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P225 A comparison of bleeding patterns with prempack C and transdermal estradiol and norethisterone acetate (Estracombi)
P224 ULTRASOUND
P225 SCREENING IN POSTMENOPAUSAL WOMEN
A COMPARISON OF BLEEDING PREMPAK C AND TRANSDERMAL NORETHISTERONE ACETATE
PATTERNS WITH ESTRADIOL AND (ESTRACOMBI)
D B Georeiev,VNetzov, T Chernev SecondOb & Gyn Hospital,Sofia 150419, Sheinovostr, Bulhgaria, A D Parsons,Rugby, D W Purdie, Hull, S M Sathanandan, Europe Stirling, D WSturdee,Solihull, W Thompson, Belfast. Ultrasonographyis a useful screeningtool for early detectionof asymptomaticendometrialand ovarian diseases in postmenopausal A multicentre study was initiated to comparethe efficacy and women.One thousandasymptomaticpostmenopausal patientswere tolerability of oral and totally transdermalhormonereplacement includedin the trial. Ultrasonographywith a 7.5 MHz probewas therapy. A total of 190postmenopausal womenwererandomised to performed.A total endometrialthicknessof 8 mmwasacceptedas treatment with either Estracombi (5Opg oestradiobday, cut-off value. norethisteroneacetate250pg/day for 14 days in each cycle) or Above this thickness a D & C was performed. Seventeen PrempakC 0.625mg/day.152 patientscompletedthe sevenmonth endometrialcarcinoma,six atypical endometrialhyperplasias and 55 treatment period. Daily Diary Cards were used to collect simpleand complex endometrialhyperplasias have beendetected. information on symptom control and bleeding patterns and In addition 16 ovarian masses,not recognisedon bimanual psychologicalquestionnaires were completedin the progestogen examinationwerediagnosed. treatmentphaseat monthone, four and sevenand in the oestrogen The frequency of asymptomaticendometrialdiseasesin a well phaseat monthfive. definedhigh-risk population was analysedretrospectivelywith a Vasomotorsymptomsaswell asSabbatsberg andLeedsscoreswere SPSSprogramme. rapidly reducedto a similardegreeby the two treatmentsover the It seems,that endovaginalultrasonographyis very useful and studyperiod. reliablefor routineoutpatientevaluationof postmenopausal women. Both treatmentsinduceda regular withdrawal bleed. The mean Although genera1screeningfor asymptomaticendometrialdiseases numberof patientshaving a bleed at each cycle was 88% for is not cost effective, a relevant number of symptom free Estracombiand 95% for PrempakC. Typically with Estracombi abnormalities of the uterinelining could be detectedin the general bleedingoccurredbetweenthe current day 22 and day 8 of the andhigh-riskpopulation. subsequentcycle and with PrempakC betweenday 26 and the subsequent day 12. Peakonsetof the PrempakC bleedwason the 4th/5thdayafter theprogestogen. Continued
P225 (cant)
P226 ENDOMETRIAL CHANGES IN POSTMENOPAUSAL BREAST CANCER PATIENTS RECEIVING TAMOXIFEN A TRANSVAGINAL ULTRASOUND STUDY
Onset of bleeding occurred during the progestogenphasewith Estracombiand the pattern of distribution of day-of-start was flatter.In both groupsbleedingdurationextendedfrom a few daysto 12-14days.70% of subjectsbled for 7 daysor lesson Estracombi comparedwith 80% on Prempak C. Prempak C bleedswere characterisedby a greater proportion of subjectshaving heavy bleedingandlesshavinglight bleeding. This randomised comparativestudy showsthat Estracombiprovides effectiverelief of menopausal symptomsandgoodbleedingcontrol. Differencesin the bleedingpatternswereobservedbetweenthe two formsof HRT employedin this trial.
:
L. Fallo, D. Dordoni, C. Ruggeri, N. Palai, U. Omodei,A.M. Boccuti, C. Daldoss ObstetricsandGynaecologyDept,University of Brescia,Italy. The purposeof the study wasto evaluatethe effectsof tamoxifen therapy on the endometriumby transvaginalsonography. Seventynine asymptomaticpostmenopausal womentreated with tamoxifen (20 mg/day) for at leastone year were recruited. Twenty healthy postmenopausal womenservedascontrols. All patientsunderwent transvaginal ultrasoundto evaluate endometrial thickness and echotexture. The distribution of endometrialthicknessin the tamoxifengroupshowsan increasingtrend during the first year of therapy,greatestvaluesarefound between1 and2 years,afterwards valuesdecrease andreacha plateauafter 4 years. Thirty-nine ptsof tamoxifen group had an endometrialthicknessof > 6mm and underwenthysteroscopy.Endometrialbiopsy revealed22 atrophic endometrium,11polyps,3 myomas,2 endometrialcancers,1 simple hyperplasia. The comparisonbetweenendometrialthicknessand hysteroscopic/histological findings shows an endometrial width (meanf SD) of 10 f 0, 5 for myomas,14,7f 6,5 for polyps, 8mm for hyperplasia,11,3 for cancer. Our data show a correlation betweenendometrialthicknessandtime of therapy and strengthen the role of transvaginalsonographyfor serialmonitoringof breast cancerpatientsreceivingtamoxifen.
187
P225 SCREENING IN POSTMENOPAUSAL WOMEN
A COMPARISON OF BLEEDING PREMPAK C AND TRANSDERMAL NORETHISTERONE ACETATE
PATTERNS WITH ESTRADIOL AND (ESTRACOMBI)
D B Georeiev,VNetzov, T Chernev SecondOb & Gyn Hospital,Sofia 150419, Sheinovostr, Bulhgaria, A D Parsons,Rugby, D W Purdie, Hull, S M Sathanandan, Europe Stirling, D WSturdee,Solihull, W Thompson, Belfast. Ultrasonographyis a useful screeningtool for early detectionof asymptomaticendometrialand ovarian diseases in postmenopausal A multicentre study was initiated to comparethe efficacy and women.One thousandasymptomaticpostmenopausal patientswere tolerability of oral and totally transdermalhormonereplacement includedin the trial. Ultrasonographywith a 7.5 MHz probewas therapy. A total of 190postmenopausal womenwererandomised to performed.A total endometrialthicknessof 8 mmwasacceptedas treatment with either Estracombi (5Opg oestradiobday, cut-off value. norethisteroneacetate250pg/day for 14 days in each cycle) or Above this thickness a D & C was performed. Seventeen PrempakC 0.625mg/day.152 patientscompletedthe sevenmonth endometrialcarcinoma,six atypical endometrialhyperplasias and 55 treatment period. Daily Diary Cards were used to collect simpleand complex endometrialhyperplasias have beendetected. information on symptom control and bleeding patterns and In addition 16 ovarian masses,not recognisedon bimanual psychologicalquestionnaires were completedin the progestogen examinationwerediagnosed. treatmentphaseat monthone, four and sevenand in the oestrogen The frequency of asymptomaticendometrialdiseasesin a well phaseat monthfive. definedhigh-risk population was analysedretrospectivelywith a Vasomotorsymptomsaswell asSabbatsberg andLeedsscoreswere SPSSprogramme. rapidly reducedto a similardegreeby the two treatmentsover the It seems,that endovaginalultrasonographyis very useful and studyperiod. reliablefor routineoutpatientevaluationof postmenopausal women. Both treatmentsinduceda regular withdrawal bleed. The mean Although genera1screeningfor asymptomaticendometrialdiseases numberof patientshaving a bleed at each cycle was 88% for is not cost effective, a relevant number of symptom free Estracombiand 95% for PrempakC. Typically with Estracombi abnormalities of the uterinelining could be detectedin the general bleedingoccurredbetweenthe current day 22 and day 8 of the andhigh-riskpopulation. subsequentcycle and with PrempakC betweenday 26 and the subsequent day 12. Peakonsetof the PrempakC bleedwason the 4th/5thdayafter theprogestogen. Continued
P225 (cant)
P226 ENDOMETRIAL CHANGES IN POSTMENOPAUSAL BREAST CANCER PATIENTS RECEIVING TAMOXIFEN A TRANSVAGINAL ULTRASOUND STUDY
Onset of bleeding occurred during the progestogenphasewith Estracombiand the pattern of distribution of day-of-start was flatter.In both groupsbleedingdurationextendedfrom a few daysto 12-14days.70% of subjectsbled for 7 daysor lesson Estracombi comparedwith 80% on Prempak C. Prempak C bleedswere characterisedby a greater proportion of subjectshaving heavy bleedingandlesshavinglight bleeding. This randomised comparativestudy showsthat Estracombiprovides effectiverelief of menopausal symptomsandgoodbleedingcontrol. Differencesin the bleedingpatternswereobservedbetweenthe two formsof HRT employedin this trial.
:
L. Fallo, D. Dordoni, C. Ruggeri, N. Palai, U. Omodei,A.M. Boccuti, C. Daldoss ObstetricsandGynaecologyDept,University of Brescia,Italy. The purposeof the study wasto evaluatethe effectsof tamoxifen therapy on the endometriumby transvaginalsonography. Seventynine asymptomaticpostmenopausal womentreated with tamoxifen (20 mg/day) for at leastone year were recruited. Twenty healthy postmenopausal womenservedascontrols. All patientsunderwent transvaginal ultrasoundto evaluate endometrial thickness and echotexture. The distribution of endometrialthicknessin the tamoxifengroupshowsan increasingtrend during the first year of therapy,greatestvaluesarefound between1 and2 years,afterwards valuesdecrease andreacha plateauafter 4 years. Thirty-nine ptsof tamoxifen group had an endometrialthicknessof > 6mm and underwenthysteroscopy.Endometrialbiopsy revealed22 atrophic endometrium,11polyps,3 myomas,2 endometrialcancers,1 simple hyperplasia. The comparisonbetweenendometrialthicknessand hysteroscopic/histological findings shows an endometrial width (meanf SD) of 10 f 0, 5 for myomas,14,7f 6,5 for polyps, 8mm for hyperplasia,11,3 for cancer. Our data show a correlation betweenendometrialthicknessandtime of therapy and strengthen the role of transvaginalsonographyfor serialmonitoringof breast cancerpatientsreceivingtamoxifen.
187