Therapeutic options for management of endometrial hyperplasia

Abstract

Endometrial hyperplasia (EH) comprises a spectrum of changes in the endometrium ranging from a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle to irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma. Generally, EH is caused by continuous exposure of estrogen unopposed by progesterone, polycystic ovary syndrome, tamoxifen, or hormone replacement therapy. Since it can progress, or often occur coincidentally with endometrial carcinoma, EH is of clinical importance, and the reversion of hyperplasia to normal endometrium represents the key conservative treatment for prevention of the development of adenocarcinoma. Presently, cyclic progestin or hysterectomy constitutes the major treatment option for EH without or with atypia, respectively. However, clinical trials of hormonal therapies and definitive standard treatments remain to be established for the management of EH. Moreover, therapeutic options for EH patients who wish to preserve fertility are challenging and require nonsurgical management. Therefore, future studies should focus on evaluation of new treatment strategies and novel compounds that could simultaneously target pathways involved in the pathogenesis of estradiol-induced EH. Novel therapeutic agents precisely targeting the inhibition of estrogen receptor, growth factor receptors, and signal transduction pathways are likely to constitute an optimal approach for treatment of EH.

The Efficacy of Dienogest in the Treatment of Simple Endometrial Hyperplasia without Atypia

“…Therefore, it becomes important that we treat patients with proper care and caution. The main treatment options are the use of progestins and surgery [3]. According to literature, there are many options for oral progestin regimens such as micronized progesterone (MP), norethisterone acetate, megestrol acetate, and medroxyprogesterone 17-acetate (MPA) [4][5][6][7].…”

Norethindrone substituted for megestrol in the treatment of metastatic endometrial carcinoma: Three cases.

“…Norethindrone is a synthetic progestin with some androgenic and estrogen/antiestrogen activity but no affinity for the glucocorticoid receptor (Koubovec et al, 2005). Norethindrone has been used for decades as an oral contraceptive, to treat endometrial hyperplasia, and as add-back hormonal replacement for women on ovarian suppression with GHRH agonists (Chandra et al, 2016;Chwalisz et al, 2012;Schindler et al, 2008). We were not able to find reports of its use to treat advanced endometrial adenocarcinoma.…”

Should progesterone and estrogen receptors be assessed for predicting the response to conservative treatment of endometrial hyperplasia and cancer? A systematic review and meta‐analysis

“…ER and PR are nuclear receptors which play a crucial role in endometrial carcinogenesis. ER mediates the action of estrogens, promoting the proliferation of endometrium, with a physiological action in the proliferative phase of the menstrual cycle . When the action of estrogens is not balanced by the action of progesterone, the endometrium goes through a phase of disordered proliferation (disordered proliferative endometrium), which leads to EH .…”