Therapeutic options of endometrial hyperplasia management. Current recommendations and prospective directions of treatment

Abstract

Endometrial hyperplasia (EH) is a pathological condition characterized by proliferation of the endometrial glands with an increase in the glands/stroma ratio compared to normal proliferative endometrium. EH is a precursor to the development of one of the most common gynecological malignancies – endometrial cancer. There are EH without atypia and with atypia.Total hysterectomy with bilateral salpingo-oophorectomy is the method of choice in the treatment of atypical EH. It is important to eliminate risk factors – overweight patients should lose weight by adjusting diet, increase physical activity. Recently, aromatase inhibitors have also proven to be an effective treatment option for EH with atypia. Oral progestogens and the levonorgestrel-releasing intrauterine device are methods of choice for conservative treatment of premenopausal and postmenopausal women with atypical EH.However, not all patients can use progestins for a long time due to possible side effects. Failure of progestin treatment may depend on various factors, such as the patient’s age, health status, other conditions, and the degree or type of hyperplasia. So it is important to look for new methods of EH management and adjuvant drugs that will potentiate the effectiveness of basic treatment, as well as opportunities to reduce the risks of progesterone receptor resistance and potentiation of progestins. Cridanimod is a new small molecule that has been shown in studies to increase the progesterone receptors expression in the endometrium. It has been suggested that in combination with progestin therapy it increases the progesterone receptors expression and thus improves the effectiveness of treatment. Research results allows to consider the possibility of using cridanimod in complex EH therapy, especially against the background of viral infection. Cridanimod reduces the risk of resistance to progestogen therapy in EH, provides the best result after conservative treatment and reduces the number of relapses.

Impact of changes in the vaginal microbiome and chronic endometritis on the initiation of hyperplastic processes of the endometrium in women

“…While estrogen stimulation is considered a major etiological risk factor for endometrial hyperplasia, immunosuppression and infection may also be involved Epplein et al, 2008;Ricci et al, 2002;Sobczuk, & Sobczuk, 2017). It is believed that immune disorders, which can lead to endometrial hyperplasia, in more than 60% of cases are caused by viral and bacterial infectious agents (Allhorn et al, 2008;Bespoiasnaia, 1998;Tatarchuk et al, 2021).…”