Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Abstract

Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

Downregulation of FOXO1 mRNA levels predicts treatment failure in patients with endometrial pathology conservatively managed with progestin-containing intrauterine devices

“…Most patients are routinely biopsied every 3–6 months within the first 2 years of diagnosis. Others have reported regression rates of 72.7–100%, with optimum results observed after 6 months of hormonal therapy [36]. A lack of response at the first post-IUD insertion biopsy is generally considered treatment failure [33].…”

Utility of Frozen Section Pathology with Endometrial Pre-Malignant Lesions

“…The prevalence of concurrent carcinoma among women diagnosed with non-atypical EH-i.e., SEH or CEH has not been well documented because most women with SEH and CEH typically receive hormonal treatment rather than hysterectomy (Randall and Kurman, 1997;Marsden and Hacker, 2001;Montz et al, 2002;Mesci-Haftaci et al, 2014).…”

Endometrial polyps

“…In a somewhat abstract way, it was considered that the conventional therapy for EP is blind dilatation and curettage, this method has been reported to eliminate only 8% of EP, whilst adding polyp forceps rises full removal to 41% [ 8 , 22 , 40 ].…”