Treatment Of Endometrial Hyperplasia Research Articles

Efficacy of drugs treatment in patients with endometrial hyperplasia with or without atypia: A systematic review and network meta-analysis.

Endometrial hyperplasia (EH) is a hyperplastic endometrial lesion with irregular gland size, increased glands, and increased glandular interstitial ratio. During follow-up, some EH progressed further to endometrial cancer. It is crucial to provide timely treatment for EH and improve the overall prognosis of EH patients. We searched the PubMed, ClinicalTrials.gov., and Embase databases for studies published from their inception to March 31, 2023. The methodological quality of each study was evaluated in accordance with the Cochrane Collaboration's tool for assessing the risk of bias. The RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis statistical analysis; and the relative risk and 95% confidence interval along with the mean difference and 95% confidence interval, were used as evaluation indexes. We included 21 randomized controlled trials involving a total of 2276 women with EH, 6 studies were of high quality, and 15 were of moderate quality. The blinding of subjects and intervention providers was identified as the main source of potential bias. Six interventions were addressed in the network meta-analysis: medroxyprogesterone acetate (MPA), plus metformin, norethisterone (NET), levonorgestrel-releasing intrauterine system (LNG-IUD), megestrol acetate, and other drugs. In the direct meta-analysis, we found the probability of endometrial complete regression (CR) in the LNG-IUD group to be significantly higher than those in the NET. In the network meta-analysis, we found the probability of CR in the NET group to be significantly lower than those in the MPA and plus metformin groups, the probability of CR in the LNG-IUD group to be significantly higher than those in the NET, the probability of CR in the other drugs group to be significantly higher than those in the LNG-IUD. The NET group had the lowest incidences of endometrial complete regression, plus metformin could have a better outcome. According to the 21 randomized controlled trials included in this study, MPA is the most effective for EH endometrial outcome when applied as a single agent, while the combination of metformin can achieve a more significant effect.

The efficacy of levonorgestrel intrauterine device, medroxyprogesterone acetate, and norethisterone acetate in the treatment of endometrial hyperplasia without atypia

Objectives: Pregestational treatments, which trigger apoptosis and suppress endometrium, are the gold standard therapy for endometrial hyperplasia without atypia. The levonorgestrel-intrauterine device is the first choice in current guidelines due to its low dose. Still, oral progestins have no clear evidence due to their lower regression rates and side effects. Here, we aimed to compare the regression rates, hysterectomy requirement, and the occurrence of side effects in the sixth month between the levonorgestrel-intrauterine device, norethisterone acetate, and medroxyprogesterone acetate treatment. Methods: A total of 60 patients were included. The study group was divided into three groups: levonorgestrel-intrauterine device group (n=20), norethisterone acetate group (n=20), and medroxyprogesterone acetate group (n=20). Demographic findings, body mass index, gravida, parity, comorbid diseases, regression, hysterectomy requirement, patient desire to continue treatment, and side effects such as amenorrhea, headache, weight gain, intermenstrual spotting, nausea, and breast tenderness were compared between three groups. Results: There was no statistically significant difference between the three groups regarding headache, weight gain, intermenstrual spotting, and breast tenderness. Regression rates were significantly higher in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.044) and norethisterone acetate group (p=0.020). Similarly, hysterectomy rates were significantly lower in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.031) and norethisterone acetate group (p=0.028). Amenorrhea was significantly more common in the levonorgestrel intrauterine device group than in other groups (p=0.020 for both), whereas nausea was rarer in the levonorgestrel intrauterine device group (p=0.047 for both). According to the patient’s satisfaction, the levonorgestrel intrauterine device was the most satisfactory treatment compared to medroxyprogesterone acetate and norethisterone acetate (p=0.028 and p=0.031). No significant difference was found between the medroxyprogesterone acetate and norethisterone acetate groups in terms of regression rates, hysterectomy requirements, amenorrhea, nausea, and patient satisfaction. Conclusion: Considering low hysterectomy requirement, high regression rates, and patient satisfaction, the levonorgestrel intrauterine device should be the first choice for endometrial hyperplasia without atypia as compared to oral progestins. Thus, patients must be informed about side effects and offered levonorgestrel intrauterine devices before oral progestins for endometrial hyperplasia without atypia.

Effects of melatonin on disease improvement and serum levels of pro-inflammatory cytokines in patients with non-atypical endometrial hyperplasia

ABSTRACT Background Endometrial hyperplasia (EH), an abnormal proliferation of the endometrial cells, is considered as one of the most common causes of abnormal uterine bleeding. Previous studies have reported that melatonin plays a fundamental role in disease treatment. This study aimed the comparison of the effects of progesterone, as the most common therapeutic approach, and melatonin with progesterone alone in improvement of non-atypical endometrial hyperplasia (NEH) and changes in pro-inflammatory cytokine levels. Methods Study population consisted of 40 patients with NEH. Patients were divided into two groups, including 20 subjects treated with melatonin and progesterone and 20 individuals treated with progesterone alone. The blood and endometrial sampling was performed from participants before and after a three-month treatment. The histological examination was microscopically done. The serum levels of tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) were measured using ELISA. Results There was no significant difference in the diabetes status and mean age between patients treated with progesterone and melatonin and those treated with progesterone alone. The improvement rate in the EH was significantly higher in individuals treated with progesterone and melatonin than those treated with progesterone alone (p < 0.05). Additionally, the patients treated with progesterone and melatonin showed significant increases inIFN-γ and TNF-αlevels compared to the control group (p < 0.001-P < 0.05). Conclusion Melatonin supplementation has a beneficial effect in the treatment of EH due perhaps to enhance the level of IFN-γ and TNF-α.

The usefulness of p16 and COX-2 expression on the prediction of progression to endometrial cancer.

Endometrial cancer (EC) is the most commonly diagnosed gynecological cancer. Endometrial hyperplasia (EH) is a more common diagnosis than EC. Endometrial hyperplasia is found in approximately 1.5% of all women presenting with abnormal bleeding. Endometrial hyperplasia progresses to EC, and especially, cancer risk increases in cases with atypical hyperplasia. p16, one of the tumor suppressor proteins involved in the cell cycle, and COX-2, one of the key enzymes of prostaglandin synthesis, are important markers for the diagnosis of both EH and EC. There is lack of consensus in the classification, diagnosis and treatment of EH. The subject of changes in the cell cycle in the progression of endometrial pathologies may help to identify and prevent these affected pathways in the treatment stage. The aim of this study is to investigate the expression of p16 and COX-2 during the development of EC from EH. We investigated COX-2 and P16 expressions in patients with proliferative endometrium, complex/simple endometrial hyperplasia and endometrioid adenocarcinoma. p16 expression increased in EH and EC (p<0.001). COX-2 expression was increased in endometrial cancer compared to other groups, but this increase was not found to be statistically significant. Although p16 and COX-2 expression were increased in patients with advanced grade/stage, lymphovascular invasion, and >50% of myometrial invasion, this increase was not statistically significant. More detailed studies are needed to investigate the prognostic significance of the COX-2 molecule. COX-2 might be a potential biomarker for the prognosis of endometrial cancer and a potential therapeutic target for EC treatment. Also, it might be used to prevent the progression of precursor lesions to invasive EC.

Racial disparities in the treatment of endometrial hyperplasia and cancer (2211)

Racial disparities in the treatment of endometrial hyperplasia and cancer (2211)

Dienogest versus norethisterone acetate in management of endometrial hyperplasia without atypia

ObjectivesTo compare the effectiveness of dienogest (DIE) and norethisterone acetate (NETA) regimens in the treatment of endometrial hyperplasia (EH) without atypia.MethodsParticipants were premenopausal women with irregular uterine bleeding, and endometrial hyperplasia without atypia on endometrial biopsy. Enrolled patients were randomly allocated into two groups: group I got DIE 2 mg/day (orally Visanne) for 14 days (10th to the 25th day of cycle) while group II received between the 16th and 25th day of the cycle, norethisterone acetate (NETA) 15 mg/d (orally Primolut Nor) was administered for 10 days. Both groups continued the therapy for six months.ResultsThe DIE group showed a higher resolution (32.7%) and regression (57.7%) than NETA group (31% & 37.9%, respectively) with significant regression (p = 0.039). No progression in DIE group while four (6.9%) women in NETA group were recorded a progression to complex type without a significance. Also, NETA group showed a significant persistence rate (22.5%) than DIE group (3.8%) (p = 0.005). Also number in NETA group managed by hysterectomy with significant difference (p = 0.042).ConclusionIf used as first-line treatment, Dienogest produces a better rate of regression and a lower incidence of hysterectomy than Norethisterone Acetate does when used in EH without atypia.

Protective effect of eicosapentaenoic acid against estradiol valerate-induced endometrial hyperplasia via modulation of NF-κB/HIF-1α/VEGF signaling pathway in rats

BackgroundEarly diagnosis and treatment of endometrial hyperplasia (EH) remains mandatory for endometrial cancer (EC) prevention. ObjectiveTo study the possible protective effect of eicosapentaenoic acid (EPA) in EH - induced by estradiol valerate (EV) in rats. Methods/materialsAdult female Wistar rats were given EV with or without EPA for 10 days. The uterine changes were evaluated by both physical (weight index) and histopathological methods. The markers of oxidative stress (Uterine malondialdehyde (MDA) and serum total antioxidant capacity (TAC) as well as serum estradiol and progesterone levels, and apoptosis (uterine caspase-3) were determined. Immunohistochemical estimations of nuclear factor kappa B (NF-κB) and vascular endothelial growth factor (VEGF) in addition to hypoxia-inducible factor 1 alpha (HIF-1α) immunoblotting were measured in uterine tissue. Key findingsEV showed significant increase in uterine weight index that is accompanied with histopatholigical evidences of EH. Such changes were associated with significant alterations in oxidative stress markers, modulation of estradiol and progesterone serum levels, an increase in HIF-1α, NF-κB and VEGF immuno-expressions and a significant decrease in caspase-3. EPA, in either dose, showed significant amelioration in uterine weight index as well as in histopathological changes. Such effect was accompanied with significant improvement in the measured hormonal levels, oxidative stress, apoptosis, and inflammatory parameters. ConclusionsEPA in the used doses provided biochemical and histopathological improvement in EV-induced EH via modulation of NF-κB/HIF-1α/VEGF signaling pathway.

Гиперпластические процессы эндометрия у пациенток с хронической болезнью почек: выбор тактики ведения

This article provides a literature review demonstrating modern paradigms concerning etiology, pathogenesis and management of endometrial hyperplasia processes in female patients with chronic kidney disease (CKD). Endometrial hyperplasia (EH) is a pathological process with various phenotypic cell changes and a characteristic predominance of glands over the stromal and epithelial components in the endometrium. Untimely diagnosis and treatment of EH can cause the pathology progression and the development of endometrium malignant transformation. Endometrial cancer (EC) refers to one of the most common malignant tumor forms of the female reproductive system, and EH, as a rule, is its precursor. In the gynecological morbidity structure, EH is 10 to 55%, and its incidence is steadily increasing. EH occurs as a result of excessive estrogen stimulation, when it is not compensated by the progesterone action. In addition, patients with CKD develop "immunosuppressive states" due to the use of various types of renal replacement therapy (hemodialysis, peritoneal dialysis, taking immunosuppressive drugs in patients with kidney transplant). Every year there are more and more such female patients. Over the past decade, there has been no reference in the Russian literature concerning a systematic approach to the diagnosis and treatment of EH in female patients with CKD. Considering that these were female patients of the reproductive period to a greater extent, who wanted to perform the childbearing function in the future, therefore, this problem is very relevant for the world medical community. KEYWORDS: endometrial hyperplasia, abnormal uterine bleeding, chronic kidney disease, hemodialysis, kidney transplant, peritoneal dialysis, immunosuppression. FOR CITATION: Dobrokhotova Yu.E., Lysenko M.A., Grabovsky V.M., Shevchenko N.A., Zapolskaya N.P. Endometrial hyperplasia process in female patients with chronic kidney disease: the choice of treatment tactics. Russian Journal of Woman and Child Health. 2023;6(4):380–384 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-9.

Progestin versus Metformin and Progestin in Treatment of Endometrial Hyperplasia without Atypia in premenopausal women

Progestin versus Metformin and Progestin in Treatment of Endometrial Hyperplasia without Atypia in premenopausal women

Short-term treatment results of endometrial hyperplasia without atypia

Objectives: Endometrial hyperplasia is a pathology that often represents with abnormal uterine bleeding and develops under the influence of unopposed estrogen. In this study, the response to cyclic medroxyprogesterone acetate (MPA) treatment in endometrial hyperplasia without atypia, which is known to have a good response to progestagen agents, was retrospectively evaluated. Methods: Control endometrial biopsy results of 111 patients who were initiated cyclic MPA treatment due to endometrial biopsy results of endometrial hyperplasia without atypia were evaluated after 3 months of treatment. Endometrial hyperplasia free biopsy results after treatment were accepted as a successful treatment in those patient. Results: Control biopsies revealed proliferative endometrium in 37 (33.3%) patients, secretory endometrium in 34 (30.6%) patients, inactive endometrium in 9 (8.1%) patients, endometritis in 4 (3.6%) patients, endometrial hyperplasia without atypia in 26 (23,4%) patients, and endometrial hyperplasia with atypia in 1 (0.9%) patient. Our response rate to treatment was 75.7% (84/111) and the persistence was found to be 23.4% (26/111). In patients with a positive response to treatment (n = 84), the mean age was 45.15 ± 5.19 years and in patients with no response to treatment (n = 27) the mean age was 45.56 ± 6.41 years, and there is no difference between the two groups in terms of average age. Conclusions: Although the use of cyclic MPA in the treatment of endometrial hyperplasia without atypia is an effective treatment method, we believe that better results will be achieved in the use of more than 3 months duration.

MOLECULAR MECHANISMS OF THE ENDOMETRIAL HYPERPLASIA OF THE ENDOMETRIAL THERAPY ON THE BASIS OF THE STUDY OF RECEPTOR EXPRESSION, CELL MARKERS OF PROLIFERATION, DIFFERENTIATION AND APOPTOSIS OF THE ENDOMETRIAL CELLS IN THE HORMONE’S DEPENDENT SIGNAL PATH O

The article considers the issues of differential diagnosis and treatment of endometrial hyperplasia without atypia in women of reproductive age with the use of different types of progestins. Estrogen, progesterone, marker differentiation, apoptosis, and paracrine markers of cellular interactions have been studied to predict the efficacy and causes of resistance to progestin therapy.

Role of metformin in functional endometrial hyperplasia and polycystic ovary syndrome involves the regulation of MEG3/miR‑223/GLUT4 and SNHG20/miR‑4486/GLUT4 signaling.

Metformin (MET) can effectively treat endometrial hyperplasia (EH), and the expression of glucose transporter type 4 insulin-responsive (GLUT4) is closely associated with the development of EH. The present study aimed to verify the effect of MET in functional EH and polycystic ovary syndrome (PCOS). H&E staining was performed to analyze the severity of EH, and immunohistochemistry was performed to evaluate the expression of GLUT4 in the endometrium of PCOS rats. Reverse transcription-quantitative PCR was used to calculate the expression of long non-coding (lnc)RNA-maternally expressed gene 3 (MEG3), lncRNA-small nucleolar RNA host gene 20 (SNHG20), GLUT4 mRNA, microRNA (miR)-223 and miR-4486. Sequence analysis and luciferase assays were performed to explore the regulatory relationship among certain lncRNAs, miRNAs and target genes. EH in PCOS rats was efficiently inhibited by MET administration. The increased expression of GLUT4 in PCOS rats was attenuated by MET treatment. Moreover, the expression levels of lncRNA-MEG3 and lncRNA-SNHG20 were significantly inhibited in the endometrium of PCOS rats. MET treatment also showed remarkable efficiency in restoring the expression of lncRNA-MEG3 and lncRNA-SNHG20. Meanwhile, the expression levels of miR-223 and miR-4486 were notably elevated in the endometrium of PCOS rats, while MET treatment reduced the expression of miR-223 and miR-4486 in PCOS rats. Furthermore, a luciferase assay confirmed the inhibitory relationship between miR-223 and lncRNA-MEG3/GLUT4 expression, as well as between miR-4486 and lncRNA-SNHG20/GLUT4 expression. GLUT4 knockdown restored the decreased viability of HCC-94 cells induced by overexpression of lncRNA-MEG3. To conclude, MET exhibited a therapeutic effect in the treatment of EH by modulating the lncRNA-MEG3/miR-223/GLUT4 and lncRNA-SNHG20/miR-4486/GLUT4 signaling pathways. This work provides mechanistic insight into the development of EH.

A Traditional Chinese Medicine for the Treatment of Endometrial Hyperplasia via Regulating the HPO Axis in Rats.

Dysfunctional uterine bleeding, accompanied by endometrial hyperplasia (EH), is a common gynecological disease that seriously affects female physical and mental health. Some drugs have been prompted to cure the disease, but most medications have certain side effects and limitations. In the present study, we demonstrated an unexploited Chinese traditional medicine, a combination of Saururus chinensis, Celosia cristata, and Spatholobus suberectus (SCS), which could be used for the treatment of EH and associated complications in rats. We identified the active components from the three Chinese herbs via thin-layer chromatography and high-performance liquid chromatography methods. In addition, serum biochemical indexes and histologic section results found that acute high-dose SCS exerted no adverse impacts on the rats. We then showed that SCS shortened coagulation time (p=0.018) and degree of swelling (p=0.021) on rats at 30 min compared to blank control. Further studies proved that recovered endometrial thickness was associated with the modulation of four hormones (follicle-stimulating hormone, luteinizing hormone, estrogen, and progesterone). Specifically, follicle-stimulating hormone and progesterone contents increased gradually with time, and estrogen was decreased, whereas luteinizing hormone content was returned to normal after a short-term elevation (p < 0.05). Besides, SCS increased uterine endometrium's mRNA expression levels of matrix metalloproteinase-1 (p < 0.001) and tissue inhibitor of matrix metalloproteinase-1 (p < 0.001), promoting the repair of proliferating endometrium in the rats. Collectively, our study indicates that SCS harbors a profoundly curative effect on the treatment of EH and relative complications and uncovers the mechanism at molecular and gene expression levels.

Effect of Nonionizing Radiation on Progesterone Treatment in Endometrial Hyperplasia: An Experimental Rat Study

Objectives: The aim of the study was to evaluate the negative effect of nonionizing radiation on the treatment of endometrial hyperplasia (EH) with oral progesterone. Design: Forty oophorectomized Wistar Albino female rats were included in this experimental rat study. Materials and Methods: The 4 groups were planned as follows: Group A; sham group; Group B; group receiving oral estradiol hemihydrate 4 mg/kg/day; Group C; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day medroxy progesterone acetate (MPA) and Group D; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day MPA with exposure to nonionizing radiation at 1800 mHz/3 h/day. After the experimental model, uterine horns were sampled and the preparations were evaluated for pathological parameters (glandular density, epithelial cell length, and luminal epithelial cell length) via light microscopy. Nonionizing radiation was created by a signal generator and a compatible mobile phone. Results: Estrogen was found to increase all parameters related to EH (p < 0.05). Progesterone treatment was found to decrease parameters related to EH (Group B vs. C; luminal epithelial cell length, glandular density, and epithelial length; 11.2 vs. 13.2 μm p = 0.007; 32.5 vs. 35.5, p = 0.068; and 219.9 μm vs. 285 µm, p < 0.001, respectively). Final analyses revealed reduced effectiveness of progesterone treatment in the rats exposed to nonionizing radiation (Group C vs. D); luminal epithelial cell length, glandular density, and epithelial length (11.2 μm vs. 13.5 μm, p = 0.179; 32.5 vs. 52, p < 0.001; and 219.9 μm vs. 374.1 μm, p = 0.001, respectively). Limitations: The limitations of our study are that the results of animal experiments may not be appropriate for direct adaptation to humans and the relatively low number of rats included in the study. Conclusion: Nonionizing radiation reduces the effect of progesterone in patients receiving treatment for EH.

PROSPECTIVE STUDY OF THE EFFECTIVENESS OF DIFFERENTIATED THERAPY OF ENDOMETRIUM HYPERPLASIA WITHOUT ATYPIA IN WOMEN IN REPRODUCTIVE AGE

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.

Comparative aspects of treatment of endometrial hyperplasia in women of reproductive age with overweight

The aim. Minimization of the frequency of recurrence of endometrial hyperplasia (EH) in women of reproductive age with overweight (OW) depending on the tactics of treatment.&#x0D; Materials and methods. 90 women of reproductive age with endometrial hyperplasia and OW were selected. They, in turn, were divided into three groups: group 1 – 30 women who took a gonadotropin-releasing hormone agonist (GnRH agonist), namely at a dose of 3.75 mg intramuscularly once every 28 days; group 2 – 30 women who used progestin (norethisterone) at a dose of 10 mg per day from day 16 to 25 of the cycle, group 3 – 30 women who took combined oral contraception (COC) (30 mcg ethinyl estradiol and 150 mcg desogestrel) in a cyclic mode 21/7.&#x0D; Evaluation of the effectiveness of therapy included a clinical picture of the disease 6 months after the start of treatment, assessment of the variability of the average values of endometrial thickness and uterine size on ultrasound (US) of the pelvis 6 months after treatment. Also analyzed the effectiveness of therapy based on the results of morphological examination of the endometrium in a biopsy of the uterine mucosa, performed 6 months after the start of treatment. In addition, a general analysis of the frequency of EH recurrence was performed 6–24 months after treatment.&#x0D; Results. The results showed that in the group in which women were prescribed GnRH agonist, there was a significantly higher effectiveness of treatment, in particular the absence of uterine bleeding and menstrual disorders (MD). At the same time, in the other norethisterone group, 53.3 % (16) of women had intermenstrual uterine bleeding. In patients in the group in which women received COC, uterine bleeding was observed in 30.0 % (i.e. 9) of patients (p &lt;0.05).&#x0D; Immediately after treatment, the average values of endometrial thickness in patients of group 1, according to ultrasound, was 3.59±0.47 mm, which was significantly less than in women of groups 2 and 3 – 6.81±0.59 mm (p&lt;0.001) and 7.58±0.69 mm (p&lt;0.001).&#x0D; In addition, patients in group 1 at 3, 6, 12, 24 months after the end of hormone therapy were registered significantly lower average values of endometrial thickness, compared with patients receiving norethisterone and estrogen-progestogen drugs.&#x0D; Conclusions. In a comparative evaluation of the effectiveness of treatment of endometrial hyperplastic processes in overweight women, it was found that the recurrence rate after 6–24 months occurs in 6.7 % (i.e. 2) of patients after GnRH agonist therapy, in 33.3 % (i.e. in 10) patients receiving norethisterone (p&lt;0.001), and in 50 % (i.e. 15) of women treated with COC (p&lt;0.001).

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

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.

Современные представления об этиологии, патогенезе и принципах лечения гиперплазии эндометрия

Современные представления об этиологии, патогенезе и принципах лечения гиперплазии эндометрия

An integrated approach to the management of patients with endometrial hyperplasia and metabolic syndrome

Despite the achieved success in the treatment of endometrial hyperplasia processes, some issues related to the treatment of these diseases have not been completely resolved, especially in the presence of metabolic syndrome.&#x0D; Aim. To optimize the management of patients with endometrial hyperplasia and metabolic syndrome.&#x0D; Materials and methods. The study included 50 women with a verified diagnosis of recurrent endometrial hyperplasia. As a control value, a BMI of 25.0 kg/m2 was taken, two subgroups were identified with normal body weight and with overweight and obesity of the 1st degree. Treatment with GnRH was carried out in the following regimen: intramuscular injection of the drug at a dose of 3.75 mg once every 4 weeks with an assessment of the results after 3 and 6 months. In the course of the study, we assessed metabolic parameters, parameters of the hemostasis and fibrinolysis system before and during therapy. The baseline studied parameters were compared with the control group of healthy women without endometrial hyperplastic processes and overweight as well as patients of the control group with metabolic syndrome.&#x0D; Results. Hormonal treatment of recurrent endometrial hyperplasia without atypia using GnRH a positive effect on the dynamics of clinical manifestations, which is confirmed by the data of ultrasound and histological research methods and does not cause a sharp procoagulant shift, regardless of the patients body weight.&#x0D; Conclusion. Our results allow GnRH to be the drugs of choice in the treatment of endometrial hyperplasia in overweight patients, since they have a fairly safe and effective effect. It is necessary to remember about an integrated approach to patient management and to carry out the prevention of endothelial dysfunction in this group of patients due to the high risk of complications to potentiate a beneficial effect on hemostasiological and metabolic parameters.

THE DYSFUNCTIONAL UTERINE BLEEDING (DUB) DUE TO ENDOMETRIAL HYPERPLASIA WITH BULKY UTERUS IN AYURVEDIC VIEW – CASE STUDY

ABSTRACT :-&#x0D; Endometrial is inner lining of uterus. Hyperplasia is excessive growth of cells. Endometrial Hyperplasia is excessive cell growth or thickness of inner lining of uterus. Endometrial hyperplasia is excessive or abnormal thickening of the lining of the uterus, which is most probable cause of Dysfunctional Uterine Bleeding (DUB). In most of the cases, it is benign in nature. The treatment of endometrial hyperplasia of uterus is mainly done by hormonal treatment (especially by progesterone) and by surgical treatment such as hysterectomy, which are having their own side effects. Ayurveda is a health care system sensitive to women’s special health needs. Women are far more sensitive to the rhythms and cycles of nature, Ayurveda is founded on the principle of keeping the body toned in time with nature, and naturally, women find Ayurveda very suitable. In Ayurveda, Endometrial hyperplasia of uterus can be correlated with Lohitakshara Yonivyapada. The present case revealed the Raktastambhaka, Shothhara evum Tridoshahara properties of some Ayurvedicmedicines viz. Pushyanuga Churna, Ashokarishta and Dashamoola Kashaya in a known case of DUB due to endometrial hyperplasia with Bulky Uterus. After 3 months of treatment sonography report showed no hyperplasia of uterus.&#x0D; AIMS AND OBJECTIVES &#x0D; To evaluate the efficacy of Shamana Aushadhi in the management of Dysfunctional Uterine Bleeding (DUB) due to Endometrial Hyperplasia &#x0D; MATERIALS AND METHODS&#x0D; It is a case study of the subject of 35 yrs age with Dysfunctional Uterine &#x0D; Bleeding (DUB) due to Endometrial Hyperplasia who has been treated with Shamana Chikitsa.&#x0D; RESULTS AND DISCUSSION &#x0D; The subject is on follow up and without any medicine on normal cyclic rhythm till date with overall feeling of wellbeing. There is improvement and no evidence recurrence of Dysfunctional Uterine Bleeding and Endometrial Hyperplasia.&#x0D; CONCLUSION &#x0D; The selected treatment protocol i.e. Shamana Aushadha is very effective in the management of Endometrial Hyperplasia &#x0D; KEYWORDS –​&#x0D; Ayurveda, Lohitakshara Yonivyapada, Endometrial Hyperplasia, Raktastambhaka Drugs