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

Literature review

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.60.86-90

Keywords:

endometrial hyperplasia with atypia, endometrial cancer, progesterone receptors, conservative treatment, cridanimod, progestins

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.

Author Biographies

T.F. Tatarchuk, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, head of the Endocrine Gynecology Department;
Head of Department of Reproductive Health

T.I. Kvasha, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

PhD, senior researcher, Endocrine Gynecology Department

N.F. Zakharenko, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”; Institute for Planning Family Clinic, Kyiv

MD, senior researcher, Endocrine Gynecology Department;
Chairman of the Academic Council

N.V. Kosei, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”; SSI “Center for Innovative Medical Technologies of the NAS of Ukraine, Kyiv

MD, professor, chief researcher, Endocrine Gynecology Department;
Head of Department of Reproductive Health

V.S. Solskyy, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

PhD, senior researcher, Endocrine Gynecology Department

I.V. Shmulian, Clinic “Verum”, Kyiv

Obstetrician-gynecologist

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Published

2021-09-24

How to Cite

Tatarchuk, T., Kvasha, T., Zakharenko, N., Kosei, N., Solskyy, V., & Shmulian, I. (2021). Therapeutic options of endometrial hyperplasia management. Current recommendations and prospective directions of treatment: Literature review. REPRODUCTIVE ENDOCRINOLOGY, (60), 86–90. https://doi.org/10.18370/2309-4117.2021.60.86-90

Issue

Section

Tumors and pretumoral pathology

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