Endometrial carcinoma on continuous combined HRT: case report and literature review.

BACKGROUND: Continuous combined hormone replacement therapy (HRT) has been introduced in an attempt to increase patient compliance by eliminating withdrawal bleeding which is one of the most significant and troublesome side effects of sequential HRT. Moreover, when given on a daily basis, progestin is thought to be more protective against the development of endometrial carcinoma.

CASE REPORT: We describe the case of a 59-year-old woman, diagnosed with endometrial carcinoma while on continuous combined HRT. Her last menstrual period was 7 years ago and she had been on HRT ever since. Initially, she tricycled her preparation using transdermal gel 17beta-estradiol 1.5 mg daily along with vaginal micronised progesterone 200 mg daily from day 1 to 12 every 3 months for the first 5 years and she had regular withdrawal bleeding. She was then moved on to continuous combined HRT (transdermal gel 17beta-estradiol 2.25 mg daily plus dydrogesterone 10 mg per os daily) and started to be amenorrhoeic. A routine transvaginal ultrasound showed an increased endometrial echo (10 mm). She was completely asymptomatic. Further investigations resulted in a report of a well differentiated grade II endometrial carcinoma with squamous differentiation. A review of literature confirms endometrial cancer to be rare while on continuous progesterone and difficulties posed in diagnosing it.