Clinical and pathological responses of progestin therapy for non‐atypical endometrial hyperplasia: A prospective study

Rattanachaiyanont, Manee; Angsuwathana, Surasak; Techatrisak, Kitirat; Tanmahasamut, Prasong; Indhavivadhana, Suchada; Leerasiri, Pichai

doi:10.1111/j.1447-0756.2005.00253.x

Cited by 18 publications

(14 citation statements)

References 23 publications

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“…Therefore, progesterone-based oral contraceptives are used for inhibition of endometrial hyperproliferation and improvement of menstrual dysfunction 25. In fact, approximately 92.5% of PCOS women who do not develop atypical endometrial hyperplasia after treatment have a return to normal endometria 26. Furthermore, treatment with megestrol progesterone or medroxyprogesterone can also improve certain cases of endometrial atypical hyperplasia in some PCOS women 27.…”

Section: Discussionmentioning

confidence: 99%

Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Li¹,

Guo²,

Lin³

et al. 2014

J. Cancer

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Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin.Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined.Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment.Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

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Section: Discussionmentioning

confidence: 99%

Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Li¹,

Guo²,

Lin³

et al. 2014

J. Cancer

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“…Follow-up endometrial biopsy should be offered to the patients, because 7.5% have persistent or progressive lesions, necessitating aggressive treatment (14). In our study, the most commonly seen pelvic pathologies were not found to be associated with disease persistence.…”

Section: Discussionmentioning

confidence: 48%

Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

Özkaya

Korkmaz

Özkaya

et al. 2013

J Turkish German Gynecol Assoc

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Objective: We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia. Material and Methods:We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success.Results: Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03). Conclusion:Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia. (J Turkish-German Gynecol Assoc 2013; 14: 19-22) Key words: Endometrial hyperplasia, medroxyprogesterone acetate, endometrial thickness, ultrasonography, atypia Received: 13 October, 2012 Accepted: 8 February, 2013 Amaç: Bu çalışma ile atipisiz endometriyal hiperplazide tedaviye cevabı öngören faktörlerin belirlenmesi amaçlandı. Gereç ve Abstract ÖzetOriginal Investigation 19

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“…15,16 For this reason, we further studied some of the possible molecular pathways involved in the mechanism of action of genistein aglycone in promoting the reduction of endometrial hyperplasia in subjects without signs of atypia. Growth factors involved in the establishment of endometrial hyperplasia act through kinase-associated receptors, and stimulate tissue and vascular growth.…”

Section: Discussionmentioning

confidence: 99%

Genistein reduces angiogenesis and apoptosis in women with endometrial hyperplasia

Granese¹,

Bitto²,

Polito³

et al. 2015

BTAT

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Endometrial hyperplasia without cytological atypia is commonly treated with progestins, but other treatments may be available with equivalent efficacy and reduced side effects. Here, we evaluate the effect of genistein aglycone on angiogenesis and apoptosis-related markers women with endometrial hyperplasia. Premenopausals (n=38) with nonatypical endometrial hyperplasia were administered either genistein aglycone (54 mg/day, n=19) or norethisterone acetate (10 mg/day, n=19) on days 16-25 of the menstrual cycle and evaluated for 6 months. Biopsies were taken during hysteroscopy at baseline and 6 months, and symptoms including excessive uterine bleeding were assessed at baseline and 3 and 6 months following recruitment. The expression of angiogenesis (Vegf), epithelial (Egf and Tgfb), and apoptosis-related (Bax, Bcl-2, and Casp-9) molecules, were assessed in uterine biopsies at baseline and after 6 months of therapy. Follicle-stimulating hormone, luteinizing hormone, estradiol, SHBG, and progesterone levels were also measured. After 6 months, 42% of genistein aglycone-administered patients had a significant improvement of symptoms compared to 47% of norethisterone acetate subjects. No significant differences were noted in hormone levels for any treatment. Gene expression revealed a significant reduction in Vegf, Egf, and Tgfb (P,0.05 versus baseline), and an increase in proapoptotic molecules , with a concomitant decrease in Bcl-2 values (P,0.05) in both groups. These results suggest that genistein aglycone might be useful for the management of endometrial hyperplasia without atypia in women who cannot or do not wish to be treated with progestin.

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Clinical and pathological responses of progestin therapy for non‐atypical endometrial hyperplasia: A prospective study

Cited by 18 publications

References 23 publications

Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

Genistein reduces angiogenesis and apoptosis in women with endometrial hyperplasia

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