EP20.15: Five years of follow‐up by transvaginal ultrasound of women in the menopausal transition treated with cyclic progesterone

To correlate the ultrasound exam for the assessment of the endometrium in perimenopausal women with symptoms and clinical findings after supplementation with cyclic progesterone and to confirm this exam as an accurate follow-up tool. We perform a prospective observational study of 24 women, age 42 - 44, followed-up for 5 years by clinical exam and transvaginal (TV) ultrasound after receiving treatment with cyclic progesterone. All had heavy menstrual bleeding with prolonged duration, shortening of the menstrual cycle, and were diagnosed with early menopausal transition. TV ultrasound exam was in the early proliferative phase detected a hyperechogenic endometrium, > 14 mm, with non-homogeneous appearance. All underwent hysteroscopy and endometrial biopsy. In 3 cases single small endometrial polyps were discovered, all other were diagnosed with dysfunctional endometrium, then started cyclic progesterone. TV ultrasound endometrial assessment was done at 6 month after treatment initiation and then once a year; on day 4-6 of the menstrual cycle, endometrial thickness was measured in the sagittal plane including both the anterior and the posterior portion of it, at the thickest portion. After 6 month of lutheal phase progesterone supplementation all patients experienced normal menses in terms of flow, duration and frequency. The TV ultrasound detected normal thickness and appearance of the endometrium, consistent with the clinical findings. During the 5 years follow-up 3 patients experienced irregular heavy menstrual bleedings, TV ultrasound showed thickened and hyperechoic endometrium; endometrial biopsy was repeated (1 case of discordant proliferative endometrial changes, 2 cases complex endometrial hyperplasia). TV ultrasound was an accurate follow-up tool in perimenopausal women with cyclic progesterone supplementation; thus the assessment of the thickness and echogenic appearance of the endometrium was correlated with the clinical results of the hormonal therapy.