Murat EKİN, Rana KARAYALÇIN, Selda KARADENİZ, Dündar Pınar ERENOĞLU

Devamlı kombine hormon replasman tedavisinin uterin perfüzyon ve endometrial kalınlık üzerine etkisinin uterin arter Doppler bulguları ile değerlendirilmesi

Amaç: Devamlı kombine hormon replasman tedavisinin (HRT) uterin perfüzyon ve endometrial kalınlık üzerine etkisinin Doppler sonografiiledeğerlendirilmesi.Materyal ve metod: Menapoz Kliniğine hormon replasman tedavisi almak için başvuran veya hormon replasman tedavisi almakta olan toplam 100 hasta çalışmaya dahil edildi. Hormon replasman tedavisi alan hastalarda yirmişer kişilik 4 gruba ayrıldı: Grup 1: 2 mg estradiol + 1mg norethisteron asetat; Grup 2: konjuge östrojen 0.625 mg + medroksiprogesteron asetat2.5 mg; Grup 3: konjuge östrojen 0.625 mg + medroksiprogesteron asetat 5 mg; Grup 4: transdermal matriks sistemi 3.9 mg östradiol 12.5 cm2 + doğal mikronize progesteron 100mg. Kontrol grubuna (Grup 5) hormon replasman tedavisi almak için başvuran en az altı aylık amenoresi olup hormonal değerlendirilmesinde menapoz tespit edilen yirmi hasta dahil edildi. Hastalar kan östradiol seviyeleri, endometrial kalınlık ve uterin arter Doppler rezistivite indeksleri (RI) açısından değerlendirildiler. Bulgular: Kan östradiol seviyeleri açısından değerlendirildiğinde hormon replasman tedavisi alan gruplar arasında anlamlı farklılık olmamakla beraber kontrol grubu ile karşılaştırıldıklarında anlamlı oranda yükseklik tespit edildi. Endometriyal kalınlık açısından değerlendirilme yapıldığında HRT alan olgularda endometriyal kalınlık kontrol grubuna oranla anlamlı olarak yüksek olmakla birlikte HRT alan gruplar arasında ortalama endometriyal kalınlıklar arasında istatistiksel fark tespit edilmedi. Benzer olarak, uterin arter Doppler RI ölçümleri, HRT alan gruplar arasında anlamlı farklılık oluşturmazken kontrol grubuna kıyaslandığında anlamlı olarak düşük bulundu. Sonuç: Devamlı kombine hormon replasman tedavileri ile endometrial kalınlıkta patolojik değişiklikler olmadan uterin arter kan akımında anlamlı olumlu değişiklikler sağlanmaktadır. Tedavinin transdermal veya oral olması kan östrojen seviyesi yeterli olduğu sürece uterin arter kan akımı açısından anlamlı fark oluşturmamaktadır. Tedaviye eklenecek progestagenik ajan açısından sentetik veya doğal progestinler arasında uterin arter kan akımı açısından anlamlı fark tespit edilmemiştir.

The effect of continuous hormone replacement therapy on endometrial thickness and uterine perfusion with Doppler sonography of the uterine arteries

Aim: To investigate the effect of different continuous combined hormone replacement therapy modalities on endometrial thickness and uterine perfusion by Doppler sonograpy of the uterine arteries. Material andmethods: One hundred patients who were willing to have hormone replacement therapy and or still under different continuous combined hormone replacement therapy modalities were included. Patients that were under hormone replacement therapy were divided into four subgroups having 20 patients in each according to the type of hormone replacement therapy modalities. Group 1: 2mg estradiol + 1mg norethisterone acetate; Group 2: conjugated estrogen 0.625 mg + medroxyprogesterone acetate2.5 mg; Group 3: conjugated estrogen 0.625 mg + medroxyprogesterone acetate 5 mg; Group 4: transdermal matrix system 3.9 mg estradiol 12.5 cm2 + natural micronized progesterone 100mg. Control group was consisted of women who were not under hormone replacement therapy, and suffering from amenorrhea duration of at least six months and diagnosed as menopause according to their hormonal status. Blood estradiol levels, endometrial thickness and resistivity index of uterine arteries with Doppler ultrasonography were investigated. Results: There was no significant difference in blood estradiol levels among study groups but a significant difference existed with the study groups compared to the controls. Endometrial thickness and resistivity index of the uterine arteries were also similar within the study groups but was found to be higher when compared with the controls. Conclusion: Continuous combined hormone replacement therapies improve uterine perfusion without deleterious effect on endometrial thickness. There is no difference between transdermal and per oral administration of the hormone replacement therapy on uterine perfusion correlated to blood estradiol levels. Also there is no difference in the type of progestins added to the therapy on the uterine perfusion

PDF

___

1. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. J Am Med Assoc 2002; 288:321–33.
2. Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women. The Women’s Health Initiative Randomized Trial. J Am Med Assoc 2003; 289:3243–53.
3. Million Women Study Collaborators. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003; 362:419–27.
4. Vyas S, Gangar K. Postmenopausal oestrogens and arteries. Br.J.Obstet.Gynecol. 1995; 102:942-6.
5. Bergqvist A, Bergqvist D, Ferno M. Estrogen and progesterone receptors in vessel walls. Biochemical and immunochemical assays. Acta Obstet.Gynecol Scand. 1993; 72:10-6.
6. Bourne TH, Hillard T, Witehead M et al. Oestrogen, arterial status and postmenopausal women. Lancet. 1990; 335:1470-1.
7. Gangar KF, Viyas S, Witehead MI. Pulsatility index in internal carotid artery in relation to transdermal öestradiol and time since menopause. Lancet. 1991; 338:839-42.
8. Bekavac I, Kupesic S, Mihaljevic D et al. Vascular impedeance of uterine, inferior vesicle and ophtalmic arteries in postmenopausal women receiving hormone replacement therapy. Comperative doppler study. Croat med. J. 2000; 41:3:235-9.
9. Sturdee DW, Barlow DH, Urlich LG et al. Is the timing of withdrawal bleeding a quide to endometrial safety during sequential oestrogen progesterone replacement therapy? Lancet 1994; 343:979-82.
10. Exacoustos C, Lello S, Caporale E, et al. Monitoring of hormone replacement therapy in postmenopausal women by transvaginal sonography. And color flow doppler: Study in different phases of sequential therapy. Fertil. Steril 1999; 71:536-43.
11. Bourne TH, Hillard T, Whitehead M, et al. Transvaginal ultrasonography with color flow imaging to monitor hormonere placement threpy in postmenopausal women. Br.J. Radiol 1991; 64:657-61.
12. Hillard TC, Bourne TH, Whitehead MI et al. Differential effects of transdermal oestradiol and sequential progestogens on impedance to flow with in the uterine arteries of postmenopausal women. Fertil. Steril. 1992; 58:959-63.
13. Persson I, Adami HO, Lindberg BS et al. Characteristics of oestrogen treated women. Acta Obstet.Gynecol. Scand. 1983; 62:297-302.
14. Ylikorkala O, Puolakkala J, Viinikka L. Vasoconstictory tromboxane a2 and vasodilatotory prostacyclin in climacteric woman. Effect of oestrogen progesterone therapy. Maturitas1984;5:201-5.
15. Jarvella I, Raudaskoski T, Tekay A et al. Effect of the levonorgestrel relaasing intrauterine system on the uterine artery Pulsatility index in postmenopaual hormone replacement therapy. Ultrasound. Obstet. Gynecology. 1997; 10:350-5.
16. Bonilla-musoles F, Marty MC. Effect of hormonere placemet therapy on uterine blood flow and endometrial status in postmenopausal women. In:Fleicher Kurjak A, Granberg S, editors Ultrasound and the endometrium Newyork:Partenon 1997; 97-108.
17. Cacciatore B, Paakkari I, Toivonen J, et al. Randomized comparison of oral and transdermal hormon replacement on carotid and uterin artery resistance to blood flow.Obstet.Gynecol.1998; 92:563-8.
18. Zalud I, Conway C, Schulman H et al. Endometrial and myometrial thicknes and uterine blood flow in postmenopausal women. The influence of hormone replacement therapy and age. J.Ultrasound med.1993; 12:737-41.
19. Penooti M, Farina M, Sironi L, et al. Long term effects of postmenopausal hormone replacement therapy on pulsatility index of internal carotid and middle cerebral arteries. Menopause 1997; 4:101-4.
20. Predanic M, Ujevic B, Aleem F et al. Correlation serum oestrogen levels with uterine and carotid arteries flow in post menopausal women on hormone replacement therapy. Croat Med. J. 1998; 39:2:181-4.