Analysis of the objective and preventative treatment and efficacy of therapeutic approaches in women with non-atypical endometrial hyperplasia
Keywordsendometrial hyperplasia, premenopause, progestogens, reccurens, results of treatment, observation
Non-atypical endometrial hyperplasia (EH) is prone to recurrence and has an unspecified residual monitoring and treatment algorithm. The main factors that influence the possibility of recurrence and progression are not known yet.
The objective: examination of the frequency of hyperproliferative endometrial pathology (HPE) in premenopausal women, organization of treatment and prophylactic measures and their influence on the recurrence or progression of HPE.
Design of the study: a retrospective observational study.
Results of the study: The results of monitoring and treatment were analysed in 380 premenopausal women according to STRAW+10 criteria. The structure was dominated by non-atypycal endomrtrial hyperplasia (EH)- in 356 (93.7%) cases, atypycal hyperplasia (AH) - in 16 (4.2%), endometrial cancer (EC) - in 8 (2.6%). 60 women underwent hysterectomy (24 - AH and EC, 36 - concomitant pathology). Results from 320 women with EH excluding hysterectomy, have been monitored over 3 years. Hormonal treatment with gestagens was given to 138 of 320 women (43.1%), 78 (24.3%) received oral progestins without an interruption for 3 months, 34 (10.6%) for 6 months and 26 (8.1%) received LNG-IUDs 52 mg, in 182 (56.8%) no treatment was provided. The effectiveness of EH therapy in women with LNG-IUDs was achieved in 92.3% of cases, with gestagen treatment at 6 months in 70.6%, and at 3 months in 39.7%. With no therapy, regression of the disease was 28.8%. The incidence of EH at the 3rd year of follow-up in women without treatment was 2.4 times higher than at the 6-month course of oral gestagen therapy (71.4 vs 29.4%) and was not significantly different from the 3-month course (71.4 vs 60.3%).
There is a lack of clarity in the treatment and monitoring system for women with EH in the study centres; short timing of gestagen prescriptions are insufficiently effective and contribute to a high rate of recurrence; the LNG IUD showed the best efficacy results (93.7%) and absence of recurrence over the course of the study.
Al-Sabbagh M, Lam EWF, Brosens JJ. Mechanisms of endometrial progesterone resistance. Mol Cell Endocrinol. 2012;358:208–215.
Doherty MT, Sanni OB, Coleman HG, Cardwell CR, McCluggageWG, Quinn D, et al. Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PloS ONE. 2020;15(4):e0232231. DOI: https://doi.org/10.1371/journal.pone.0232231.
Doherty, M. T., Sanni, O. B., Coleman, H. G., Cardwell, C. R., McCluggage, W. G., Quinn, D., Wylie, J., & McMenamin, Ú. C. (2020). Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PloS one, 15(4), e0232231. https://doi.org/10.1371/journal.pone.0232231
Dolanbay M. Kutuk MS, Uludag S, Bulut AN, Ozgun MT, Ozcelik B, et al. Concurrent endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of endometrial hyperplasia in curettage specimens. Ginekologia polska. 2015;86(10):753–758. DOI: doi.org/10.17772/gp/57813.
Gallos ID, Ganesan R, Gupta JK. Prediction of regression and relapse of endometrial hyperplasia with conservative therapy. Obstetrics and gynecology. 2013;121(6):1165–1171. DOI: https://doi.org/10.1097/AOG.0b013e31828cb563
Harlov S.D. Executive summary of the Stages of Reproductive Aging Workshop+10% addressing the unfinished agenda of staging reproductive aging /S. D. Yarlow, M. Gass, J. E. Hall et al. //Climacteric. – 2012. -№ 15. – p. 105-114.
Ismail MT, Fahmy DM, Elshmaa NS. Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia. Reproductive sciences (Thousand Oaks, California). 2013;20(1):45–50. DOI: https://doi.org/10.1177/1933719112459243.
Iversen ML, Dueholm M. Complex of non atypical hyperplasia and the subsequent risk of carcinoma, atypia and hysterectomy during the following 9-14 years. European journal of obstetrics, gynecology, and reproductive biology. (2018);222:171–175. DOI: https://doi.org/10.1016/j.ejogrb.2018.01.026.
Kurman RJ, Carcangiu ML, Herrington CS, Young RH, editors. WHO Classification of Tumours of Female Reproductive Organs. 4th ed. [Lyon]: IARC; 2014],
Lacey JVJ, Sherman ME, Rush BB, Ronnett BM, Ioffe OB, Duggan MA, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. Journal of clinical oncology: official journal of the Americ Society of Clinical Oncology. 2010:28(5);788–792. DOI: https://doi.org/10.1200/JCO.2009.24.1315.
Ozdegirmenci O, Kayikcioglu F, Bozkurt UA, Akgul MA, Haberal AV. Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecologic and obstetric investigation. 2011;72(1):10–14. DOI: https://doi.org/10.1159/000321390
Pal'tsev MA, Aylamazyan EK, Grigoryan IYU, Kvetnoy IM, Pechenikova VA, Polyakova VO. Molecularnye mehanismy zabolevaniy reproduktivnoy systemy. Sankt-Peterburg: Eco-Vector; 2017. 256 s. [in Russian]
Rak v Ukraine 2018-2019 /Z.P.Fedorenko, L.O. Gulak, Y.I. Mihaylovich //Bulleten Nacionalnogo kancer-reyestru Ukrainy № 21. – Kiiv, 2020 [in Ukraine]
Royal College of Obstetricians & Gynaecologists. RCOG/BSGE Green-top Guideline No. 67: Management of Endometrial Hyperplasia [Internet]. London: Royal College of Obstetricians & Gynaecologists; 2016. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg67/.
Rusakevich PS. Hyperplasticheskiye processi endometria v gynecologii: uchebnoye posobie. Minsk: Adukacyja i Vychavannie; 2012. 448 s. [in Russian].
Sanderson PA, Critchley HO, Williams AR, Arends MJ, Saunders PT. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Human reproduction update. 2017;23(2):232–254. DOI: https://doi.org/10.1093/humupd /dmw042.
Travaglino A, Raffone A, Saccone G, D'Alessandro P, Arduino B, Placido G, et al. Significant risk of occult cancer in complex non-atypical endometrial hyperplasia. Archiv of gynecology and obstetrics. 2019;300(5):147–1154. DOI: https://doi.org/10.1007/s00404-019-05299-
How to Cite
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 193
Number of citations: 0