Abstract
The paper considers the issues of improving the effectiveness of treatment of endometrial hyperplasia without atypia in women of reproductive age with the use of progestins as a pathogenetic therapy and should be personalized (targeted) taking into account the receptor sensitivity of endometrial tissue to progestins. The positive effects of progestin use are mainly due to the expression of progesterone receptors in the endometrial tissue, which must be taken into account during hormone therapy. A prospective study was performed in 60 patients of reproductive age with abnormal uterine bleeding, who according to the results of histological examination of endometrial tissue was diagnosed with endometrial hyperplasia without atypia. All patients were treated with micronized progesterone at a dose of 400 mg / day continuously for 6 months. To determine the effect of the use of progestins was performed by studying the expression of receptors for estrogen (ER) and progesterone (PR) in histological blocks of the endometrium by immunohistochemistry. In all women there was a significant expression of EP in endometrial cells, which led to its proliferative activity against the background of reduced expression of progesterone receptors by 65%, which caused no effect of therapy in 25% of women. Studies have shown that when deciding on the appointment of micronized progesterone for the treatment of endometrial hyperplasia without atypia, it is recommended to study the expression of progesterone receptors in endometrial tissue to clarify the possibility of a pharmacological effect. Treatment of endometrial hyperplasia without atypia with progesterone drugs is not effective in low expression of progesterone receptors in endometrial tissue. Based on this, we can identify a group of women with progesterone-resistant hyperplasia who require other treatments.
Highlights
We examined, treated and monitored over the three years 101 women of late reproductive age (36-45 years) with a confirmed histological diagnosis of GPE, who were registered at the dispensary in the medical institution where the research
To determine the reasons for the lack of regression of GPE in women from the use of progestogens, we analyzed the results of the study of nuclear progestogens to the corresponding nuclear receptor (PGR) expression in endometrial samples obtained at the screening stage before treatment in 28 women who received a positive result of progestogen treatment and 22 - with negative morphological result after treatment with micronized progesterone and dydrogesterone
We found that in the endometrium of women with GE resistant to progestogen therapy, the expression of PGR in glandular cells (50.8 ± 0.7) and stroma (47.3 ± 0.8) was significantly lower than in the corresponding structures in samples of GPE with a positive result of progestogen therapy (Fig. 2)
Summary
All patients received treatment with micronized progesterone at a dose of 400 mg / day continuously for 6 months, followed by histological examination of the endometrium by scraping the uterine cavity in the late secretory phase and repeated immunohistochemical examination of PR expression. The criterion for the effectiveness of GPE treatment was considered to be obtaining at least two negative results of endometrial biopsy in a row with an interval of 6 months, as well as the absence of recurrence of the disease during three years of follow-up.
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