Is bleeding a predictor of endometrial hyperplasia in postmenopausal women receiving hormone replacement therapy?

OBJECTIVE: We evaluated bleeding as a predictor of endometrial hyperplasia in postmenopausal women receiving conjugated estrogens (Premarin) alone or with medroxyprogesterone acetate, STUDY DESIGN: This study was a retrospective assessment of bleeding and endometrial histologic data gathered during the prospective Menopause Study Group trial. RESULTS: Approximately 20% of women (n = 57) who received unopposed conjugated estrogens for 1 year had endometrial hyperplasia. These women (n = 56) had more bleeding days than did women who did not have hyperplasia (p < 0.001). For users of unopposed conjugated estrogens, the predictive value of amenorrhea to indicate a nonhyperplasia diagnosis was 95%. Irregular bleeding did not appear to be indicative of hyperplasia when continuous or Cyclic medroxyprogesterone acetate was added to conjugated estrogens. CONCLUSION: Unanticipated prolonged bleeding in postmenopausal women receiving unopposed estrogen is suggestive of endometrial hyperplasia. Some irregular bleeding is anticipated in women who receive conjugated estrogens plus medroxyprogesterone acetate as they acclimate to therapy, and this was not associated with hyperplasia.