Comparative aspects of treatment of endometrial hyperplasia in women of reproductive age with overweight
The aim. Minimization of the frequency of recurrence of endometrial hyperplasia (EH) in women of reproductive age with overweight (OW) depending on the tactics of treatment.
Materials and methods. 90 women of reproductive age with endometrial hyperplasia and OW were selected. They, in turn, were divided into three groups: group 1 – 30 women who took a gonadotropin-releasing hormone agonist (GnRH agonist), namely at a dose of 3.75 mg intramuscularly once every 28 days; group 2 – 30 women who used progestin (norethisterone) at a dose of 10 mg per day from day 16 to 25 of the cycle, group 3 – 30 women who took combined oral contraception (COC) (30 mcg ethinyl estradiol and 150 mcg desogestrel) in a cyclic mode 21/7.
Evaluation of the effectiveness of therapy included a clinical picture of the disease 6 months after the start of treatment, assessment of the variability of the average values of endometrial thickness and uterine size on ultrasound (US) of the pelvis 6 months after treatment. Also analyzed the effectiveness of therapy based on the results of morphological examination of the endometrium in a biopsy of the uterine mucosa, performed 6 months after the start of treatment. In addition, a general analysis of the frequency of EH recurrence was performed 6–24 months after treatment.
Results. The results showed that in the group in which women were prescribed GnRH agonist, there was a significantly higher effectiveness of treatment, in particular the absence of uterine bleeding and menstrual disorders (MD). At the same time, in the other norethisterone group, 53.3 % (16) of women had intermenstrual uterine bleeding. In patients in the group in which women received COC, uterine bleeding was observed in 30.0 % (i.e. 9) of patients (p <0.05).
Immediately after treatment, the average values of endometrial thickness in patients of group 1, according to ultrasound, was 3.59±0.47 mm, which was significantly less than in women of groups 2 and 3 – 6.81±0.59 mm (p<0.001) and 7.58±0.69 mm (p<0.001).
In addition, patients in group 1 at 3, 6, 12, 24 months after the end of hormone therapy were registered significantly lower average values of endometrial thickness, compared with patients receiving norethisterone and estrogen-progestogen drugs.
Conclusions. In a comparative evaluation of the effectiveness of treatment of endometrial hyperplastic processes in overweight women, it was found that the recurrence rate after 6–24 months occurs in 6.7 % (i.e. 2) of patients after GnRH agonist therapy, in 33.3 % (i.e. in 10) patients receiving norethisterone (p<0.001), and in 50 % (i.e. 15) of women treated with COC (p<0.001).
Armstrong, A. J., Hurd, W. W., Elguero, S., Barker, N. M., Zanotti, K. M. (2012). Diagnosis and Management of Endometrial Hyperplasia. Journal of Minimally Invasive Gynecology, 19 (5), 562–571. doi: http://doi.org/10.1016/j.jmig.2012.05.009
Sanderson, P. A., Critchley, H. O., Williams, A. R., Arends, M. J., Saunders, P. T. (2017). New concepts for an old problem: the diagnosis of endometrial hyperplasia. Human reproduction update, 23 (2), 232–254. doi: http://doi.org/10.1093/humupd/dmw042
Moore, E., Shafi, M. (2013). Endometrial hyperplasia. Obstetrics, Gynaecology & Reproductive Medicine, 23 (3), 88–93. doi: http://doi.org/10.1016/j.ogrm.2013.01.002
Chernyshova, A. L., Kolomiets, L. A., Stucanov, S. L. (2012). Role of steroid hormones, estrogen receptors and metabolites in the development of endometrial hyperplasia and carcinoma. Bulletin of Siberian Medicine, 11 (6), 172–177. doi: http://doi.org/10.20538/1682-0363-2012-6-172-177
Wise, M. R., Jordan, V., Lagas, A., Showell, M., Wong, N., Lensen, S., Farquhar, C. M. (2016). Obesity and endometrial hyperplasia and cancer in premenopausal women: A systematic review. American Journal of Obstetrics and Gynecology, 214 (6), 689.e1–689.e17. doi: http://doi.org/10.1016/j.ajog.2016.01.175
Beavis, A. L., Cheema, S., Holschneider, C. H., Duffy, E. L., Amneus, M. W. (2015). Almost half of women with endometrial cancer or hyperplasia do not know that obesity affects their cancer risk. Gynecologic Oncology Reports, 13, 71–75. doi: http://doi.org/10.1016/j.gore.2015.07.002
Baziuta, L. Z., Polova, S. P. (2015). Morfolohichna diahnostyka patolohii edometriia u zhinok reproduktyvnoho viku. Klinichna anatomiia ta operatyvna khirurhiia, 14 (3), 68–70.
Kuzеmenska, M. L., Dovgal, L. V. (2013). Diagnosis and treatment of atypical endometrialhyperplasia in the reproductive period. Health of Woman, 9, 78–80.
Auclair, M.-H., Yong, P. J., Salvador, S., Thurston, J., Colgan, T. (Terry) J., Sebastianelli, A. (2019). Guideline No. 390-Classification and Management of Endometrial Hyperplasia. Journal of Obstetrics and Gynaecology Canada, 41 (12), 1789–1800. doi: http://doi.org/10.1016/j.jogc.2019.03.025
Chandra, V., Kim, J. J., Benbrook, D. M., Dwivedi, A., Rai, R. (2016). Therapeutic options for management of endometrial hyperplasia. Journal of Gynecologic Oncology, 27 (1). doi: http://doi.org/10.3802/jgo.2016.27.e8
Kubyshkin, A. V., Aliev, L. L., Fomochkina, I. I., Kovalenko, Y. P., Litvinova, S. V., Filonenko, T. G. et. al. (2016). Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia. Inflammation Research, 65 (10), 785–794. doi: http://doi.org/10.1007/s00011-016-0960-z
Suskic, A., Suskic, S., Opric, D., Maksimovic, S. (2016). Obesity as a significant risk factor for endometrial cancer. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5 (9), 2949–2951. doi: http://doi.org/10.18203/2320-1770.ijrcog20162970
Mitsuhashi, A., Uehara, T., Hanawa, S., Shozu, M. (2016). Prospective evaluation of abnormal glucose metabolism and insulin resistance in patients with atypical endometrial hyperplasia and endometrial cancer. Supportive Care in Cancer, 25 (5), 1495–1501. doi: http://doi.org/10.1007/s00520-016-3554-y
Raffone, A., Travaglino, A., Saccone, G., Di Maio, A., Mollo, A., Mascolo, M. et. al. (2019). Diabetes mellitus and responsiveness of endometrial hyperplasia and early endometrial cancer to conservative treatment. Gynecological Endocrinology, 35 (11), 932–937. doi: http://doi.org/10.1080/09513590.2019.1624716
Travaglino, A., Raffone, A., Saccone, G., D’Alessandro, P., Arduino, B., de Placido, G. et. al. (2019). Significant risk of occult cancer in complex non-atypical endometrial hyperplasia. Archives of Gynecology and Obstetrics, 300 (5), 1147–1154. doi: http://doi.org/10.1007/s00404-019-05299-2
Jeong, J. Y., Hwang, S. O., Lee, B., Kim, K., Kim, Y. B., Park, S. H., Choi, H. Y. (2020). Risk factors of progression to endometrial cancer in women with endometrial hyperplasia: A retrospective cohort study. PLOS ONE, 15 (12), e0243064. doi: http://doi.org/10.1371/journal.pone.0243064
Nazim, F., Hayat, Z., Hannan, A., Ikram, U., Nazim, K. (2013). Role of transvaginal ultrasound in identifying endometrial hyperplasia. Journal of Ayub Medical College Abbottabad, 25 (1-2), 100–102.
Ozkaya, E., Korkmaz, V., Ozkaya, Y., Tosun, A., Bostan, H. (2013). Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia. Journal of the Turkish German Gynecological Association, 14 (1), 19–22. doi: http://doi.org/10.5152/jtgga.2013.05
Goncharenko, V. M., Beniuk, V. A., Kalenska, O. V., Demchenko, O. M., Spivak, M. Y., Bubnov, R. V. (2013). Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age. EPMA Journal, 4 (1). doi: http://doi.org/10.1186/1878-5085-4-24
Cong, Q., Luo, L., Fu, Z., Lu, J., Jiang, W., Sui, L. (2021). Histopathology of women with non-uniform endometrial echogenicity and risk factors for atypical endometrial hyperplasia and carcinoma. American Journal of Translational Research, 13 (5), 4500–4509.
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