is transvaginal ultrasound the key?
Unopposed estrogen (previously called ERT, now referred to as ET) increases a patient’s risk of endometrial cancer. The addition of a progestogen to estrogen (previously called HRT, now referred to as HT) will decrease that additional risk of endometrial cancer although it will not eliminate it. Initially this was always done in a sequential fashion. More recently, continuous-combined HT, utilizing daily progestogen, has been popularized. Increasingly, published data points to progestogen and estrogen together causing an increase in the risk of breast cancer two to three times above that of estrogen alone. In the past, less-than-monthly progestogen has been attempted. It results in less bleeding, as well as some simple hyperplasia. Transvaginal ultrasound has a very poor positive predictive value (4% for serious endometrial disease and 9% for any endometrial disease) but a very high negative predictive value (99%) when the echo is distinct, and thin (<5 mm). Thus, patients with an init
