P42.01: Transvaginal ultrasonography in the treatment of mature active women with functional uterine bleeding

To establish ultrasonographic criteria in the treatment of mature active women (20–44 years old) with functional uterine bleeding. Clinical randomized study including 184 patients, women aged 20–44 years, with functional uterine bleeding. We considered normal endometrium thickness between 4 and 8 mm, measured in anterior/posterior median plan of uterus, limited by hypoechogenic layers generated by basal endometrium and myometrium. A number of 43 women (39.5%, aged more than 35 years) were diagnosed with atrophic endometrium. An estroprogestative treatment was administrated in these cases with monofasic low-dose oral contraceptives (ethynilestradiol 30 µg + levonorgestrel 150µg, 3 pills by day till the bleeding stopped and then with gradual reduced dose at 1 pill by day, for 10 days). A number of 141 women were found with hyperplasic endometrium, 40% (57) aged less than 34 years old. The women included in the last group received a synthetic progestative (dydrogesteron, 40 mg by day, till the bleeding stopped and then with gradual reduced dose at 20 mg by day, for 10 days); patients older than 35 years received dilatation and currettage with hystopathologic exam. In all cases when we adopted a conservative attitude, the result was a normal quantitative hormonal privation bleeding in 2–5 days after the cessation of hormonal treatment. None of our patients had a relapse in the next 12 months. For mature reproductive active women with uterine functional bleeding the disease has an occasional and self-limiting character. Ultrasonic evaluation of endometrium thickness followed by conservative hormonal therapy in selected cases is able to avoid unecessary uterine hemostatic curettage and endometrial biopsy in more than 54% cases (54.3%, P < 0.05).