Korean J Obstet Gynecol.  1999 Aug;42(8):1655-1660.

Treatment of endometrial hyperplasia with Medroxyprogesterone acetate(MPA)

Abstract


OBJECTIVE
To investigate the response of hyperplastic endometrium to Medroxyprogesterone acetate according to the histologic types such as simple typical, complex typical and atypical hyperplasia.
METHODS
A total of 79 patients with histologically proved endometrial hyperplasia were enrolled into this prospective study between March 1996 and May 1998. Patients without atypia were placed on a regimen of cyclic therapy with 10mg MPA orally, each day for 14days per month for 3 months. In the cases in which hyperplasia did not regress , MPA was increased to 20mg. Patients with atypical hyperplasia received continuous MPA therapy, 20mg orally each day for 3 month. All patients were followed up for a minimum of 3 months and a maximum of 1 year(mean 7 months).
RESULTS
In patients with simple typical hyperplasia, 45 patients(80.4%) had regression, 11 patients(19.6%) had persistence and none had progression. In patients with complex typical hyperplasia, 10 patients(83.3%) had regression, 2 patients(16.7%) had persistence and none had progression. But, in patients with atypical hyperplasia 5 patients(45.4%) had regression, 4 patients(36.4%) had persistence and 2(18.2%) patients had well differentiated endometrial adenocarcinoma. There was no recurrence during the follow up.
CONCLUSION
This data suggest that most women with typical hyperplasia respond to progestin therapy, but there is high failure rate of response to progestin therapy and risk of endometrial cancer in patients with atypical hyperplasia. If the young patient desires to preserve her fertility, then progestin therapy may be considered as primary treatment in patients with atypical hyperplasia. But older patients in whom fertility is not an issue, hysterectomy should be selected as treatment of choice for atypical lesion.

Keyword

Endometrial hyperplasia; medroxyprogesterone acetate(MPA); Progestin

MeSH Terms

Adenocarcinoma
Endometrial Hyperplasia*
Endometrial Neoplasms
Endometrium
Female
Fertility
Follow-Up Studies
Humans
Hyperplasia
Hysterectomy
Medroxyprogesterone Acetate
Medroxyprogesterone*
Prospective Studies
Recurrence
Medroxyprogesterone
Medroxyprogesterone Acetate
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