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P235 Endometrial histology and the bleeding pattern of postmenopausal women on continuous combined HRT compared to tibolone
P234
P235
THE BLEEDING PATTERNS IN THREE HORMONE REPLACEMENT THERAPY (HRT) REGIMENS: THE EFFECT OF A HYPO-OESTROGENIC STATE? F AI-Azmwi, S C Bell, MA Habiba, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
ENDOMETRIAL HISTOLOGY AND THE BLEEDING PATTERN OF POSTMENOPAUSAL WOMEN ON CONTINUOUS COMBINED HRT COMPARED TO TIBOLONE
School of
We compared the bleeding pattern in 103 postmenopausal women receiving oral cyclical sequential combined HRT over six months, to the bleeding pattern in women receiving transdermal oestrogen with either transdermal progestogen (n=33) or with oral progestogen (n=ll). All women recorded the onset, duration and subjective assessment of the severity of bleeding episodes. In women on oral oestrogen, two groups were identified amongst the 99 women who experienced bleeding. Those with a mean cycle length of 29 or more days (termed ‘late bleeders’, n=50) and those with a shorter mean cycle length (termed ‘early bleeders’, n=49). Four women experienced no bleeding (termed ‘non-bleeders’). With transdermal oestrogen therapy, 31 women were ‘early bleeders’ and only 5 were ‘late bleeders’, 8 were ‘non bleeders’, (p
F Al-Azmwi, MA Habiba, A A Akkad, B Phipps, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
School of
We report on a multicentre randomised open label study. 116 women received a new continuous combined HRT, Climesse (2mg micronized oestradiol valerate & 0.7 mg norethisterone, Sandoz), and 120 women receivedtibolone 2.5 mg. All women were healthy, with intact uterus, at least 12 month past the menopause with no demographic differences between the groups. 164 women completed 12 months on therapy, 79 on Climesse and 85 on tibolone. No endometrium was obtained in 19 women on Chmesse and in 21 women on tibolone, in the majority of casesthis was attributableto atrophic changes. Histological confirmation of atrophic endometriumwas obtained in 22 women on Climesse and in 27 on tibolone. Secretory endometrium was demonstrated in 24 and 20 cases in the two groups respectively, and proliferative endometrium was demonstrated in 3 women on tibolone, but in no cases receiving Climesse. There were no casesof endometrial hyperplasia or malignancy in either group. In the first month on therapy, the total bleeding score (TBS) for women on Climesse (mean 6.77, range 050), was significantly higher than for women treated by tibolone (mean 1.1 range O-23). However the TBS of women on Chmesse fell progressively during the study, and the mean TBS at month 6 was 1.6 (range O-27) for the Climesse group, and 2.11 (range O-45) for the tibolone group, and at month 12 was 1.96 (range O-33) for the Climesse group and 0.86 (range O-16) for the tibolone group. This study demonstrates endometrial protection by Climesse.
P237
P236
ENHANCED PROLIFERATION OF ENDOMETRIAL STROMAL LEUKOCYTES DURING THE LATE PSEUDOLUTEAL PHASE OF A HORMONE REPLACEMENT THERAPY (HRT) REGIMEN.
ENDOMETRIAL RESPONSES TO A HORMONE REPLACEMENT THERAPY (HRT) REGIMEN: COMPARATIVE HISTOPATHOLOGICAL ASSESSMENT DURING THE LATE “PSEUDO-LUTEAL” PHASE. MA Habiba, S C Bell, S Deen, FAI-Azzawi, The Menopause Research Unit, Leicester University School of Medicine, Leicester, LE2 7LX, UK.
MA Habiba, S C Bell, FAl-Auawi, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
We examined endometrial biopsies obtained from 75 patients on days 27-29 of a cyclical sequential combined HRT regimen. Of those (n=42) who bled on average after day 28 i.e. late-bleeders, 35 had not bled by day 27-29 in the cycle of biopsy collection, and were termed late ‘pseudo-luteal’ phase specimens. They were compared to late luteal phase biopsies obtained from control patients (n=ll). Using classical histopathology criteria all biopsies were assessed as ‘secretory’ endometria. However in contrast to endometrial biopsies obtained during the late luteal phase, in biopsy specimens from HRT-treated patients the histological features detected were more diverse between biopsies, and more diverse and variably distributed within each specimen. We therefore developed a semiquantitative histological method for the assessment of the frequency of presence of individual features. In biopsies from the late ‘pseudo-luteal’ phase of HRT-treated patients there was an increased incidence of pseudostratftcation within all epithelial populations, metaplasia, glands containing invaginations, apical glandular epithelial vesicular clusters, stromal leukocytes and spiral arterioles, albeit the latter being more poorly developed. We conclude it is inappropriate to assess biopsies from HRT-treated patients according to classical histopathological criteria.
The frequency of mononuclear stromal cells in the endometrium of women treated by a cyclical sequential combined HRT, was assessed and compared to late luteal LH dated endometria. Biopsies were obtained on days 27-29 and before bleeding. Employing a semiquantitative histological method we detected an increased frequency of round mononuclear stromal cells in HRT endometria compared to controls. The number of leukocytes was estimated in 10 fields per biopsy (X200) using an immunohistochemical technique, with a monoclonal antibody to leukocyte common antigen (CD45 Dako Ltd) employing an Image Analysis programme. There was a 2.2-fold increase (p
190
School of
P235
THE BLEEDING PATTERNS IN THREE HORMONE REPLACEMENT THERAPY (HRT) REGIMENS: THE EFFECT OF A HYPO-OESTROGENIC STATE? F AI-Azmwi, S C Bell, MA Habiba, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
ENDOMETRIAL HISTOLOGY AND THE BLEEDING PATTERN OF POSTMENOPAUSAL WOMEN ON CONTINUOUS COMBINED HRT COMPARED TO TIBOLONE
School of
We compared the bleeding pattern in 103 postmenopausal women receiving oral cyclical sequential combined HRT over six months, to the bleeding pattern in women receiving transdermal oestrogen with either transdermal progestogen (n=33) or with oral progestogen (n=ll). All women recorded the onset, duration and subjective assessment of the severity of bleeding episodes. In women on oral oestrogen, two groups were identified amongst the 99 women who experienced bleeding. Those with a mean cycle length of 29 or more days (termed ‘late bleeders’, n=50) and those with a shorter mean cycle length (termed ‘early bleeders’, n=49). Four women experienced no bleeding (termed ‘non-bleeders’). With transdermal oestrogen therapy, 31 women were ‘early bleeders’ and only 5 were ‘late bleeders’, 8 were ‘non bleeders’, (p
F Al-Azmwi, MA Habiba, A A Akkad, B Phipps, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
School of
We report on a multicentre randomised open label study. 116 women received a new continuous combined HRT, Climesse (2mg micronized oestradiol valerate & 0.7 mg norethisterone, Sandoz), and 120 women receivedtibolone 2.5 mg. All women were healthy, with intact uterus, at least 12 month past the menopause with no demographic differences between the groups. 164 women completed 12 months on therapy, 79 on Climesse and 85 on tibolone. No endometrium was obtained in 19 women on Chmesse and in 21 women on tibolone, in the majority of casesthis was attributableto atrophic changes. Histological confirmation of atrophic endometriumwas obtained in 22 women on Climesse and in 27 on tibolone. Secretory endometrium was demonstrated in 24 and 20 cases in the two groups respectively, and proliferative endometrium was demonstrated in 3 women on tibolone, but in no cases receiving Climesse. There were no casesof endometrial hyperplasia or malignancy in either group. In the first month on therapy, the total bleeding score (TBS) for women on Climesse (mean 6.77, range 050), was significantly higher than for women treated by tibolone (mean 1.1 range O-23). However the TBS of women on Chmesse fell progressively during the study, and the mean TBS at month 6 was 1.6 (range O-27) for the Climesse group, and 2.11 (range O-45) for the tibolone group, and at month 12 was 1.96 (range O-33) for the Climesse group and 0.86 (range O-16) for the tibolone group. This study demonstrates endometrial protection by Climesse.
P237
P236
ENHANCED PROLIFERATION OF ENDOMETRIAL STROMAL LEUKOCYTES DURING THE LATE PSEUDOLUTEAL PHASE OF A HORMONE REPLACEMENT THERAPY (HRT) REGIMEN.
ENDOMETRIAL RESPONSES TO A HORMONE REPLACEMENT THERAPY (HRT) REGIMEN: COMPARATIVE HISTOPATHOLOGICAL ASSESSMENT DURING THE LATE “PSEUDO-LUTEAL” PHASE. MA Habiba, S C Bell, S Deen, FAI-Azzawi, The Menopause Research Unit, Leicester University School of Medicine, Leicester, LE2 7LX, UK.
MA Habiba, S C Bell, FAl-Auawi, The Menopause Research Unit, Leicester University Medicine, Leicester, LE2 7LX, UK.
We examined endometrial biopsies obtained from 75 patients on days 27-29 of a cyclical sequential combined HRT regimen. Of those (n=42) who bled on average after day 28 i.e. late-bleeders, 35 had not bled by day 27-29 in the cycle of biopsy collection, and were termed late ‘pseudo-luteal’ phase specimens. They were compared to late luteal phase biopsies obtained from control patients (n=ll). Using classical histopathology criteria all biopsies were assessed as ‘secretory’ endometria. However in contrast to endometrial biopsies obtained during the late luteal phase, in biopsy specimens from HRT-treated patients the histological features detected were more diverse between biopsies, and more diverse and variably distributed within each specimen. We therefore developed a semiquantitative histological method for the assessment of the frequency of presence of individual features. In biopsies from the late ‘pseudo-luteal’ phase of HRT-treated patients there was an increased incidence of pseudostratftcation within all epithelial populations, metaplasia, glands containing invaginations, apical glandular epithelial vesicular clusters, stromal leukocytes and spiral arterioles, albeit the latter being more poorly developed. We conclude it is inappropriate to assess biopsies from HRT-treated patients according to classical histopathological criteria.
The frequency of mononuclear stromal cells in the endometrium of women treated by a cyclical sequential combined HRT, was assessed and compared to late luteal LH dated endometria. Biopsies were obtained on days 27-29 and before bleeding. Employing a semiquantitative histological method we detected an increased frequency of round mononuclear stromal cells in HRT endometria compared to controls. The number of leukocytes was estimated in 10 fields per biopsy (X200) using an immunohistochemical technique, with a monoclonal antibody to leukocyte common antigen (CD45 Dako Ltd) employing an Image Analysis programme. There was a 2.2-fold increase (p
190
School of