Human Reproduction, Vol 13, 1674-1682, Copyright © 1998 by Oxford University Press
MA Habiba, SC Bell and F Al-Azzawi
We evaluated the histological features of the endometrium in relation to
the bleeding pattern in a group of women receiving oral cyclical combined
hormone replacement therapy (HRT), and compared the histological features
with those of luteinizing hormone (LH)-dated endometrial biopsies obtained
from healthy women at the time of sterilization. A total of 103 women
completed 6 months of HRT therapy. All received a regimen of 2 mg
oestradiol valerate daily, with 1 mg norethisterone added for the last 12
days of every 28-day cycle. Endometrial biopsies were scheduled for the end
of the study (days 27- 29 of the last cycle of therapy). Using the
classical histological criteria, secretory endometrial changes were
demonstrated in the majority (n = 89) of cases. The remaining were
insufficient or inactive (n = 12), proliferative (n = 1) or atrophic (n =
1). Forty-nine women had a mean cycle length of less than 29 days (early
bleeders), 50 women experienced cycles of more than 29 days (late bleeders)
and four did not experience any bleeding. When the individual histological
structures were examined, using image analysis, there were no statistically
significant differences in the histological features when the long cycles
in early bleeders were compared with those in late bleeders. LH-dated
endometrium showed a high degree of homogeneity that was consistent with
cycle day as described by the classic criteria, but HRT-treated endometrium
exhibited a wide range of variability. HRT- treated endometrium from the
subset of women who bled on or after day 29, and whose biopsies were
obtained before the onset of bleeding, differed significantly from the
endometrium taken at the corresponding phase of the physiological cycle. We
conclude that the use of classical histological criteria, which are used in
relation to the physiological cycle, in the study of HRT-treated endometria
is inappropriate.
ARTICLES
Endometrial responses to hormone replacement therapy: histological features compared with those of late luteal phase endometrium
Department of Obstetrics and Gynaecology, Leicester University School of Medicine, UK.
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