View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
Restricted access

Cékitűzés: A vizsgálat célja meghatározni a postmenopausalis hormonterápia (kizárólagos ösztrogén-, szekvenciális és folyamatosan kombinált ösztrogén-progesztogén kezelés) hatását az endometrialis vérzésre és a méhnyálkahártya szövettani átalakulására. Beteganyag: Szerzők klinikájának Menopauza Ambulanciáján ötéves időszakban (2000–2005) 5893 beteget gondoztak, és vizsgálták a postmenopausalis méhvérzések előfordulását a hormonterápiában részesültek és nem részesültek csoportjában. Vérzés esetén mindig frakcionált abrasiót végeztek, és a mintákat szövettanilag feldolgozták. Eredmények: A postmenopausában lévő betegek hormonkezelésben nem részesítettek csoportjában több mint kétszer több vérzés fordult elő, mint a hormonkezelésben részesültek között. Anyagukban a proliferatiós és a hyperplasiás endometrium-leletek elsősorban a nem kezelt páciensek közül kerültek ki, ami amellett szól, hogy a megfelelő időben, akár már a menopausa előtt megkezdett hormonkezelés csökkentheti a hyperplasia és ezáltal közvetve az adenocarcinoma kialakulásának az esélyét. A kizárólag ösztrogént alkalmazó betegekben gyakoribb volt a hyperplasia. Elképzelhetőnek tartják, hogy az ellensúlyozatlan ösztrogénkezelés a már meglévő endometrium-hyperplasiát tovább súlyosbíthatja. A hormonkezeltek csoportjában atípiával járó komplex hyperplasia nem, csak simplex hyperplasia fordult elő. A folyamatosan kombinált készítmények alkalmazása mellett az esetek döntő részében a méhnyálkahártya atrófizálódott, így lényegesen csökkent a hyperplasiával járó eltérések s a mellékhatásként jelentkező vérzés esélye. A hormonkezeltek között gyakoribb volt az endometrium-polip, és nem tudják megmagyarázni, de a cervicalis polypusok aránya is. Következtetés: A szerzők tapasztalata szerint a hormonkezelés nem rizikótényezője az endometrium-karcinómának, hanem a kombinált készítmények a hyperplasia és ezen keresztül az adenocarcinoma eredeti esélyét csökkentik.

  • Papp Z.: (szerk.) A szülészet-nőgyógyászat tankönyve. Semmelweis Kiadó, Budapest, 2002.

    '', in A szülészet-nőgyógyászat tankönyve , (2002 ) -.

  • Burger, H. G., Dudley, E. C., Hopper, J. L. és mtsai: The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample. J. Clin. Endocrinol. Metab., 1995, 80 , 3537–3545.

    Hopper J. L. , 'The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample ' (1995 ) 80 J. Clin. Endocrinol. Metab. : 3537 -3545.

    • Search Google Scholar
  • Seltzer, V. L., Benjamin, F., Deutsch, S.: Perimenopausal bleeding patterns and pathological findings. J. Am. Med. Womens. Assoc., 1990, 45 , 132–134.

    Deutsch S. , 'Perimenopausal bleeding patterns and pathological findings ' (1990 ) 45 J. Am. Med. Womens. Assoc. : 132 -134.

    • Search Google Scholar
  • Klein, N. A., Soules, M. R.: Endocrine changes of the perimenopause. Clin. Obstet. Gynecol., 1998, 41 , 912–920.

    Soules M. R. , 'Endocrine changes of the perimenopause ' (1998 ) 41 Clin. Obstet. Gynecol. : 912 -920.

    • Search Google Scholar
  • March, C. M.: Bleeding problems and treatment. Clin. Obstet. Gynecol., 1998, 41 , 928–939.

    March C. M. , 'Bleeding problems and treatment ' (1998 ) 41 Clin. Obstet. Gynecol. : 928 -939.

    • Search Google Scholar
  • Samsioe, G.: Hormone replacement therapy: aspects of bleeding problems and compliance. Int. J. Fertil. Menopausal. Stud., 1996, 41 , 11–15.

    Samsioe G. , 'Hormone replacement therapy: aspects of bleeding problems and compliance ' (1996 ) 41 Int. J. Fertil. Menopausal. Stud. : 11 -15.

    • Search Google Scholar
  • Wren, B. G., Brown, L.: Compliance with hormonal replacement therapy. Maturitas, 1991, 13 , 17–21.

    Brown L. , 'Compliance with hormonal replacement therapy ' (1991 ) 13 Maturitas : 17 -21.

  • Weber, A. M., Belinson, J. L., Piedmonte, M. R.: Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding. Obstet. Gynecol., 1999, 93 , 594–598.

    Piedmonte M. R. , 'Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding ' (1999 ) 93 Obstet. Gynecol. : 594 -598.

    • Search Google Scholar
  • Bachmann, L. M., Riet, G., Clark, T. J. és mtsai: Probability analysis for diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding: an approach for a rational diagnostic workup. Acta Obstet. Gynecol. Scand., 2003, 82 , 1–6.

    Clark T. J. , 'Probability analysis for diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding: an approach for a rational diagnostic workup ' (2003 ) 82 Acta Obstet. Gynecol. Scand. : 1 -6.

    • Search Google Scholar
  • Farquhar, C. M., Lethaby, A., Sowter, M. és mtsai: An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am. J. Obstet. Gynecol., 1999, 181 , 525–529.

    Sowter M. , 'An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding ' (1999 ) 181 Am. J. Obstet. Gynecol. : 525 -529.

    • Search Google Scholar
  • Grimes, D. A.: Diagnostic dilation and curettage: a reappraisal. Am. J. Obstet. Gynecol., 1982, 142 , 1–6.

    Grimes D. A. , 'Diagnostic dilation and curettage: a reappraisal ' (1982 ) 142 Am. J. Obstet. Gynecol. : 1 -6.

    • Search Google Scholar
  • Mishell, D. R., Jr., Kaunitz, A. M.: Devices for endometrial sampling. A comparison. J. Reprod. Med., 1998, 43 , 180–184.

    Kaunitz A. M. , 'Devices for endometrial sampling. A comparison ' (1998 ) 43 J. Reprod. Med. : 180 -184.

    • Search Google Scholar
  • Dijkhuizen, F. P., Mol, B. W., Brolmann, H. A. és mtsai: The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer, 2000, 89 , 1765–1772.

    Brolmann H. A. , 'The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis ' (2000 ) 89 Cancer : 1765 -1772.

    • Search Google Scholar
  • Goldschmit, R., Katz, Z., Blickstein, I. és mtsai: The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness. Obstet. Gynecol., 1993, 82 , 727–730.

    Blickstein I. , 'The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness ' (1993 ) 82 Obstet. Gynecol. : 727 -730.

    • Search Google Scholar
  • Epstein, E., Valentin, L.: Managing women with post-menopausal bleeding. Best Pract. Res. Clin. Obstet. Gynaecol., 2004, 18 , 125–143.

    Valentin L. , 'Managing women with post-menopausal bleeding ' (2004 ) 18 Best Pract. Res. Clin. Obstet. Gynaecol. : 125 -143.

    • Search Google Scholar
  • Omodei, U., Ferrazzia, E., Ruggeri, C. és mtsai: Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound / hysteroscopic study. Ultrasound Obstet. Gynecol., 2000, 15 , 317–320.

    Ruggeri C. , 'Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound / hysteroscopic study ' (2000 ) 15 Ultrasound Obstet. Gynecol. : 317 -320.

    • Search Google Scholar
  • Perrone, G., DeAngelis, C., Critelli, C. és mtsai: Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users and non-users. Maturitas, 2002, 43 , 251–255.

    Critelli C. , 'Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users and non-users ' (2002 ) 43 Maturitas : 251 -255.

    • Search Google Scholar
  • Mossa, B., Imperato, F., Marziani, R. és mtsai: Hormonal replacement therapy and evalution of intrauterine pathology in postmenopausal women: a ten-year study. Eur. J. Gynaecol. Oncol., 2003, 24 , 507–512.

    Marziani R. , 'Hormonal replacement therapy and evalution of intrauterine pathology in postmenopausal women: a ten-year study ' (2003 ) 24 Eur. J. Gynaecol. Oncol. : 507 -512.

    • Search Google Scholar
  • Schmidt, T., Nawroth, F., Breidenbach, M. és mtsai: Differential indication for histological evaluation of endometrial fluid in postmenopause. Maturitas, 2005, 50 , 177–181.

    Breidenbach M. , 'Differential indication for histological evaluation of endometrial fluid in postmenopause ' (2005 ) 50 Maturitas : 177 -181.

    • Search Google Scholar
  • Bernard, J. P., Rizk, E., Camatte, S. és mtsai: Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders. Ultrasound Obstet. Gynecol., 2001, 17 , 145–149.

    Camatte S. , 'Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders ' (2001 ) 17 Ultrasound Obstet. Gynecol. : 145 -149.

    • Search Google Scholar
  • Goldstein, S. R., Zeltser, I., Horan, C. K. és mtsai: Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am. J. Obstet. Gynecol., 1997, 177 , 102–108.

    Horan C. K. , 'Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding ' (1997 ) 177 Am. J. Obstet. Gynecol. : 102 -108.

    • Search Google Scholar
  • Valle, R. F.: Office hysteroscopy. Clin. Obstet. Gynecol., 1999, 42 , 276–289.

    Valle R. F. , 'Office hysteroscopy ' (1999 ) 42 Clin. Obstet. Gynecol. : 276 -289.

  • Oehler, M. K., MacKenzie, I., Kehoe S. és mtsai: Assessment of abnormal bleeding in menopausal women: an update. Brit. Menopause Soc., 2003, 9 , 117–121.

    Kehoe S. , 'Assessment of abnormal bleeding in menopausal women: an update ' (2003 ) 9 Brit. Menopause Soc. : 117 -121.

    • Search Google Scholar
  • Zerbe, M. J., Zhang, J., Bristow, R. E. és mtsai: Retrograde seeding of malignant cells during hysteroscopy in presumed early endometrial cancer. Gynecol. Oncol., 2000, 79 , 55–58.

    Bristow R. E. , 'Retrograde seeding of malignant cells during hysteroscopy in presumed early endometrial cancer ' (2000 ) 79 Gynecol. Oncol. : 55 -58.

    • Search Google Scholar
  • Clark, T. J., Barton, P. M., Coomarasamy, A. és mtsai: Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. Brit. J. Obstet. Gynecol., 2006, 113 , 502–510.

    Coomarasamy A. , 'Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies ' (2006 ) 113 Brit. J. Obstet. Gynecol. : 502 -510.

    • Search Google Scholar
  • Gusberg, S. B.: Precursors of corpus carcinoma. Estrogens and adenomatous hyperplasia. Am. J. Obstet. Gynecol., 1947, 54 , 905–907.

    Gusberg S. B. , 'Precursors of corpus carcinoma. Estrogens and adenomatous hyperplasia ' (1947 ) 54 Am. J. Obstet. Gynecol. : 905 -907.

    • Search Google Scholar
  • Hulley, S., Grady, D., Bush, T. és mtsai: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women: Heart and Estrogen/Progestin Replacement Study (HERS). JAMA, 1998, 280 , 605–613.

    Bush T. , 'Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women: Heart and Estrogen/Progestin Replacement Study (HERS) ' (1998 ) 280 JAMA : 605 -613.

    • Search Google Scholar
  • Sivridis, E., Giatromanolaki, A.: Proliferative activity in postmenopausal endometrium: the lurking potentional for giving rise to an endometrional adenocarcinoma. J. Clin. Pathol., 2004, 57 , 840–844.

    Giatromanolaki A. , 'Proliferative activity in postmenopausal endometrium: the lurking potentional for giving rise to an endometrional adenocarcinoma ' (2004 ) 57 J. Clin. Pathol. : 840 -844.

    • Search Google Scholar
  • Cerin, A., Heldaas, K., Moeller, B.: Adverse endometrial effects of long-cycle estrogen and progestagen replacement therapy. The Scandinavian Long-Cycle Study Group. New Engl. J. Med., 1996, 334 , 668–669.

    Moeller B. , 'Adverse endometrial effects of long-cycle estrogen and progestagen replacement therapy. The Scandinavian Long-Cycle Study Group ' (1996 ) 334 New Engl. J. Med. : 668 -669.

    • Search Google Scholar
  • Shapiro, S., Kelly, J. P., Rosenberg, L. és mtsai: Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N. Engl. J. Med., 1985, 313 , 969–972.

    Rosenberg L. , 'Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens ' (1985 ) 313 N. Engl. J. Med. : 969 -972.

    • Search Google Scholar
  • Toon, V. G., Patrick, N.: Endometrial safety of hormone replacement therapy: rewiew of literature. Maturitas, 2002, 42 , 93–104.

    Patrick N. , 'Endometrial safety of hormone replacement therapy: rewiew of literature ' (2002 ) 42 Maturitas : 93 -104.

    • Search Google Scholar
  • Wildemeersch, D., Schacht, E., Wildemeersch, P.: Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri- and postmenopausal women. Maturitas, 2003, 44 , 237–245.

    Wildemeersch P. , 'Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri- and postmenopausal women ' (2003 ) 44 Maturitas : 237 -245.

    • Search Google Scholar
  • Grady, D., Ernster, V. L.: Hormone replacement therapy and endometrial cancer: are current regimens safe? J. Nat. Cancer Inst., 1997, 89 , 1088–1089.

    Ernster V. L. , 'Hormone replacement therapy and endometrial cancer: are current regimens safe? ' (1997 ) 89 J. Nat. Cancer Inst. : 1088 -1089.

    • Search Google Scholar
  • Van de Weijer, P. H. M., Scholten, P., van der Mooren, M. J.: Bleeding patterns and endometrial histology in postmenopausal women taken low dose, sequential combined E2 and dydrogesterone. Climact., 1999, 2 , 1–9.

    Mooren M. J. , 'Bleeding patterns and endometrial histology in postmenopausal women taken low dose, sequential combined E2 and dydrogesterone ' (1999 ) 2 Climact. : 1 -9.

    • Search Google Scholar
  • Ferenczy A., Gelfand, M. M.: Endometrial histology and bleeding patterns in postmenopausal women taking sequential, combined E2 and dydrogesterone. Maturitas, 1997, 26 , 219–226.

    Gelfand M. M. , 'Endometrial histology and bleeding patterns in postmenopausal women taking sequential, combined E2 and dydrogesterone ' (1997 ) 26 Maturitas : 219 -226.

    • Search Google Scholar
  • Woodruff, J. D., Pickar, J. H.: Incidence of endometrial hyperpasia in postmenopausal women taken conjugated estrogens (Premarin) with medroxyprogesterone acetate versus conjugated estrogens alone. Am. J. Obstet. Gynecol., 1994, 170 , 1213–1223.

    Pickar J. H. , 'Incidence of endometrial hyperpasia in postmenopausal women taken conjugated estrogens (Premarin) with medroxyprogesterone acetate versus conjugated estrogens alone ' (1994 ) 170 Am. J. Obstet. Gynecol. : 1213 -1223.

    • Search Google Scholar
  • Erkkola, R., Kumento, U., Lehmuskoski, S. és mtsai: No increased risk of endometrial hyperplasia with fixed long-cycle oestrogen-progestogen therapy after five years. Brit. Menopause Soc., 2004, 10 , 9–13.

    Lehmuskoski S. , 'No increased risk of endometrial hyperplasia with fixed long-cycle oestrogen-progestogen therapy after five years ' (2004 ) 10 Brit. Menopause Soc. : 9 -13.

    • Search Google Scholar
  • Pike, M. C., Peters, R. K., Cozen, W.: Estrogen-progestin replacement therapy and endometrial cancer. J. Natl. Cancer Inst., 1997, 89 , 1110–1116.

    Cozen W. , 'Estrogen-progestin replacement therapy and endometrial cancer ' (1997 ) 89 J. Natl. Cancer Inst. : 1110 -1116.

    • Search Google Scholar
  • Holst, T., Lang, E., Winkler, U. és mtsai: Bleeding patterns in peri- and postmenopausal women taking a continuous combined regimen of estradiol with norethisterone acetate or a conventional sequential regimen of conjugated equine estrogens with medrogestrone. Maturitas, 2002, 43 , 265–275.

    Winkler U. , 'Bleeding patterns in peri- and postmenopausal women taking a continuous combined regimen of estradiol with norethisterone acetate or a conventional sequential regimen of conjugated equine estrogens with medrogestrone ' (2002 ) 43 Maturitas : 265 -275.

    • Search Google Scholar
  • Ferenczy A.: Pathophysiology of endometrial bleeding. Maturitas, 2003, 45 , 1–14.

    Ferenczy A. , 'Pathophysiology of endometrial bleeding ' (2003 ) 45 Maturitas : 1 -14.

  • Hickey, M., Fraser, I. S.: The structure of endometrial microvessels. Hum. Reprod., 2000, 3 , 57–66.

    Fraser I. S. , 'The structure of endometrial microvessels ' (2000 ) 3 Hum. Reprod. : 57 -66.

  • Hickey, M., Pillai, G., Higham, J. M. és mtsai: Changes in endometrial blood vessels in the endometrium of women with hormone replacement therapy-related irregular bleeding. Hum. Reprod., 2003, 18 , 1100–1106.

    Higham J. M. , 'Changes in endometrial blood vessels in the endometrium of women with hormone replacement therapy-related irregular bleeding ' (2003 ) 18 Hum. Reprod. : 1100 -1106.

    • Search Google Scholar
  • Mirkin, S., Navarro, F., Archer, D. F.: Hormone therapy and endometrial angiogenesis. Climact., 2003, 6 , 273–277.

    Archer D. F. , 'Hormone therapy and endometrial angiogenesis ' (2003 ) 6 Climact. : 273 -277.

    • Search Google Scholar
  • Dahmoun, M., Ödmark, I. S., Risberg, B. és mtsai: Apoptosis, proliferation, and sex steroid receptors in postmenopausal endometrium before and during HRT. Maturitas, 2004, 49 , 114–123.

    Risberg B. , 'Apoptosis, proliferation, and sex steroid receptors in postmenopausal endometrium before and during HRT ' (2004 ) 49 Maturitas : 114 -123.

    • Search Google Scholar
  • Hickey, M., Higham, J., Sullivan, M. és mtsai: Endometrial bleeding in hormone replacement therapy users: preliminary findings regarding the role of matrix metalloproteinase 9 (MMP-9) and tissue inhibitors of MMPs. Fertil. Steril., 2001, 75 , 288–296.

    Sullivan M. , 'Endometrial bleeding in hormone replacement therapy users: preliminary findings regarding the role of matrix metalloproteinase 9 (MMP-9) and tissue inhibitors of MMPs ' (2001 ) 75 Fertil. Steril. : 288 -296.

    • Search Google Scholar
  • Zupi, E., Sbracia, M., Marconi, D. és mtsai: TNFalpha expression in hyperplastic endometrium. Am. J. Reprod. Immunol., 2000, 44 , 153–159.

    Marconi D. , 'TNFalpha expression in hyperplastic endometrium ' (2000 ) 44 Am. J. Reprod. Immunol. : 153 -159.

    • Search Google Scholar
  • Anastasiadis, P. G., Koutlaki, N. G., Skaphida, P. G. és mtsai: Endometrial polypus: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur. J. Gynaecol. Oncol., 2000, 21 , 180–183.

    Skaphida P. G. , 'Endometrial polypus: prevalence, detection, and malignant potential in women with abnormal uterine bleeding ' (2000 ) 21 Eur. J. Gynaecol. Oncol. : 180 -183.

    • Search Google Scholar
  • Reslova, T., Tosner, J., Resl, M. és mtsai: Endometrial polypus. A clinical study of 245 cases. Arch. Gynecol. Obstet., 1999, 262 , 133–139.

    Resl M. , 'Endometrial polypus. A clinical study of 245 cases ' (1999 ) 262 Arch. Gynecol. Obstet. : 133 -139.

    • Search Google Scholar
  • Astrup, K., Olivarius, N.: Frequency of spontaneously occuring postmenopausal bleeding in the general population. Acta Obstet. Gynecol. Scand., 2004, 83 , 203–205.

    Olivarius N. , 'Frequency of spontaneously occuring postmenopausal bleeding in the general population ' (2004 ) 83 Acta Obstet. Gynecol. Scand. : 203 -205.

    • Search Google Scholar
  • Kimura, T., Kamiura, S., Yamamoto, T. és mtsai: Abnormal uterine bleeding and prognosis of endometrial cancer. Int. J. Gynecol. Obstet., 2004, 85 , 145–150.

    Yamamoto T. , 'Abnormal uterine bleeding and prognosis of endometrial cancer ' (2004 ) 85 Int. J. Gynecol. Obstet. : 145 -150.

    • Search Google Scholar
  • Writing Group for the PEPI Trial: Effects of hormonal replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen-Progestin Interventions (PEPI) Trial. JAMA, 1996, 275 , 370–375.

    'Effects of hormonal replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen-Progestin Interventions (PEPI) Trial ' (1996 ) 275 JAMA : 370 -375.

    • Search Google Scholar

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Jan 2021 26 0 0
Feb 2021 26 0 0
Mar 2021 36 0 0
Apr 2021 22 0 0
May 2021 25 0 1
Jun 2021 13 0 0
Jul 2021 0 0 0