Relation of serum estrogen level to endometrial abnormalities and uterine blood flow in cases of post menopausal bleeding

ABSTRACT

Post menopausal women are subject to various endometrial changes, this study was done to determine the relation between endometrial thickness, abnormalities and uterine blood flow, to the serum estrogen level in cases of postmenopausal bleeding. The study was carried out for Two years period May 2005-Apr 2007 including 50 patients with postmenopausal uterine bleeding, examined by transvaginal ultrasound to assess the endometrial thickness and echogenicity; Color Doppler imaging was used to evaluate blood flow velocity through both uterine arteries and Pulsatility Index [PI] to analyze the waveform; Serum estrogen level was measured to all cases using the Radio-immunoassay [RIA] technique, The normal value of serum estrogen in postmenopausal women is 5-25 pg/ml. Dilatation and curettage was done to study the endometrial and endocervical histopathological feature. TVS and measurement of serum E2 were used as a screening tests for the detection of postmenopausal endometrial hyperplasia and/or malignancy. Doppler flow mapping for the uterine arteries and histopathological evaluation further added as complementary parameters. Endometrial hyperplasia was reported in 22 cases [44%] and endometrial cancer in 12 cases [24%]. The hyperplasia group further classified into simple, complex and atypical. Simple hyperplasia recorded in 12 cases [24%], complex in 7 cases [14%], and atypical in 3 cases [6%]. Endometrial polyp was seen in 5 cases [10%], Endometrial atrophy was seen in 7 cases [14%], while fibroid was seen in 4 patients [8%]. Assessment of the endometrium by TVS and measurement of serum E2 should be used as a primary diagnostic simple screening tests for the detection of postmenopausal endometrial hyperplasia and/or malignancy; But they must be supplemented by Doppler sonography of the uterine arteries whenever the serum E2 level is above normal or endometrial thickness is more than 5 mm in order to detect cancer at an early stage