Elsevier

Fertility and Sterility

Volume 62, Issue 6, December 1994, Pages 1181-1185
Fertility and Sterility

Menopause
Endometrial ablation for refractory postmenopausal bleeding with continuous hormone replacement therapy

https://doi.org/10.1016/S0015-0282(16)57182-9Get rights and content
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Objective

To determine the role of endometrial ablation and benign uterine pathology in menopausal women with refractory bleeding who were treated with continuous hormone replacement therapy (HRT).

Design

Prospective.

Setting

Health maintenance organization.

Patients

One hundred seventy-one menopausal women with an average age of 55 were enrolled in an algorithm of continuous HRT, endometrial biopsy for bleeding with initial therapy, doubling of the progestin dose, hysteroscopy, and endometrial resection-ablation for continued refractory bleeding.

Intervention

Endometrial biopsy, hormone manipulation, office hysteroscopy, and hysteroscopic resection-ablation.

Main Outcome Measures

Refractory menopausal bleeding and benign uterine pathology.

Results

One hundred sixty-two women completed the study. One hundred six (65.4%) remained free of bleeding at the end of the initial 3 months of hormone therapy. Fifty-six (34.6%) had one or more bleeding episodes and required office biopsy and an increase in dosage of progestin. Bleeding ceased in an additional 35 (87%) while 21 (13%) continued to bleed. Those patients underwent endometrial resection-ablation. Surgical specimen demonstrated endometrial polyps, submucous leiomyomas, and adenomyosis in 85.7% of the cases. All patients are now free of bleeding.

Conclusion

Many women become amenorrheic on the initial dose of continuous HRT; however, if bleeding continues, most stop when the dosage of progestin is doubled. Benign uterine pathology may cause refractory bleeding in a small group of patients but may be eliminated with endometrial resection-ablation.

Key Words

Hormone replacement therapy
menopausal bleeding
endometrial ablation

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Reprint requests: Lyman B. Spaulding, M.D., Ph.D., Department of Obstetrics and Gynecology, Colorado Permanente Medical Group, 8383 West Alameda Avenue, Lakewood, Colorado 80226 (FAX: 303-239-7568).