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Obstetrics and Gynecology · Gynecology

Menopausal hormone therapy

Therapia hormonalis in menopause

Menopausal hormone therapy (MHT) requires strict monitoring of the endometrium and ovaries. In postmenopause, any changes in uterine dimensions or the onset of uterine bleeding serve as an indication for a mandatory examination.

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Ultrasound screeningIt is recommended to perform it twice a year for the early detection of pathologies.
Oncological alertnessGrowth of myoma nodes without MHT stimulation requires the exclusion of sarcoma.
M-echo normEndometrial thickening greater than 4–5 mm in postmenopause is a sign of hyperplasia.
Bleeding riskSubmucous myoma is a frequent cause of uterine bleeding during this period.
2 min readFor medical studentsUpdated Sep 20, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Changes in uterine myoma

In postmenopause, myoma nodes undergo involution driven by apoptosis processes. Main signs:

  • Echogenicity: increases, which complicates the visualization of the node structure.
  • Blood flow: intranodular signals on color Doppler mapping (CDMs) are practically undetectable.
  • Topography: due to myometrial atrophy, interstitial nodes may shift, forming a submucous component, which provokes bleeding.

Endometrial hyperplastic processes

The development of hyperplasia is associated with hyperestrogenemia caused by obesity, liver pathology, or hormone-producing ovarian tumors. The process progresses from glandular polyps to atypical hyperplasia.

Progression vector:

  1. Glandular polyps.
  2. Glandular-fibrous polyps.
  3. Glandular hyperplasia.
  4. Atypical hyperplasia.

Important to remember: the concentration of estrogen and progesterone receptors decreases as the pathology transitions to more severe forms.

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Diagnosis and management

Standard echography is often limited; therefore, when pathology is suspected, hydrosonography and hysteroscopy are used. The latter is the "gold standard" as it allows visual control over the completeness of lesion removal during fractional diagnostic curettage (FDC). When any ovarian or endometrial formations are detected, histological confirmation is necessary to rule out malignancy.

How to memorize

The "4-5-2" rule: M-echo > 4–5 mm is an indication for biopsy; ultrasound screening is performed 2 times a year.

Class and exam questions

Why can a myoma start bleeding in postmenopause?

This occurs due to the formation of a submucous component of the node resulting from atrophic processes in the myometrium.

What conditions must be ruled out in case of uterine growth in postmenopause?

It is necessary to rule out hormone-producing ovarian pathology (e.g., thecomatosis) and uterine sarcoma.

What is the advantage of hysteroscopy over conventional ultrasound?

Hysteroscopy allows for visual assessment of the uterine cavity and control over the quality of removal of the pathological focus, which is impossible with a simple ultrasound.

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What else to study on this topic

  • Mechanisms of peripheral conversion of androgens to estrogens in obesity.
  • Differential diagnosis of glandular polyps and the uterine rim.
  • The role of hyperinsulinemia in stimulating the ovarian stroma.
  • Features of the clinical course of ovarian tumors in elderly patients.
  • The relationship between the proliferative potential of tissue and disease prognosis.

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