Journal of the European Society for Gynaecological Endoscopy


Estro-progestin and progestogen intake: What’s the impact on hysteroscopic imaging?

G. Garuti, M. Colonnelli, A. Soliani, C. Lubrano, M. Soligo

Department of Obstetrics and Gynaecology, Public Hospital of Lodi via Savoia, Lodi, Italy


Hysteroscopy, Endometrium, Estro-progestins, Progestogens, Hormonal Replacement Therapy, Endometrial hyperplasia

Published online: Mar 31 2023


Background: In current literature there is no report aimed to evaluate the effects of exogenous steroids on hysteroscopic imaging.

Objectives: To evaluate the hysteroscopic features of endometrium in women undergoing female hormones administration.

Material and Methods: We reviewed video-records of hysteroscopies carried-out in women taking estro-progestins (EP), progestogen (P) and Hormonal Replacement Therapy (HRT). All women underwent biopsies resulting in atrophic, functional, or dysfunctional pathological reports.

Main Outcome Measures: Description of hysteroscopic pictures related to each schedule of therapy.

Results: The study included 117 women. We evaluated 82, 24 and 11 women treated by EP, P and HRT, respectively. In EP users, imaging indistinguishable from physiological pictures was found when high oestrogen dosage and low-potency progestogen as 17-OH progesterone derivatives were administered. By enhancing progestogen potency with 19-norprogesterone and 19-nortestosterone derivatives we observed a promotion of progestogen differentiation such as polypoid-papillary pseudo-decidualisation, spiral artery differentiation, inhibition of gland-proliferation and endometrial atrophy. In P users we distinguished two patterns, depending on continuous or sequential schedules. Continuous therapy resulted in atrophic or proliferative-secretory features whereas sequential ones led to endometrial overgrowth reflecting stromal pseudo-decidualisation. Women undergoing HRT showed atrophic features in combined continuous and polypoid overgrowth in sequential schedules. In women taking Tibolone we found pictures ranging from atrophic to hyperplastic appearances.

Conclusions: Exogenous steroids lead to significant endometrial moulding. Depending on schedule, hysteroscopic-view appears predictable and often showing overgrowths mimicking proliferative pathologies. In this case biopsy is recommended but in common practice physicians should gain awareness with hysteroscopic pictures induced from hormone administration.

What is new? Systematic assessment of hysteroscopic pictures during estro-progestins intake.