ABSTRACT
Tamoxifen, a triphcnylethylenc derivative, was approved by the Food and Drug Administration in 1978. In 1985, the first report of its association with endometrial neoplasia appeared. Numerous letters and case reports followed. The American College of Obstetricians and Gynecologists document further states, given that up to 39% of postmenopausal women taking tamoxifen have abnormal endometria, and that the annual risk of endometrial cancer is 2–3 and 1000, that it is apparent that hyperplastic lesions seldom evolve into invasive cancers. Raloxifene, a benzothiophene derivative, stimulate the endometrium in ovariectomized rats. Raloxifene appears to act differently from tamoxifen in experimental animals and in clinical trials. However, one short-coming of the Raloxifene Endometrial Safety Study is that women with pre-existing endometrial lesions, a high-risk group for tamoxifen therapy, were excluded from the study. An algorithm of uterine surveillance using transvaginal ultrasound and saline infusion sonohysterography has been described to overcome the short-comings of blind endometrial sampling or the expense, operator dependency of hysteroscopy.
