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Uterine effects of tamoxifen: a prospective study
  1. K. F. Mcgonigle*,
  2. D. D. Smith,
  3. H. F. Marx,
  4. R. J. Morgan§,
  5. S. A. Vasilev,
  6. S. Roy,
  7. P. T. Wong#,
  8. J. F. Simpson** and
  9. S. P. Wilczynski††
  1. *Section of Gynecology, Virginia Mason Medical Center, Seattle, WA
  2. Department of Biostatistics, City of Hope National Medical Center, Duarte, CA
  3. Department of Radiology, City of Hope National Medical Center, Duarte, CA
  4. §Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA
  5. Department of Gynecologic Oncology, Kaiser Permanente Southern California, Los Angeles, CA
  6. Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
  7. #Department of Gynecology, City of Hope National Medical Center, Duarte, CA
  8. **Department of Pathology, Vanderbilt University, Nashville, TN
  9. ††Department of Pathology, City of Hope National Medical Center, Duarte, CA
  1. Address correspondence and reprint requests to: Kathryn F. McGonigle, MD, Section of Gynecology and Gynecologic Oncology, Virginia Mason Medical Center, Mailstop: X8-GYO, 1100 9th Avenue, Seattle, WA 98111, USA. Email: kathyinseattle{at}


The purpose of the study was to evaluate tamoxifen-associated changes in the vagina and uterus in postmenopausal breast cancer patients. Between June 1994 and December 1998, 45 patients enrolled in a prospective study before commencing tamoxifen therapy. Patients with endometrial thickness >5 mm or neoplasia were excluded. Transvaginal ultrasonography, vaginal maturation indexes (VMI), and endometrial biopsy were performed at baseline and repeated at 6 months (n= 42), 1 year (n= 39), 2 years (n= 32), 3 years (n= 26), 4 years (n= 19), and 5 years (n= 15). For the 39 patients followed for 1 year, VMI (% parabasal/intermediate/superficial) was 21/71/8 at baseline compared with 1/90/9 at 1 year (P value = 0.0008/0.001/0.78). At baseline, mean endometrial thickness and uterine volume were 2.6 mm and 64 cm3, respectively, compared with 5.8 mm and 84 cm3 at 1 year (P= 0.0002, 0.002). At baseline, 80% of patients had atrophic endometrium and 9% proliferative endometrium compared with 61% and 26% at 1 year, respectively (P= 0.04). No cases of endometrial hyperplasia or adenocarcinoma were detected. Findings observed at 6 months persisted through 5 years of follow-up. Tamoxifen exerts a weak estrogenic effect on the vagina and uterus in highly prescreened postmenopausal women without preexisting endometrial pathology.

  • endometrial cancer
  • endometrial polyps
  • tamoxifen
  • transvaginal ultrasound
  • vaginal maturation indexes

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