Sonographic Changes in Endometrium after Use of Tamoxifen in Breast Cancer

Sonographic Changes in Endometrium


  • Aakash Ramchand Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Ghulam Haider Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Abdul Rehman Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • . Muneeza Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Damisha Jabeen Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Nargis Aalam Abro Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Khadijah Abid Department of Public Health, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan



Breast Cancer, Carcinoma, Endometrium, Endometrial Changes, Tamoxifen, Uterine Changes, Ultrasound


Breast cancer poses a significant global health concern affecting a large number of women. Treatment strategies for breast cancer often involve the use of hormonal therapy, such as tamoxifen. However, the use of tamoxifen is associated with potential side effects, particularly in the endometrium. Objective: To evaluate the sonographic changes in the endometrium following the use of tamoxifen therapy in breast cancer patients. Methods: It was a quasi-experimental trial conducted at the Department of medical oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan from Jan 2023 to Jun 2023. Patients aged 18 years or older, histologically confirmed hormone receptor-positive breast cancer, and having tamoxifen treatment with a dose of 20mg/day for at least six months were included. Endometrial evaluation using transvaginal ultrasonography performed by experienced sonographer and sonographic parameters were assessed. Endometrial evaluation was conducted at baseline and 6 months after start of tamoxifen at regular interval as determined by the treating physician. Results: The median duration of tamoxifen therapy was 24 months with IQR as 10 to 36 months. There was statistically significant difference in pre-treatment and post-treatment endometrial thickness with p-value=0.0001. About 80.5% of the females had endometrial thickness difference of less and equal to 5mm and polyps were observed in 5 cases. Conclusions: Tamoxifen increases the risk of endometrial abnormality; this study highlights the need for monitoring endometrial changes before and after starting tamoxifen therapy in breast cancer patients to detect early suspected neoplastic changes in endometrium.


Shen CT, Hsieh HM, Pan CH, Wu MT, Chuang YS. Breast Cancer Risk Among Female Health Professionals: A 35-Year Population-Based Longitudinal Cohort Study in Taiwan. American Journal of Preventive Medicine. 2021 Dec; 61(6): 831-40. doi: 10.1016/j.amepre.2021.05.024. DOI:

Wang Y and Minden A. Current molecular combination therapies used for the treatment of breast cancer. International Journal of Molecular Sciences. 2022 Sep; 23(19): 11046. doi: 10.3390/ijms231911046. DOI:

Farrar MC and Jacobs TF. Tamoxifen. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Ryu KJ, Kim MS, Lee JY, Nam S, Jeong HG, Kim T, et al. Risk of endometrial polyps, hyperplasia, carcinoma, and uterine cancer after tamoxifen treatment in premenopausal women with breast cancer. JAMA Network Open. 2022 Nov; 5(11): e2243951-. doi: 10.1001/jamanetworkopen.2022.43951. DOI:

Schmidt D. Changes in the endometrium after tamoxifen therapy. Der Pathologe. 2006 Feb; 27: 27-32. doi: 10.1007/s00292-005-0808-8. DOI:

Lee S, Kim YH, Kim SC, Joo JK, Seo DS, Kim KH, et al. The effect of tamoxifen therapy on the endometrium and ovarian cyst formation in patients with breast cancer. Obstetrics & Gynecology Science. 2018 Sep; 61(5): 615-20. doi: 10.5468/ogs.2018.61.5.615. DOI:

Hetta WM, Samy A, Romeih M, Salah A. Role of transvaginal ultrasound in detection of endometrial changes in breast cancer patients under hormonal therapy. Egyptian Journal of Radiology and Nuclear Medicine. 2019 Dec; 50: 1-9. doi: 10.1186/s43055-019-0023-x. DOI:

Paschopoulos M, Kontostolis E, Lolis ED, Koliopoulos G, Alamanos Y, Paraskevaidis E. The use of transvaginal sonography and vaginoscopic hysteroscopy in women on tamoxifen. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2001 Jul; 5(3): 211.

Bertelli G, Hall E, Ireland E, Snowdon CF, Jassem J, Drosik K, et al. Long-term endometrial effects in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES)—a randomised controlled trial of exemestane versus continued tamoxifen after 2–3 years tamoxifen. Annals of Oncology. 2010 Mar; 21(3): 498-505. doi: 10.1093/annonc/mdp358. DOI:

Abd-Alhussain‎ GK, Alatrakji‎ MQ, Saleh‎ WA, Fawzi HA, Mahmood‎ AS. Effects of‎ tamoxifen on the reproductive system of female breast cancer patients: an ultrasound-based cohort study. F1000Research. 2020 Feb; 9: 102. doi: 10.12688/f1000research.21481.1. DOI:

Polin SA and Ascher SM. The effect of tamoxifen on the genital tract. Cancer Imaging. 2008 Jun; 8(1): 135. doi: 10.1102/1470-7330.2008.0020. DOI:

Zhou Y, Fan Y, Ma L, Nowen J. Effect of toremifene on endometrium and neurocognitive function in patients with breast cancer based on resting-state functional magnetic resonance imaging. World Neurosurgery. 2021 May; 149: 436-43. doi: 10.1016/j.wneu.2020.11.051. DOI:

Sun LM, Lin CL, Sun S, Hsu CY, Shae Z, Kao CH. Long-term use of tamoxifen is associated with a decreased subsequent meningioma risk in patients with breast cancer: a nationwide population-based cohort study. Frontiers in Pharmacology. 2019 Jun; 10: 674. doi: 10.3389/fphar.2019.00674. DOI:

Love CD and Dixon JM. Thickened endometrium caused by tamoxifen returns to normal following tamoxifen cessation. The Breast. 2000 Jun; 9(3): 156-7. doi: 10.1054/brst.1999.0160. DOI:

Fishman M, Boda M, Sheiner E, Rotmensch J, Abramowicz J. Changes in the sonographic appearance of the uterus after discontinuation of tamoxifen therapy. Journal of Ultrasound in Medicine. 2006 Apr; 25(4): 469-73. doi: 10.7863/jum.2006.25.4.469. DOI:

Gillespie JL, Chisholm G, Nebgen DR. Use of Transvaginal Ultrasound in the Evaluation of Endometrial Pathology in Women with a History of Tamoxifen Use and Postmenopausal Bleeding. Gynecologic Oncology. 2019 Jul; 154(1): e21. doi: 10.1016/j.ygyno.2019.03.208. DOI:

McGonigle KF, Lantry SA, Odom-Maryon TL, Chai A, Vasilev SA, Simpson JF. Histopathologic effects of tamoxifen on the uterine epithelium of breast cancer patients: analysis by menopausal status. Cancer Letters. 1996 Mar; 101(1): 59-66. doi: 10.1016/0304-3835(96)04114-6 DOI:

Jeon J, Kim SE, Lee DY, Choi D. Factors associated with endometrial pathology during tamoxifen therapy in women with breast cancer: a retrospective analysis of 821 biopsies. Breast Cancer Research and Treatment. 2020 Jan; 179: 125-30. doi: 10.1007/s10549-019-05448-w. DOI:

Cohen I, Azaria R, Shapira J, Yigael D, Tepper R. Significance of secondary ultrasonographic endometrial thickening in postmenopausal tamoxifen‐treated women. Cancer. 2002 Jun; 94(12): 3101-6. doi: 10.1002/cncr.10587. DOI:

Lee M, Piao J, Jeon MJ. Risk factors associated with endometrial pathology in premenopausal breast cancer patients treated with tamoxifen. Yonsei medical journal. 2020 Apr; 61(4): 317. doi: rg/10.3349/ymj.2020.61.4.317. DOI:

Parveen R, Rahman SS, Sarker T, Billah SM, Habib ZH. Sonographic Study of Female Pelvic Organs in Breast Cancer Patients Taking Tamoxifen: Clinical Correlation. Journal of Current and Advance Medical Research. 2020 Apr; 7(1): 17-23. doi: 10.3329/jcamr.v7i1.46425. DOI:



DOI: 10.54393/pjhs.v4i08.913
Published: 2023-08-31

How to Cite

Ramchand, A., Haider, G., Rehman, A., Muneeza, ., Jabeen, D., Abro, N. A., & Abid, K. (2023). Sonographic Changes in Endometrium after Use of Tamoxifen in Breast Cancer: Sonographic Changes in Endometrium. Pakistan Journal of Health Sciences, 4(08), 09–13.



Original Article


Most read articles by the same author(s)