Progesterone Challenge Test in Screening of Endometrial Pathologic Lesions in High-Risk Post-Menopausal Women

This study aimed to evaluate the prognostic value of the progesterone challenge test (PCT) in the diagnosis of hyperplastic and cancerous endometrium in high-risk postmenopausal women. In this cross-sectional study, 72 postmenopausal women without abnormal uterine bleeding who had risk factors for endometrial cancer were recruited. Patients with endometrial thickness of 4 mm or more as determined transvaginal ultrasonography were tested with progesterone challenge test. If there were any bleeding (spotting to severe bleeding) in the next two weeks, the test would be considered positive. After two weeks, all of the participants despite the result of PCT underwent office endometrial biopsy. In the end, all the results of PCT were compared with endometrial biopsy results. The mean age of the participants was 57.7 ±8.15 years. The progesterone challenge test was positive in 17 women (22%). Among the participants with positive progesterone challenge test, most of them show hyperplasia (62.5%) and 4.2% show endometrial cancer. According to the results, PCT had 37.5% accuracy, 20.8% sensitivity, 70.8 % specificity, 58.8% positive predictive value (PPV), and 30.9 % negative predictive value (NPV) for diagnosis of endometrial pathology. We suggest that due to the unacceptable sensitivity and specificity of the PCT, this test alone is not suitable for screening of endometrial cancer or hyperplasia.