Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

  • Mesci-Haftaci, Simender (Department of Obstetrics and Gynecology, Duzce Public Hospital) ;
  • Ankarali, Handan (Department of Biostatistics, School of Medicine, Duzce University Duzce) ;
  • Yavuzcan, Ali (Department of Obstetrics and Gynecology, School of Medicine, Duzce University Duzce) ;
  • Caglar, Mete (Department of Obstetrics and Gynecology, School of Medicine, Duzce University Duzce)
  • Published : 2014.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

Keywords

References

  1. Acmaz G, Aksoy H, Unal D, et al (2014). Are neutrophil/lymphocyte and platelet/lympocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev, 15, 1689-92. https://doi.org/10.7314/APJCP.2014.15.4.1689
  2. ACOG Practice Bulletin No. 128 (2012). Diagnosis of abnormal uterine bleeding in reproductive-aged women. Committee on Practice Bulletins-Gynecology. Obstet Gynecol, 120, 197-206. https://doi.org/10.1097/AOG.0b013e318262e320
  3. Baker J, Obermair A, Gebski V, Janda M (2012). Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature. Gynecol Oncol, 125, 263-70. https://doi.org/10.1016/j.ygyno.2011.11.043
  4. Balik G, Kagitci M, Ustuner I, Akpınar F, Guvendag Guven ES (2013). Which endometrial pathologies need intraoperative frozen sections? Asian Pac J Cancer Prev, 14, 6121-5. https://doi.org/10.7314/APJCP.2013.14.10.6121
  5. Epplein M, Reed SD, Voigt LF, et al (2008). Risk of complex and atypical endometrial hyperplasia in relation to anthropometyric measures and reproductive history. Am J Epidemiol, 168, 563-70. https://doi.org/10.1093/aje/kwn168
  6. Espindola D, Kennedy KA, Fischer EG (2007). Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin North Am, 34, 717-37. https://doi.org/10.1016/j.ogc.2007.09.001
  7. Ferenczy A, Gelfand M (1989). The biologic and significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol, 160, 126-31. https://doi.org/10.1016/0002-9378(89)90103-8
  8. Gallos ID, Shehmar M, Thanqaratinam S, et al (2010). Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol, 203, 547, 1-10.
  9. Gallos ID, Devey J, Ganesan R, Gupta JK (2013). Predictive ability of estrogen receptor(ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for regression and relapse of endometrial hyperplasia treated with LNGIUS:a prospective cohort study. Gynecol Oncol, 130, 58-63. https://doi.org/10.1016/j.ygyno.2013.04.016
  10. Gallos ID, Krishan P, Shehmar M, Ganesan R, Gupta JK (2013). Relapse of endometrial hyperplasia after conservative treatment: a cohort study with long term follow up. Hum Reprod, 28, 1231-6. https://doi.org/10.1093/humrep/det049
  11. Gallos ID, Yap J, Rajkhowa M, et al (2012). Regression, relapse, and live birth rates with fertility sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and meta-analysis. Am J Obstet Gynecol, 207, 266, 1-12.
  12. Horn LC, Schnurrbusch U, Bilek K, Hentschel B, Einenkel J (2004). Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer, 14, 348-53. https://doi.org/10.1111/j.1048-891x.2004.014220.x
  13. Ismail MT, Fahmy DM, Elshmaa NS (2013). Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia. Reprod Sci, 20, 45-50. https://doi.org/10.1177/1933719112459243
  14. Marret H, Fauconnier A, Chabbert-Buffet N, Cravello L, et al (2010). Clinical practice guidelines on menorrhagia:management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol, 152, 133-7. https://doi.org/10.1016/j.ejogrb.2010.07.016
  15. Montgomery BE, Daum GS, Dunton CJ (2004). Endometrial hyperplasia: a review. Obstet Gynecol Surv, 59, 368-78. https://doi.org/10.1097/00006254-200405000-00025
  16. Munro MG, Critchley HO, Broder MS, Fraser IS (2011). FIGO classification system(PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. FIGO Working Group on Menstruel Disorders. Int J Gynaecol Obstet, 113, 3-13. https://doi.org/10.1016/j.ijgo.2010.11.011
  17. Orbo A, Arnes M, Hancke C, et al (2008). Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNGIUD and oral progestins versus observation only. Gynecol Oncol, 111, 68-73. https://doi.org/10.1016/j.ygyno.2008.06.014
  18. Ozdegirmenci O, Kayikcioglu F, Bozkurt U, Akgul MA, Haberal A (2011). Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecol Obstet Invest, 72, 10-4. https://doi.org/10.1159/000321390
  19. Randall TC, Kurman RJ (1997). Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol, 90, 434-40. https://doi.org/10.1016/S0029-7844(97)00297-4
  20. Reed SD, Voight LF, Newton KM, et al (2009). Progestin therapy of complex endometrial hyperplasia with and without atypia. Obstet Gynecol, 113, 655-62. https://doi.org/10.1097/AOG.0b013e318198a10a
  21. Robbe EJ, van Kuijk SM, de Boed EM, et al (2012). Predicting the coexistence of an endometrial adenocarcinoma in the presence of atypical complex hyperplasia: immunohistochemical analysis of endometrial samples. Int J Gynecol Cancer, 22, 264-72.
  22. Sarwar A, ul Haque A (2005). Types and frequencies of pathologies in endometrial curettings of abnormal uterine bleeding. Int pathol, 3, 65-70.
  23. Simpson AN, Feigenberg T, Clarke BA, et al (2014). Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol. 133, 229-33. https://doi.org/10.1016/j.ygyno.2014.02.020
  24. Soleymani E, Ziari K, Rahmani O, et al (2013). Histopathological findings of endometrial specimens in abnormal uterine bleeding. Arch Gynecol Obstet, 8, 10.
  25. Tabata T, Yamawaki T, Yabana T, et al (2001). Natural history of endometrial hyperplasia. Study of 77 patients. Arch Gynecol Obstet, 265, 85-8. https://doi.org/10.1007/s004040000151
  26. Tasci Y, Polat OG, Ozdogan S, et al (2014). Comparison of the efficacy of micronized progesterone and lynestrenol in treatment of simple endometrial hyperplasia without atypia. Arch Gynecol Obstet, 2, 1. https://doi.org/10.11648/j.jgo.20140201.11
  27. Turan T, Karadag B, Karabuk E, et al (2012). Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia. Asian Pac J Cancer Prev, 13, 1953-6. https://doi.org/10.7314/APJCP.2012.13.5.1953
  28. Wang S, Pudney J, Song J, et al (2003). Mechanism involved in the evolution of progestin resistance in human endometrial hyperplasia- precursor of endometrial cancer. Gynecol Oncol, 88, 108-17. https://doi.org/10.1016/S0090-8258(02)00008-2
  29. Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A (2003). Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol, 91, 526-33. https://doi.org/10.1016/j.ygyno.2003.07.002

Cited by

  1. Utility of Frozen Section Pathology with Endometrial Pre-Malignant Lesions vol.15, pp.15, 2014, https://doi.org/10.7314/APJCP.2014.15.15.6053