What do the ovaries stop responding to and in turn stop producing as women age/become postmenopausal?
- gonadotropins
- stop producing progesterone, estradiol, estrogen
Menses becomes _______ and generally ceases between the ages of ______ years.
irregular
45-55 years
Postmenopausal bleeding may be due to ___________, but any patient with bleeding is assessed.
atrophic endometrium
Describe the normal sonographic findings of a postmenopausal patient. (7)
- uterine contours and proportions are maintained
- myometrium may have calcified arcuate arteries
- a small amount of fluid in the endometrial cavity (hydrometer) is considered normal in an asymptomatic patient (often caused by cervical stenosis)
- normal endometrial stripe is less than 8mm in asymptomatic patient
- decreased estrogen levels = thinner endometrial stripe
- 4-5 mm is considered upper limits of normal, if there is a history of bleeding
- in patients receiving sequential estrogen/progesterone replacement - endometrium resembles pre-menopausal cyclic endometrium, and measuring up to 8mm
What does hormone replacement therapy help with/prevent?
helps alleviate some of the symptoms of menopause
helps prevent osteoporosis
What is unopposed estrogen associated with?
increased risk of hyperplasia and endometrial carcinoma
What happens to the endometrium in women taking cycling/sequential doses of estrogen and progesterone?
the endometrium thickens during the estrogen phase and thins during the progesterone phase
What happens to the endometrium in women taking continuous combined doses of estrogen and progesterone?
the endometrium does not cycle between thicker and thinner phases
When is it preferable to image the endometrium if on hormone therapy if possible?
estrogen phase – perform ultrasound after progesterone withdrawal (after bleeding)
Describe the sonographic findings of those on HRT.
- endometrial stripe up to 8mm on unopposed estrogen only
- endometrial stripe up to 10-12mm in estrogen phase, decreases during progesterone phase
- cyclic hormones = menstrual type endometrium
- continuous combined hormones = <8mm endometrium
Name 4 examples of combination HRT (estrogen and progesterone).
- Premphase
- Prempro
- Activella
- Combipatch
Name 3 examples of estrogen HRT.
- Premarin
- Cenestin
- Enjuvia
Name 3 examples of oral progestins.
- Provera
- Prometrium
- Aygestin
Any bleeding from the genital tract of an older women that occurs more than _______ after the last menstrual period is considered post-menopausal bleeding.
12 months
What are the 5 causes of post-menopausal bleeding? Which are the most common?
- exogenous estrogen administration –most common
- endometrial atrophy – most common cause without HRT
- endometrial carcinoma
- cervical carcinoma
- estrogen producing functional tumor of the ovary (rare)
What are the sonographic considerations for patients with postmenopausal bleeding?
- TV high-resolution measurement of the endometrial thickness is preferred
- careful evaluation of myometrium for echo texture changes
What is tamoxifen?
a non steroidal anti estrogen used as a chemo drug in patients with certain types of breast cancer
What can tamoxifen cause? What are these patients at increased risk of?
may cause changes in the endometrium
increased risk of endometrial carcinoma
Sonography is recommended for women on tamoxifen who present with ________.
vaginal bleeding
Describe the possible sonographic findings of those on tamoxifen.
- subendometrial cysts (cystic areas in endometrial-myometrial junction)
- endometrial hyperplasia
- endometrial carcinoma
