLIMATERIC PATIENTS AND ITS CORRELATION BY ULTRASOUND STUDY METHOD.
ASSESSMENT OF ENDOMETRIAL HISTOLOGY WOMEN ON TAM0XIFE.N THERAPY BY ULTRASONOGRAPHY
IN
T Moskovic, Z Neskovic, S Runic, M Labuda, A Markovic, J Lazic, M Djukic, M Bojovic, University Clinic of Obstetric and Gynecology, “Narodni Front”, Department of Menopause and Family Planing. Narodnog fronta 62, 11000 Belgrade, Yugoslavia
J E Dotto, A Vilarifio, A Ferrari, A Tempone, S Wittis, S Vighi, J ltala, B Lema, IADT & LALCEC, Buenos Aires, Argentina. We studied 834 patient by microhysteroscopy study and aspiration of endometrium according to the described technique. Previously, we have studied 602 patients with only cytology aspiration of endometrium, so we included 1436 cases in the new series. Adding the endometrial to the routine vaginal and cervical samples, one can observe endometrial cells in 98% of the cases. The cytohistopathologic correlation of this series of cases is 98. 5%. Up to now, the Ultrastructure shows that it is only possible to distinguish between hyperplasia and adenocarcinoma. The results obtained with endometrial cells aspiration and/or microhysteroscopy in high risk patients lead us to the diagnosis of cancer of the endometrium in a pre-clinical stage nd and the detection of its precursors. The percentage of search of a symptomatic lesion was 4.44%. Confidence interval 95% (1.98%-6.90%). We consider advisable the use of the microhysteroscopic study because by using this method, we have detected local atypical lesions not seen by vaginal A significant difference was seen. ultrasound method. Microhysteroscopy is a simple and reliable method that can be carried out in any consulting room and in an ambulatory way may decrease the need for D&C under general anesthesia.
P222
The study was conducted to evaluate effect of the tamoxifen therapy on endometrium in postmenopausal women with the aim of finding out if uhrasonography could be used to facilitate morphological changes. 72 postmenopausal women were allocated in 3 groups: I group 14 women receiving tamoxifen therapy; II group 36 asymptomatic women; III group 22 with irregular bleeding. We correlated endometrial histology provided by dilatation and curettage with thickness of endometrium as assessed by ultrasound. In the I group 35.7% women has pathological findings (2 cystic hyperplasia, 2 premalignant lesia and 1 has endometrial carcinoma). In the II group only 16.7% women has pathological findings with no endometrial carcinoma. In the III group 3 1.8% women have pathological findings (including 1 endometrial carcinoma). In the endometrium thickness more than 5mm we found pathological findings of endometrium: I group 71.4%; in II group 85.7%; in III group 87.5%. Low dose of tamoxifen therapy has a significant effect on endometrial appearances in postmenopausal women. Transvaginal ultrasonography can be used to monitor these changes.
P223 ENDOMETRIAL EFFECTS DURING LONG-TERM HORMONAL REPLACEMENT THERAPY.
EFFECTS OF CYPROTERONE ACETATE AND MEDROXYPROGESTERONE ACETATE ON ENDOMETRIAL LEVELS OF IGF-IR AND IGFBP-I IN ENDOMETRIAL HYPERPLASIA
Beata S&wankiewic~ Jeqy Stefmachdw I Dept. Obstet. & Gynecol. Warsaw’s University Hospital, Poland
B Baysal, A Turtiznda, d Ya&in, R G Gtilbaba, A BUyBkaren, F Eserol, S Akhan, Istanbul Faculty of Medicine, Department of Gyn and Obstet, Turkey The objective of this study was to evaluate the effects of cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) on endometrial levels of insulin-like growth factor-I receptors (IGF-IR) and insulin-like growth factor binding protein-I (IGFBP-I) of 26 women with simple endometrial hyperplasia. 13 women received estradiol valerate and CPA cyclically, while other 13 women were received MPA for 10 days in each month for six months. While receptor levels of proliferative endometrium showed no statistical difference from hyperplastic endometrium, the IGFJBP-I levels of hyperplasia group showed significantly higher levels than proliferative endometrium (~~0.05). In both of the treatment groups control D&&s revealed normal endometrial findings and statistically significant decrease of IGFBP-I levels (~~0.05). Since unopposed estrogen stimulation is a risk factor for hyperplasia and cancer of the endometrium, it is possible that estrogen induced effects on IGF-IRs and IGFBP-I may play an ,important role in the development of endometrial hyperplasia. Our findings suggest that, endometrial levels of IGFBP-I increase with unopposed estrogen for competing with IGF-IRS for binding and inhibiting of IGF-!, which mediates the mitotic actions of estradiol in this tissue. Cyclical use of est.val and CPA is effective in the treatment of simple hyperplasia.
186
In view of increasing interests in the safety of hormonal replacement therapy (HRT) we assess the endometrial effects of long-term estrogen-progesteron cyclical administration. Our study considered 70 postmenopausal women aged 46 to 56 years who received transdermal 17-beta estradiol treatment (Systen 50) complemented with 5 mg (12 days) of medroxyprogesterone acetate (Provera). At the beginning of the treatment and after two years of its duration each patient underwent hysteroscopy with direct endometrial biopsy. Hysteroscopy (previous to HRT) showed atrophic endometrium in 65,7% of patients, proliferative endometrium in 27,1% of them. In 7,2% of cases endometrial polyps were found and removed by hysteroscope. Results of second-look hysteroscopy (after two years of HRT) presented atrophic endometrium in 3 1,4% of patiens and secretary endometrium in remaining 68,6% of examined women. We concluded that in our material long-term HRT induced a physiological secretory transformation of the endometrium in greater part of patients.