Postmenopausal Sonography

Question 1

What do the ovaries stop responding to and in turn stop producing as women age/become postmenopausal?

Answer 1

• gonadotropins

- stop producing progesterone, estradiol, estrogen

Question 2

Menses becomes _______ and generally ceases between the ages of ______ years.

Answer 2

irregular

45-55 years

Question 3

Postmenopausal bleeding may be due to ___________, but any patient with bleeding is assessed.

Answer 3

atrophic endometrium

Question 4

Describe the normal sonographic findings of a postmenopausal patient. (7)

Answer 4

• 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

Question 5

What does hormone replacement therapy help with/prevent?

Answer 5

helps alleviate some of the symptoms of menopause

helps prevent osteoporosis

Question 6

What is unopposed estrogen associated with?

Answer 6

increased risk of hyperplasia and endometrial carcinoma

Question 7

What happens to the endometrium in women taking cycling/sequential doses of estrogen and progesterone?

Answer 7

the endometrium thickens during the estrogen phase and thins during the progesterone phase

Question 8

What happens to the endometrium in women taking continuous combined doses of estrogen and progesterone?

Answer 8

the endometrium does not cycle between thicker and thinner phases

Question 9

When is it preferable to image the endometrium if on hormone therapy if possible?

Answer 9

estrogen phase – perform ultrasound after progesterone withdrawal (after bleeding)

Question 10

Describe the sonographic findings of those on HRT.

Answer 10

• 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

Question 11

Name 4 examples of combination HRT (estrogen and progesterone).

Answer 11

• Premphase
• Prempro
• Activella
• Combipatch

Question 12

Name 3 examples of estrogen HRT.

Answer 12

• Premarin
• Cenestin
• Enjuvia

Question 13

Name 3 examples of oral progestins.

Answer 13

• Provera
• Prometrium
• Aygestin

Question 14

Any bleeding from the genital tract of an older women that occurs more than _______ after the last menstrual period is considered post-menopausal bleeding.

Answer 14

12 months

Question 15

What are the 5 causes of post-menopausal bleeding? Which are the most common?

Answer 15

• exogenous estrogen administration –most common
• endometrial atrophy – most common cause without HRT
• endometrial carcinoma
• cervical carcinoma
• estrogen producing functional tumor of the ovary (rare)

Question 16

What are the sonographic considerations for patients with postmenopausal bleeding?

Answer 16

• TV high-resolution measurement of the endometrial thickness is preferred
• careful evaluation of myometrium for echo texture changes

Question 17

What is tamoxifen?

Answer 17

a non steroidal anti estrogen used as a chemo drug in patients with certain types of breast cancer

Question 18

What can tamoxifen cause? What are these patients at increased risk of?

Answer 18

may cause changes in the endometrium

increased risk of endometrial carcinoma

Question 19

Sonography is recommended for women on tamoxifen who present with ________.

Answer 19

vaginal bleeding

Question 20

Describe the possible sonographic findings of those on tamoxifen.

Answer 20

• subendometrial cysts (cystic areas in endometrial-myometrial junction)
• endometrial hyperplasia
• endometrial carcinoma