Endometrial changes

Dijkhuizen FPHLJ, Brolmann HAM, Oddens BJJ et al. (1996) Transvaginal ultrasonography and endometrial changes in postmenopausal breast cancer patients receiving tamoxifen. Maturitas 24 45-50... 

An important criticism to most of the available information on tamoxifen-induced changes in endometrium has been that the initial status of the endometrium has not been assessed (Berliere et al. 1998). To establish a link between tamoxifen and endometrial changes, it has been said, the endometrium needs to be evaluated before and during treatment. 

Cohen I, Rosen DJ, Shapira J, Cordoba M, Gilboa S, Altaras MM, et al. (1994) Endometrial changes with tamoxifen comparison between tamoxifen-treated and nontreated asymptomatic, postmenopausal breast cancer patients. Gynecol Oncol 52 185-190... 

Q80 Women receiving tamoxifen should be advised to have routine gynaecological monitoring. Uterine fibroids and endometrial changes may occur v/ith tamoxifen. 

The administration of tamoxifen necessitates routine gynaecological monitoring since uterine fibroids and endometrial changes may occur with its use. Prior to starting treatment, patients should be informed of the small risk of endometrial cancer associated with tamoxifen therapy. 

There have been an increased number of incidences of endometrial changes, thromboembolic events, and uterine malignancies while using tamoxifen. 

A year or so after gonadarche, sufficient estrogen is produced to induce endometrial changes and periodic bleeding. After the first few irregular cycles, which may be anovulatory, normal cyclic function is established. 

There could be fairly simple ways of screening for endometrial disorders in women using HRT. A study in 93 such women has confirmed the earlier finding that if a Papanicolaou smear is taken from the vagina the presence of endometrial cells in the smear gives some (non-specific) indication that there are endometrial changes, which may range from hyperplasia or polyps to endometrial carcinoma (65). 

This study has again confirmed that endometrial problems can be induced by tamoxifen early in the course of treatment and that these problems do not arise with aromatase inhibitors, which may actually reduce the endometrial changes induced by tamoxifen. The idea that the new oral aromatase inhibitors might well replace tamoxifen in breast cancer was tentatively advanced in SEDA-26 (p. 445) and has now been supported by some of the material cited above, as well as by a panel consensus (25). Citing efficacy and safety data on anastrozole, exemestane, and letrozole, the authors concluded that third-generation aromatase inhibitors may be considered first-line therapy of hormone-receptor-positive advanced breast cancer in postmenopausal women and may also be used for preoperative therapy of breast cancer. 

Whether one should routinely screen patients for endometrial changes is disputed there seems to be no correlation between endometrial thickness and endometrial pathology, and complications could be easily overlooked (79). 

Cohen I, Beyth Y, Azaria R, Flex D, Figer A, Tepper R. Ultrasonographic measurement of endometrial changes following discontinuation of tamoxifen treatment in postmenopausal breast cancer patients. BJOG 2000 107(9) 1083-7. 

Apoptosis or programmed cell death is a highly regulated process required in developmental events such as embryological tissue remodelling and the endometrial changes of the menstrual cycle. The cell complement in particular tissues of metazoans derives from a balance between apoptosis and cell division and an imbalance in favour of cell multiplication is associated with cancer. 

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