Estudio del endometrio mediante ultrasonografía e histología en pacientes posmenopáusicas asintomáticas con hipertensión arterial

Resumen

Objetivo

Recientes estudios han correlacionado el hallazgo ecográfico de aumento de espesor endometrial en mujeres posmenopáusicas asintomáticas hipertensas con el consumo de fármacos antihipertensivos. En este estudio prospectivo intentamos correlacionar estas imágenes ecográficas con un sustrato histológico en mujeres menopáusicas hipertensas en tratamiento, comparándolas con las de mujeres menopáusicas normotensas

Sujetos y método

388 mujeres menopáusicas asintomáticas fueron seleccionadas para este estudio, 187 (48,2%) eran normotensas, 19 (9%) eran hipertensas sin tratamiento y 182 (46,9%) eran hipertensas con tratamiento (si consumían diuréticos no eran incluidas). A todas las pacientes se les realizaba inicialmente una ecografía transvaginal para valorar el grosor endometrial y la ecogenicidad, y posteriormente se realizaba una toma endometrial. Si la ecografía o la toma endometrial resultaban anormales se procedía a la realización de una histeroscopia con biopsia dirigida

Resultados

El grosor endometrial en las mujeres hipertensas con tratamiento farmacológico (4,2 mm ± 3,2) era significativamente mayor que en las mujeres normotensas (3,0 mm ± 2,3; p < 0,0001). Los hallazgos histológicos indicaban mayor incidencia de pólipos en el grupo de mujeres hipertensas con tratamiento (17,6%) que en las mujeres normotensas (9,6%; p < 0,001) y mujeres hipertensas sin tratamiento (10,5%; p < 0,001)

Conclusiones

Las mujeres menopáusicas asintomáticas con tratamiento antihipertensivo presentan endometrios engrosados con más frecuencia. El sustrato histológico de estos hallazgos objetiva una mayor incidencia de pólipos

Summary

Objective

Sonographic findings of increased endometrial thickness have recently been related to the use of antihypertensive drugs in asymptomatic postmenopausal women with hypertension. In this prospective case control study we aimed to compare endometrial sonographic and histologic findings in asymptomatic postmenopausal women with hypertension undergoing treatment with those in asymptomatic normotensive postmenopausal women

Study design

Three hundred eighty-eight asymptomatic postmenopausal women were recruited to this study: 187 (48.2%) were normotensive, 19 (9%) were hypertensive without pharmacological treatment and 182 women (46.9%) were hypertensive and were taking antihypertensive drugs (women taking diuretics were excluded). All patients underwent initial transvaginal sonography to assess endometrial thickness and echogenicity, with subsequent endometrial cytological sampling. Women with abnormal sonographic and/or cytological findings were then evaluated by hysteroscopy and guided endometrial biopsy

Results

Endometrial stripe was significantly thicker in postmenopausal women with hypertension undergoing antihypertensive treatment (4.2 mm ± 3.2) than in normotensive women (3.0 mm ± 2.3) (p < 0.0001). These findings were correlated with a higher incidence of endometrial polyps in hypertensive women undergoing treatment (17.6%) than in normotensive women (9.6%; p < 0.001) and in hypertensive women without treatment (10.5%; p < 0.001)

Conclusion

Increased endometrial thickness was more frequent in asymptomatic postmenopausal women with hypertension who were taking antihypertensive drugs. The histological substrate of these findings indicated a higher incidence of endometrial polyps