원저 : 호르몬 대체요법 중 발생한 비정상 자궁 출혈에서 자궁내막의 병리학적 소견과 자궁내막 두께의 진단적 유용성

Objective: To assess endometrial histology and the diagnostic value of endometrial thickness in postmenopausal women with abnormal uterine bleeding who are taking hormone replacement therapy (HRT). Design: A total of 164 postmenopausal women who experienced abnormal uterine bleeding under HRT of estrogen alone (ERT, n=12), estrogen plus progestogen (EPRT, n=144), others (n=8) were included. Endometrial thickness was measured at the thickest part of the longitudinal plane using transvaginal ultrasound. The women with irregular or unclear endometrial images were excluded. Endometrial biopsy samples were taken within 3 days of ultrasound examination with endometrial aspiration biopsy (n=149) or dilation and curettage (n=15). Result: Number of women with endometrial pathology was 9 (5.5%): simple hyperplasia 5, and complex hyperplasia 4. There was a significant difference in the prevalence of endometrial pathology between ERT (25.0%) and EPRT (3.6%) groups (P=0.005). All the endometrial pathology in ERT group occurred after 6 months of therapy. Abnormal endometrium (8.7±4.5mm) was significantly thicker than normal endometrium (5.7±3.3mm, P=0.001). Using a 5-mm threshold to define abnormal endometrial thickness, sensitivity of ultrasound examination was 100%, specificity 40.8%, positive predictive value 8.8%, negative predictive value 100%. Conclusions: The prevalence of endometrial pathology in abnormal uterine bleeding related to HRT is 5.5%, which is higher in ERT than EPRT. Endometrial thickness of 5mm or more has a high diagnostic value for detecting endometrial pathology.