Pseudomalignant endometrial changes induced by administration of new synthetic progestins.

Abstract

3 cases studies touted as the first are presented which point to undesirable endometrial changes resulting from progestin therapy. Case 1 had received various combinations of ovarian hormones cyclically for relief of menometrorrhagia; during a severe bout of vaginal bleeding she had been administered norethindrone (10 mg) daily. After 3 years hysterectomy was performed and revealed that the endometrium removed was in marked departure from the normal 50:50 ratio of glands to stroma. Case 2 complained of postmenopausal bleeding and was treated with norethynodrel (10 mg) plus ethinyl estradiol daily after curettage. Curetted material was similar to that detailed in Case 1; it was polypoid with scattered inconspicuous elongated slitlike glandular spaces in a matrix of markedly altered stroma. Case 3 suffered from amenorrhea for 3 years after bilateral salpingectomy and radiation treatments. She was administered the same medication as Case 2. Bleeding was not controlled and curettage was performed. Curetted material and biopsy specimens showed the same peculiar stromal changes. These results suggest that norethindrone and norethynodrel with ethinyl estradiol be administered cyclically according to established physiological principles to women complaining of dysfunctional uterine bleeding but treatment of menopausal and postmenopausal vaginal bleeding should still follow more traditional forms of therapy.