Haematometra secondary to hormone replacement therapy: case report

Article Abstract:

Menopause is the permanent cessation of menstrual activity, and usually occurs between the ages of 35 and 58 years. Hormone replacement therapy with estrogen and progesterone is used to prevent osteoporosis, loss of bone mass, in women who are past menopause. It is most effective in preventing bone loss between early menopause and age 65. Hormone replacement therapy may be complicated by hematometra, accumulation of blood in the uterus. A case is described of a 63-year-old woman who developed hematometra following hormone replacement therapy. The patient had reached menopause 11 years earlier. After tests revealed some bone loss, the patient was placed on hormone replacement therapy. Two months after starting hormone treatment, she developed abdominal pain but had normal results from imaging tests of the digestive tract. The abdominal pain persisted and the patient was hospitalized. She had not experienced vaginal bleeding for the past four months. The woman's cervix could not be detected by physical examination, although her uterus was enlarged. Ultrasonography, a diagnostic test in which sound waves are used to visualize internal organs, also confirmed enlargement of the uterus. The uterus was drained of 500 milliliters of blood, and a tube-like structure was placed into the cervix to keep it open. Three weeks later, the uterus had returned to normal size and the cervix remained open. The patient discontinued hormone replacement therapy. This case is unusual in that hormone replacement therapy was started 11 years after menopause. Women who are treated with hormone replacement therapy several years after menopause should be given a regimen of continuous combined estrogen and progestogen. This regimen promotes wasting of the endometrium, the inner lining of the uterus, and causes less bleeding and may be more appropriate in women with an increased risk of stenosis, or narrowing, of the cervix. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Abnormalities, Causes of, Complications and side effects, Menopause, Cervix uteri, Uterine bleeding, Uterine hemorrhage

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The endometrial status of women on long-term continuous combined hormone replacement therapy

Article Abstract:

Menopause, the cessation of menstruation, is associated with osteoporosis, or bone loss, nervousness, hot flashes, chills, excitability, fatigue, apathy, mental depression, unexplainable crying, inability to sleep, dizziness, headaches, and disorders of the urinary and digestive tract. The female hormone estrogen may be given to alleviate these symptoms and reduce bone loss. In addition, estrogen improves blood lipids, thereby protecting against heart disease. Progestogen may be added to estrogen treatment to counteract the effects of estrogen in the endometrium, or inner lining of the uterus. Progestogen was shown to prevent cell division in the endometrium. When progestogen is given in a cyclic manner, it causes withdrawal bleeding and the development of premenstrual-like symptoms. The continuous administration of estrogen and progestogen overcomes these problems of withdrawal bleeding and premenstrual-like symptoms. However, there is concern that a continuous combined regimen may be less effective in protecting the endometrium than an interrupted regimen. The effects of prolonged use of continuous combined treatment with estrogen and progestogen was assessed in 15 women, who had been on hormone replacement therapy for at least three years. Examination of the endometrium revealed no abnormalities and the endometrium appeared thin and atrophic, or wasted away. These findings suggest that inhibition of cell division in the endometrium is maintained with prolonged use of continuous combined estrogen and progestogen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Dosage and administration, Estrogen, Estrogens, Drug therapy, Combination, Combination drug therapy, Endometrium, Progestational hormones

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