Diagnosis and treatment of abnormal uterine bleeding in postmenopausal patients using hormone replacement therapy

Objective To investigate the cause of uterine bleeding in menopausal patients using hormone replacement therapy (HRT), and the efficacy of resectoscopic surgery for treatment of irregular vaginal bleeding caused by benign uterine pathology in such patients. Design Retrospective case series. Setting Endoscopy unit of a private urban hospital. Subjects 143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997. Interventions All the patients were evaluated using transvaginal sonography, hysteroscopy and endometrial biopsies. A total of 87 patients with polyps, myomas or an atrophic uterine cavity underwent polypectomy ( n = 64) and myomectomy ( n = 19) in association with endometrial resection ( n = 87). Results Endometrial polyps and submucous myomas were the most frequent cause of uterine bleeding in postmenopausal women using HRT. These conditions could be treated effectively using the resectoscope. The failure rate of resectoscopic surgery for focal lesions in patients receiving HRT was 6%. Adenomyosis and recurrence of endometrial polyps were the most frequent reasons for treatment failure and resumption of vaginal bleeding. Conclusion Uterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.