Research Article
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Year 2022, Volume: 8 Issue: 4, 491 - 496, 04.07.2022
https://doi.org/10.18621/eurj.963475

Abstract

References

  • 1. Kurman RJ, Carcangiu M, Herrington C, Young R World Health Organisation Classification of Tumors of Female Reproductive Organs, 4th edn. Lyon France: International Agency for Research on Cancer (IARC) Press, 2014.
  • 2. Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, et al; Society of Gynecologic Oncology Clinical Practice Committee. Management of endometrial precancers. Obstet Gynecol 2012;120:1160-75.
  • 3. National Collaborating Centre for Women's and Children's Health (UK). Heavy Menstrual Bleeding. London: RCOG Press; 2007.
  • 4. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. No. 292-Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can 2018;40:e391-e415.
  • 5. Sanderson PA, Critchley HO, Williams AR, Arends MJ, Saunders PT. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Hum Reprod Update 2017;23:232-54.
  • 6. Mutter GL, Zaino RJ, Baak JPA, Bentley RC, Robboy SJ. Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia. Int J Gynecol Pathol 2007;26:103-14.
  • 7. Travaglino A, Raffone A, Saccone G, Mascolo M, Pignatiello S, Mollo A, et al. PTEN immunohistochemistry in endometrial hyperplasia: which are the optimal criteria for the diagnosis of precancer?. APMIS 2019;127:161-9.
  • 8. Gallos ID, Alazzam M, Clark TJ, Faraj R, Rosenthal AN, Smith PP, et al. Management of endometrial hyperplasia. Green-top guideline No 67. London: Royal College of Obstetricians and Gynaecologists; 2016. Available at:https://www.rcog.org.uk/globalassets/documents/guidelines/green-top guidelines/gtg_67_endometrial_hyperplasia.pdf. Accessed on April 15, 2019.
  • 9. Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A. Guideline No. 392-classification and management of endometrial hyperplasia. J Obstet Gynaecol Can 2019;41:1789-800.
  • 10. Sobczuk K, Sobczuk A. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Prz Menopauzalny 2017;16:107-11.
  • 11. Bese T, Vural A, Ozturk M, Dagistanli F, Demirkiran F, Tuncdemir M, et al. The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia. Int J Gynecol Cancer 2006;16:809-13.
  • 12. Wheeler DT, Bristow RE, Kurman RJ. Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins. Am J Surg Pathol 2007;31:988-98.
  • 13. Ozdegirmenci O, Kayikcioglu F, Bozkurt U, Akgul MA, Haberal A. Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecol Obstet Invest 2011;72:10-4.
  • 14. Ismail MT, Fahmy DM, Elshmaa NS. Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia. Reprod Sci 2013;20:45-50.
  • 15. Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009;200:678.e1-e6.
  • 16. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985;56:403-12.
  • 17. Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K, et al. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynaecol Res 1997;23:223-30.
  • 18. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol 2001;15:393-405.
  • 19. Gallos ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 2010;203:547.e1-10.
  • 20. Armstrong AJ, Hurd WW, Elguero S, Barker NM, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol 2012;19:562-71.
  • 21. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 1989;160:126-31.
  • 22. Hannemann MM, Alexander HM, Cope NJ, Acheson N, Phillips A. Endometrial hyperplasia: a clinician’s review. Obstet Gynaecol Reprod Med 2010;20:116-20.
  • 23. Emarh M. Cyclic versus continuous medroxyprogesterone acetate for treatment of endometrial hyperplasia without atypia: a 2-year observational study. Arch Gynecol Obstet 2015;292:1339-43.
  • 24. Figueroa-Casas PR, Ettinger B, Delgado E, Javkin A, Vieder C. Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy. Menopause 2001;8:420-3.
  • 25. Dolapcioglu K, Boz A, Baloglu A. The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study. Clin Exp Obstet Gynecol 2013;40:122-6.
  • 26. Orbo A, Vereide A, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG 2014;121:477-86.
  • 27. Vereide AB, Arnes M, Straume B, Maltau JM, Ørbo A. Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol 2003;91:526-33.
  • 28. Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med 1995;40:553-5.

Short-term treatment results of endometrial hyperplasia without atypia

Year 2022, Volume: 8 Issue: 4, 491 - 496, 04.07.2022
https://doi.org/10.18621/eurj.963475

Abstract

Objectives: Endometrial hyperplasia is a pathology that often represents with abnormal uterine bleeding and develops under the influence of unopposed estrogen. In this study, the response to cyclic medroxyprogesterone acetate (MPA) treatment in endometrial hyperplasia without atypia, which is known to have a good response to progestagen agents, was retrospectively evaluated.

Methods: Control endometrial biopsy results of 111 patients who were initiated cyclic MPA treatment due to endometrial biopsy results of endometrial hyperplasia without atypia were evaluated after 3 months of treatment. Endometrial hyperplasia free biopsy results after treatment were accepted as a successful treatment in those patient.

Results: Control biopsies revealed proliferative endometrium in 37 (33.3%) patients, secretory endometrium in 34 (30.6%) patients, inactive endometrium in 9 (8.1%) patients, endometritis in 4 (3.6%) patients, endometrial hyperplasia without atypia in 26 (23,4%) patients, and endometrial hyperplasia with atypia in 1 (0.9%) patient. Our response rate to treatment was 75.7% (84/111) and the persistence was found to be 23.4% (26/111). In patients with a positive response to treatment (n = 84), the mean age was 45.15 ± 5.19 years and in patients with no response to treatment (n = 27) the mean age was 45.56 ± 6.41 years, and there is no difference between the two groups in terms of average age.

Conclusions: Although the use of cyclic MPA in the treatment of endometrial hyperplasia without atypia is an effective treatment method, we believe that better results will be achieved in the use of more than 3 months duration.

References

  • 1. Kurman RJ, Carcangiu M, Herrington C, Young R World Health Organisation Classification of Tumors of Female Reproductive Organs, 4th edn. Lyon France: International Agency for Research on Cancer (IARC) Press, 2014.
  • 2. Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, et al; Society of Gynecologic Oncology Clinical Practice Committee. Management of endometrial precancers. Obstet Gynecol 2012;120:1160-75.
  • 3. National Collaborating Centre for Women's and Children's Health (UK). Heavy Menstrual Bleeding. London: RCOG Press; 2007.
  • 4. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. No. 292-Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can 2018;40:e391-e415.
  • 5. Sanderson PA, Critchley HO, Williams AR, Arends MJ, Saunders PT. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Hum Reprod Update 2017;23:232-54.
  • 6. Mutter GL, Zaino RJ, Baak JPA, Bentley RC, Robboy SJ. Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia. Int J Gynecol Pathol 2007;26:103-14.
  • 7. Travaglino A, Raffone A, Saccone G, Mascolo M, Pignatiello S, Mollo A, et al. PTEN immunohistochemistry in endometrial hyperplasia: which are the optimal criteria for the diagnosis of precancer?. APMIS 2019;127:161-9.
  • 8. Gallos ID, Alazzam M, Clark TJ, Faraj R, Rosenthal AN, Smith PP, et al. Management of endometrial hyperplasia. Green-top guideline No 67. London: Royal College of Obstetricians and Gynaecologists; 2016. Available at:https://www.rcog.org.uk/globalassets/documents/guidelines/green-top guidelines/gtg_67_endometrial_hyperplasia.pdf. Accessed on April 15, 2019.
  • 9. Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A. Guideline No. 392-classification and management of endometrial hyperplasia. J Obstet Gynaecol Can 2019;41:1789-800.
  • 10. Sobczuk K, Sobczuk A. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Prz Menopauzalny 2017;16:107-11.
  • 11. Bese T, Vural A, Ozturk M, Dagistanli F, Demirkiran F, Tuncdemir M, et al. The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia. Int J Gynecol Cancer 2006;16:809-13.
  • 12. Wheeler DT, Bristow RE, Kurman RJ. Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins. Am J Surg Pathol 2007;31:988-98.
  • 13. Ozdegirmenci O, Kayikcioglu F, Bozkurt U, Akgul MA, Haberal A. Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecol Obstet Invest 2011;72:10-4.
  • 14. Ismail MT, Fahmy DM, Elshmaa NS. Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia. Reprod Sci 2013;20:45-50.
  • 15. Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009;200:678.e1-e6.
  • 16. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985;56:403-12.
  • 17. Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K, et al. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynaecol Res 1997;23:223-30.
  • 18. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol 2001;15:393-405.
  • 19. Gallos ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 2010;203:547.e1-10.
  • 20. Armstrong AJ, Hurd WW, Elguero S, Barker NM, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol 2012;19:562-71.
  • 21. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 1989;160:126-31.
  • 22. Hannemann MM, Alexander HM, Cope NJ, Acheson N, Phillips A. Endometrial hyperplasia: a clinician’s review. Obstet Gynaecol Reprod Med 2010;20:116-20.
  • 23. Emarh M. Cyclic versus continuous medroxyprogesterone acetate for treatment of endometrial hyperplasia without atypia: a 2-year observational study. Arch Gynecol Obstet 2015;292:1339-43.
  • 24. Figueroa-Casas PR, Ettinger B, Delgado E, Javkin A, Vieder C. Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy. Menopause 2001;8:420-3.
  • 25. Dolapcioglu K, Boz A, Baloglu A. The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study. Clin Exp Obstet Gynecol 2013;40:122-6.
  • 26. Orbo A, Vereide A, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG 2014;121:477-86.
  • 27. Vereide AB, Arnes M, Straume B, Maltau JM, Ørbo A. Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol 2003;91:526-33.
  • 28. Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med 1995;40:553-5.
There are 28 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Original Articles
Authors

Zeliha Atak 0000-0002-4876-0573

Sakine Rahımlı Ocakoglu 0000-0001-8159-9489

Ayşe Erdoğan This is me 0000-0002-2169-8423

Gökhan Ocakoğlu 0000-0002-1114-6051

Publication Date July 4, 2022
Submission Date July 8, 2021
Acceptance Date January 10, 2022
Published in Issue Year 2022 Volume: 8 Issue: 4

Cite

AMA Atak Z, Rahımlı Ocakoglu S, Erdoğan A, Ocakoğlu G. Short-term treatment results of endometrial hyperplasia without atypia. Eur Res J. July 2022;8(4):491-496. doi:10.18621/eurj.963475

e-ISSN: 2149-3189 


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