Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses

Abstract

The aim of this study is to evaluate the response rate to natural progesterone in non-atypical endometrial hyperplasia and to identify the lowest effective dose. A total of 197 patients of childbearing age with simple or complex hyperplasia were retrospectively identified. The women were treated with a cyclic administration of progesterone at different dosages (100 versus 200 versus 300 mg daily). Endometrial biopsies were performed at 6, 12, 18 months. In comparing progesterone to a regimen of no therapy, a significantly higher remission rate was observed in the progesterone group than in the latter (95 versus 75%, p = 0.05 for simple hyperplasia; 89 versus 35%, p < 0.001 for complex hyperplasia). Out of 60 women with simple hyperplasia, remission was observed in 9/11 (81.8%), 40/41 (97.5%) and 8/8 (100%) patients treated, respectively, with progesterone 100, 200 and 300 mg daily. Out of 72 women with complex hyperplasia, remission was observed in 3/5 (60%), 49/53 (92.4%) and 12/14 (85.7%) patients treated with progesterone 100, 200 and 300 mg daily, respectively. There was no statistically significant difference in the response rate in the two groups, neither with simple nor with complex hyperplasia. In conclusion, progesterone increased the regression rate of both simple and complex hyperplasia.

Chinese abstract

这项研究的目的在于评估天然孕激素对无非典型性增生的子宫内膜增殖症的应答率，以确定最低有效剂量。本文回顾性分析了197例患有单纯性增生或复杂性增生的育龄期女性。对这些女性采用了不同剂量的孕激素周期治疗（每日100mg、200mg或300mg），治疗后6、12、18个月进行子宫内膜活检。孕激素组和没有药物治疗的食物疗法组比较，孕激素组的退变率明显高于后者（单纯性增生组95% vs 75%，p=0.05；复杂性增生组89% vs 35%，p<0.001）。60例单纯性增生的患者中，每日使用孕激素100mg、200mg、300mg的退变率分别为9/11 (81.8%), 40/41 (97.5%) 及8/8 (100%)。72名复杂性增生的患者中，每日使用孕激素100mg、200mg、300mg的患者退变率分别为3/5 (60%), 49/53 (92.4%) 及12/14 (85.7%)。无论是单纯性增生还是复杂性增生，两组间不同剂量的退变率均没有显著的差异。综上所述，孕激素能增加单纯性增生和复杂性增生的消退速度。

• Conservative therapy of endometrial hyperplasia
• endometrial hyperplasia in childbearing age
• natural progesterone
• non-atypical endometrial hyperplasia
• premalignant endometrial lesions

Acknowledgements

The authors are grateful to the whole team of nurses and physicians of the gynaecological department of San Gerardo Hospital, Monza.