Ultrasound assessment of endometrial thickness and endometrial polyps in women on hormonal replacement therapy

Objective: This study was performed to evaluate the thickness and the sonographic features of the endometrium in postmenopausal women on hormone replacement therapy (HRT). Study Design: This prospective study was based on 483 vaginal ultrasound examinations performed in 238 consecutive postmenopausal women on HRT. Results: Endometrial polyps were diagnosed by ultrasound in 16.3% of the patients; 43.6% were asymptomatic. In the nonpolyp group, a significant difference in endometrial thickness between sequential and continuous schemes was found. In sequential HRT, a three-layer ultrasound pattern of the endometrium was seen in 47% of the women in the estrogen-alone phase of cycle versus 11% in the estrogen-progestogen phase. Conclusion: Patients on HRT need other reference values for endometrial thickness compared with postmenopausal women without HRT. In women on sequential HRT, a transvaginal sonographic evaluation performed in the estrogen-alone phase of cycle may optimize the accuracy for focal lesion detection. The significance of the incidental finding of polyps in an important number of asymptomatic women on HRT remains unsettled. (Am J Obstet Gynecol 2003;188:1249-53.)