Evaluation of The Effect of Metformin and Progesterone on The Endometrium in Cases of Peri Menopausal Bleeding

Abstract

Background: Numerous epidemiologic and experimental studies have suggested that unopposed estrogen may be a major factor in the development of benign, premalignant, and malignant endometrial lesions. Objective: To assess the unique effects of progesterone and metformin on simple endometrial hyperplasia and disorganized proliferative endometrium, and to ascertain if metformin is clinically helpful in this situation. Patients and Methods: The study was conducted between April 2023 and September 2023 at the obstetrics and gynecology department of Damanhur Medical National Institute. The study was a double blinded randomized study. 100 patients were involved in this study who were divided into 2 groups: The 1st one (50 cases) was treated with metformin (Glucophage) 500 mg in the first week then raise the dose to reach 1000 mg in the 4th week, for three months long. The 2nd group (50 cases) was administered medroxy progesterone acetate (Provera) 4mg once per day for 3 months long. Next 3 months all cases in both groups were gone for 2nd time endometrial biopsy for assessment of response of treatment and will have ultrasound examination every three months also. Result: Uterine hemorrhage after treatment and endometrial thickness after treatment did not statistically differ between the two study groups. Additionally, there was no statistically significant difference in patient satisfaction or hysterectomy between the two study groups. There was no discernible difference in the two groups' treatment lengths. While there was a high statistical rise in the incidence of nausea, vomiting, and diarrhea in group 2 compared to group 1, there was a strong statistical increase in the incidence of sore breasts, weakness, and metallic taste in group 1 compared to group 2. Conclusion: Progesterone and metformin may both be useful in treating benign endometrial proliferative lesions. To prevent its problems, endometrial proliferative lesions should be identified and treated properly.