In many developing countries, the public sector has the major responsibility to develop the health system infrastructure, where the private sector plays a minor role due to factors such as high costs, long-run return on investment, weak financial power, and the lack of supportive laws and regulations. On the other hand the extensive bureaucracy in public sector induces many problems in the health sector. These include (among other factors) focused decision-making, poor management, poor inter-level communication, and low motivation for high efficiency. 5In Iran, while both public and private sector contribute to provide health services, the public sector is responsible for the majority of health system development expenditures. 6 The lion share of health expenses in Iran is given to the hospitals. However, the situation of hospitals in terms of efficiency is not much satisfactory. (EH) is an abnormal overgrowth of endometrium that may lead to endometrial cancer, especially when accompanied by atypia. The treatment of EH is challenging, and previous studies report conflicting results. Metformin (dimethyl biguanide) is an anti-diabetic and insulin sensitizer agent, which is supposed to have antiproliferative and anticancer effects and the potential to decrease cell growth in endometrium. While some studies have evaluated the anticancer effect of metformin, studies on its potential effect on endometrial hyperplasia are rare. To address this gap, in this comparative trial study, we evaluate the effect of additive metformin to progesterone in patients with EH.
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