Modern view on the treatment of endometrial hyperplasia in women of late reproductive age

Authors

DOI:

https://doi.org/10.18370/2309-4117.2024.74.8-12

Keywords:

endometrial hyperplasia, late reproductive age, treatment, dienogest

Abstract

Objective of the study: to evaluate the effectiveness of progestagen treatment of endometrial hyperplasia (EG) in women of late reproductive age.
Materials and methods. 48 patients aged 37–45 with EG were under observation. The EG diagnosis in patients was verified by histological examination. The treatment effectiveness was evaluated based on the results of clinical-instrumental and morphological examination after 6 months of treatment and every 3 months in the dynamics of observation. All patients with EG received dienogest (Vigest-KV) 2 mg once a day continuously for 6 months.
Results. 60.4% (29) of women had abnormal uterine bleeding at the time of examination. 39.5% (19) of patients had no pronounced clinical symptoms. Evaluating the effectiveness of the proposed therapy after 6 months of treatment showed that the endometrium thickness was 7.8 ± 0.36 mm on average, which is significantly lower than it was before treatment – 23.0 ± 2.8 mm (p ≤ 0.05). This indicator was practically at the same level after 9 months – 9.4 ± 0.48 mm (p ≥ 0.05). Pipelle biopsy showed that 42 patients (87.5%) experienced regression of the hyperplastic endometrium, and the ratio of stromal and glandular components in histological preparations also normalized. Persistence of the disease was noted in 12.5% (6) of women according to the morphological examination after treatment, EG without atypia was found. In 14.9% (5) of these 42 patients with a regression of the disease were a relapse of the disease according to a pipelle biopsy after 3 months, – EG without atypia was detected.
Conclusions. The effectiveness of the proposed therapy in patients with EG in late reproductive age after 6 months was 87.5%, the progression of the disease was not noted, and the relapse rate after 9 months of observation was 11.9%.
Thus, dienogest therapy in a continuous long-term regimen in women with EG in late reproductive age showed high clinical and morphological effectiveness due to the powerful antiproliferative effect of the drug.

Author Biography

O.V. Kravchenko, Bukovinian State Medical University, Chernivtsi

MD, professor, head of the Department of Obstetrics, Gynecology and Perinatology

References

  1. Vitale SG, Riemma G, Carugno J, et al. Hysteroscopy in the management of endometrial hyperplasia and cancer in reproductive aged women: new developments and current perspectives. Transl Cancer Res 9(12) (2020): 67–77. DOI: 10.21037/tcr-20-2092
  2. Wang Y, Nisenblat V, Tao L, et al. Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience. J Gynecol Oncol 30(3) (2019):49. DOI: 10.3802/jgo.2019.30.e49
  3. Sadoviak, I.D, Tatarchuk, T.F, Idoyatova, et al. Endometrial hyperplasia. Clinical guideline, based on evidence. Kyiv: Ministry of Health of Ukraine (2021):74.
  4. Tatarchuk TF, Dubossarskaya YO, Dubossarskaya ZM, et al. Endometrial hyperplasia: modern approaches to diagnosis and treatment (Literature review and personal experience). Reprod endocrinol. 2021:2 :18-27. DOI: 10.18370/2309-4117.2021.58.18-27
  5. Tatarchuk TF, Kvasha T., Zakharchenko NF, Therapeutic options for the management of endometrial hyperplasia. Current recommendations and promising areas of treatment (literature review). Reprod endocrinol. 2021;4:86–90. DOI: 10.18370/2309-4117.2021.60.86-90
  6. Shiwani H, Clement NS, Daniels JP, Atiomo W. Metformin for endometrial hyperplasia. Cochrane Database Syst Rev. 2024;5(5):CD012214. DOI: 10.1002/14651858.cd012214.pub3
  7. Benyuk V, Goncharenko V, Kravchenko Y, et al. Modern aspects of the etiology and pathogenesis of hyperplastic processes of the endometrium. Reproductive health of women. 2021;4:7–18. DOI: 10.30841/2708-8731.4.2021.238156
  8. Abdullaev VE, Grigorenko AM. The results of treatment of endometrial hyperplasia with the use of anti-inflammatory nonsteroidal drugs in the setting of chronic endometritis and without concomitant inflammatory process. Bukovinian Medical Journal. 2022;26(3):3–8. DOI: 10.24061/2413-0737.XXVI.3.103.2022.1
  9. Boychuk AV, Shadrina VS, Vereshchagina TV. Endometrial hyperplasia – a modern systemic and pathogenetic view of the problem (literature review). Topical issues of pediatrics, obstetrics and gynecology. 2019:1:67–72. DOI: 10.11603/24116-4944.2019.1.9906
  10. Chatzipantelis P, Koukourakis M, Balaska K, Giatromanolaki A. Endometrial Stromal Expression of ER, PR, and B-Catenin Toward Differentiating Hyperplasia Diagnoses. Int J Surg Pathol. (2022;30(5):49–8. DOI: 10.1177/10668969211065110
  11. Nosenko O M, Yurchenko SV. Restoration of endometrial receptivity and reproductive function in infertile women with excess body weightand complex non-atypical endometrial hyperplasia. Journal of Education, Health and Sport. 2022:12(1):523–8. DOI: 10.12775/JEHS.2022.12.01.044
  12. Ring KL, Mills AM, Modesitt SC. Endometrial Hyperplasia. Obstet Gynecol. (2022);140(6):1061–75. DOI: 10.1097/aog.0000000000004989
  13. De Franciscis P, Riemma G, Schiattarella A, et al. Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination. Diagnostics (Basel). 2019:9(4);142. DOI: 10.3390/diagnostics9040142
  14. Potapov V.O, Khaskhachykh DA, Finkova OP, et al. Epigenetic profile of endometrial proliferation in the different morphotypes of endometrial hyperplasia. Reprod. Endocrinol. 2021;57:68–78. DOI: 10.18370/2309-4117.2021.57.68-78
  15. Potapov VO, Khaskhachikh DA, Kukina GA, et al. Endometrial receptor status in hyperplastic processes in premenopausal women Neonatology, surgery and perinatal medicine. 2021;11;1(39): 33–8.
  16. Khaskhachykh DA, Potapov VO, Kukina GA. Differentiated approach to the treatment of endometrial hyperplasia without atypia in women of reproductive age. Actual issues of pediatrics, obstetrics and gynecology 2 (24) (2019):149–54.DOI 10.11603/24116-4944.2019.2.10935
  17. Gromova OL, Potapov VO, Khaskhachikh DA, et al. Analysis of the reasons for the ineffectiveness of hormone therapy for endometrial hyperplasia without atypia in premenopausal women. Bulletin of Vinnytsia National Medical University. 2020;24(4):625–31. DOI: 10.31393/reports-vnmedical-2020-24(4)-08
  18. Horban NY, Vovk IB, Lysiana T.O, et al. Peculiarities of uterine cavity biocenosis in patients with different types of endometrial hyperproliferative pathology. J. Med. Life. 2019;12(3):266–70. DOI: 10.25122/jml-2019-0074
  19. Polyakova EM, Lutsenko NS, Gaidai NV. Diagnosis of endometrial hyperplasia in routine gynecological practice. Zaporizhzhya Medical Journal. 2019;21(1): 95–9. DOI: 10.14739/2310-1210.2019.1.155836
  20. Semenyuk AO. Tactics of management of women of reproductive age with hyperplastic endometrial processes on the background of overweight.» Women’s reproductive health. 2020;3:28–31. DOI: 10.30841/2708-8731.3.2020.215009
  21. Auclair MH, Yong PJ, Salvador S, et al. Guideline No. 390-Classification and Management of Endometrial Hyperplasia. J Obstet Gynaecol Can. 2019;41(12):1789–800. DOI: 10.1016/j.jogc.2019.03.025
  22. Dore M, Filoche S, Danielson K, Henry C. Efficacy of the LNG-IUS for treatment of endometrial hyperplasia and early stage endometrial cancer: Can biomarkers predict response? Gynecol Oncol Rep 2021;36 :100732. DOI: 10.1016/j.gore.2021.100732
  23. Raffone A, Travaglino A, Saccone G, et al. 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. Acta Obstet Gynecol Scand. 2019;98(8):976–87. DOI: 10.1111/aogs.13586
  24. Ren H, Zhang Y, Duan H. Recent advances in the management of postmenopausal women with non-atypical endometrial hyperplasia. Climacteric. 2023.–26(5):411–418. DOI: 10.1080/13697137.2023.2226316
  25. Khaskhachikh DA, Potapov VO, Kukina GO. Treatment of endometrial hyperplasia without atypia with micronized progesterone. Expected and actual results Topical issues of pediatrics, obstetrics and gynecology. 2(2021):125–130. DOI: 10.11603/24116-4944.2021.2.12425
  26. Beniuk VO, Ginzburg VG, Govseev DO, et al. New approaches to the prevention of recurrence of endometrial hyperplasia in premenopausal women. Reprod. Endocrinol. 2 (2021):63–66. DOI: 10.18370/2309-4117.2021.58.63-72

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Published

2024-11-29

How to Cite

Kravchenko, O. (2024). Modern view on the treatment of endometrial hyperplasia in women of late reproductive age. REPRODUCTIVE ENDOCRINOLOGY, (74), 8–12. https://doi.org/10.18370/2309-4117.2024.74.8-12

Issue

No. 74 (2024)

Section

Gynecology

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Copyright (c) 2024 О.В. Кравченко

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