The progestogen challenge test in postmenopausal women
clinical and morphologic aspects
Keywords:
Endometrium, Progesterone, MenopauseAbstract
The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.
Downloads
References
Baracat EC. Aspectos morfológicos e morfométricos do endométrio humano na pós-menopausa antes e após estrogenioterapia oral e transdérmica. São Paulo, 1991. (Concurso Docente-Livre - Escola Paulista de Medicina).
Utian WH. Overview on menopause. Am J Obstet Gynecol 1987;156:1280-3.
American College of Obstetricians and Gynecologists. Carcinoma of Endometrium. Int J Gynecol Obstet 1993;40:255-61.
More JAR. The normal human endometrium. In: Fox H, ed. Haines and Taylor Obstetrical and Gynaecological Pathology, 3rd.ed. Edinburg: Churchill Livingstone, 1987:302-19.
American College of Obstetricians and Gynecologists. Hormone replacement therapy. Int J Gynecol. Obstet 1993;41:194-202.
Fothergill DJ, Brown VA, Hill AS. Histological sampling of the endometrium: a comparison between formal curettage and the Pipelle sampler. Br J Obstet Gynaecol 1992;99:779 80.
Grönroos M, Salmi TA, Vuento MH, et al. Mass screening for endometrial cancer directed in risk groups of patients with diabetes and patients with hypertension. Cancer 1993;71:1279-82.
Lutz MH, Underwood PB, Kreutner A, Mitchell KS. Vacuum aspirator: an efficient outpatient screening technique for endometrial disease. South Med J 1977;70:393-5.
Gambrell Jr RD, Massey FM, Castaneda TA, Ugenas AJ, Ricci CA, Wright JM. Use of the progestogen challenge test to reduce the risk of endometrial cancer. Obstet Gynecol 1980;55:732-8.
Gambrell JR RD. Progestogen challenge test. Obstet Gynecol 1981;57:268.
Hanna JH, Brady WK, Hill JM, Phillips GL. Detection of postmenopausal women at risk for endometrial carcinoma by a progesterone challenge test. Am J Obstet Gynecol 1983;147:872-5.
Erny R, Isnard S, Boubli L. Tests aux progestatifs après la ménopause. Rev Fr Gynécol Obstét 1986;81:195-8.
Toppozada MK, Ismail AAA, Hamed RSM, Sid-Ahmed K, EI-Faras A. Progesterone challenge test and estrogen assays in menopausal women with endometrial adenomatous hyperplasia. Int J Gynecol Obstet 1988;26:115-9.
Wehba S. Teste da progesterone para detecção de lesões hiperplásicas do endométrio em mulheres na pós-menopausa. São Paulo, 1988. (Dissertation, Escola Paulista de Medicina).
Bortoletto CCR, Gonçalves WJ, Baracat EC, Lima, GR. The use of progestogen challenge test, transvaginal ultrasonography and endometrium biopsy in postmenopause. Int J Gynecol Obstet 1994;46(1):76.
Macía M, Novo A, Ces J, Gonzáles M, Quintana S, Codesido J. Progesterone challenge test for the assessment of endometrial pathology in asymptomatic menopausal women. Int J Gynecol Obstet 1993;40:145-9.
Gonçalves WJ, Simões RD, Stávale JN, Baracat EC. Estudo histológico do endométrio em mulheres na pós-menopausa. In: Jornada Paulista De Obstetrícia E Ginecologia, 2, Guarujá, São Paulo, 1993:42.
Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chron Dis 1972;25:329-43.
Pansini F, De Paoli D, Serra MM, Campobasso C, Levato F, Giulini D. Combined use of progesterone challenge test and endometrium thickness evaluated by transvaginal ultrasonography in the preventive management of postmenopausal women. Gynecol Obstet Invest 1992;34:237-9.
Siegel S. Estadistica no paramétrica. México: Trillas, 1975:346.
Gallen RS, Gambino R. Beyond normality: the predictive value and efficiency of medical diagnoses. New York: John Wiley & Sons, 1975.
Valenzuela P, Sabatel RM, Valls V, Nieto A, Gonzalez-Gomez F. Progestin challenge test in postmenopausal patients. Int J Gynecol Obstet 1993;43:313-6.
Kneale BLG, Giles GG. Endometrial cancer: trends in incidence and survival: a preventable disease? Aust NZ J Obstet Gynaecol 1993;33:1-7.
Parazzini F, La Vecchia C, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynecol Oncol 1991;41:1-16.
Levi F, La Vechchia C, Negri E, Parazzini F, Franceschi S. Body mass at different ages and subsequent endometrial cancer risk. Int J Cancer 1992;50:67-71.
Dallenbach-Hellweg G. The endometrium in the climateric and after menopause. In: Dallenbach-Hellweg G - Histopathology of the endometrium, 4th ed. New York: Springer-Verlag, 1987:86-92.
Shermann BM, West JH, Korenman SG. Analysis of LH, FSH, estradiol and progesterone concentrations during menstrual cycles of older women. J Clin Endocr Metabol 1976;42:629-36.
Erny R, Serradimigni F. Dépistage des hyperplasies et des cancers de l'endomètre. Rev Fr. Gynécol Obstét 1984;79:91-6.
Hempel VE, Nöschel H, Eichhorn KH, Rasch A, Franke D. Vergleich von progesterntest and uterussonographie als screening-verfahren zur erkennung von risikopatientinnen hinsichtlich endometriumkarzinom. Zentralblatt Gynäkol. 1988;110:597-602.
