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Complex Atypical Hyperplasia of the Endometrium: Differences in Outcome Following Conservative Management of Pre- and Postmenopausal Women

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Abstract

Objective

To compare the safety and regression rates of conservative treatments for complex atypical hyperplasia (CAH) between pre- and postmenopausal women.

Methods

Historical cohort study of pre- and postmenopausal women with CAH managed conservatively at one center (Royal Women’s Hospital, Melbourne, Australia) between September 1999 to June 2012.

Results

Of the 153 women with CAH, 92 (60%) underwent hysterectomy and the remaining 61 were managed conservatively with oral or intrauterine progestogen: 42 were premenopausal and 19 were postmenopausal. Within 12 months, 32 (76%) premenopausal women demonstrated regression of CAH and none developed endometrial cancer. In contrast, only 4 (21%) postmenopausal women showed disease regression and 4 (21%) progressed to endometrial cancer. Over a median of 24 months, 3 premenopausal women relapsed with CAH and 2 developed endometrial cancer. Four premenopausal women had successful pregnancies.

Conclusion

Conservative treatment with progestogen in premenopausal women with CAH leads to high regression rates within the first 12 months. In contrast, postmenopausal women have high rates of ongoing disease and cancer progression and conservative therapy should be avoided.

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References

  1. Ayman E, Alfhaily F. Use of levonorgestrel-releasing intrauterine system in the prevention and treatment of endometrial hyperplasia. Obstet Gynaecol Surv. 2012;67(11):726–733.

    Article  Google Scholar 

  2. Benshushan A. Endometrial adenocarcinoma in young patients: evaluation and fertility-preserving treatment. Eur J Obstet Gynecol Reprod Biol. 2004;117(2):132–137.

    Article  Google Scholar 

  3. Cade TJ, Quinn MA, Rome RM, Neesham D. Progestogen treatment options for early endometrial cancer. BJOG. 2010;117(7):879–884.

    Article  CAS  Google Scholar 

  4. Jadoul P, Donnez J. Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma. Fertil Steril. 2003;80(6):1315–1324.

    Article  Google Scholar 

  5. Kaku T, Yoshikawa H, Tsuda H. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett. 2001;167(1):39–48.

    Article  CAS  Google Scholar 

  6. Travassoli FA. World Health Organisation Classification of Tumors: Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2003.

    Google Scholar 

  7. Trimble CL, Kauderer J, Zaino R, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia; a gynaecologic oncology group study. Cancer. 2006;106(4):812–819.

    Article  Google Scholar 

  8. Pennant S, Manek S, Kehoe S. Endometrial atypical hyperplasia and subsequent diagnosis of endometrial cancer: a retrospective audit and literature review. J Obstet Gynaecol. 2008;28(6):632–623.

    Article  CAS  Google Scholar 

  9. Zaino RJ, Kauderer J, Trimble CL, et al. Reproducibility of the diagnosis of atypical endometrial hyperplasia: a gynecologic oncology group study. Cancer. 2006;106(4):804–811.

    Article  Google Scholar 

  10. Clark TJ, Neelakantan D, Gupta JK. The management of endometrial hyperplasia: an evaluation of current practice. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):259–264.

    Article  Google Scholar 

  11. Randell IC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997:90(3):434–440.

    Article  Google Scholar 

  12. Yamazawa K, Hirai M, Fujrto A, et al. Fertility-preserving treatment with progestin and pathological criteria to predict responses in young women with endometrial cancer. Hum Reprod. 2007;22(7):1953–158.

    Article  CAS  Google Scholar 

  13. Orbo A, Arnes M, Hancke C, Vereide AB, Pettersen I, Larsen K. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow up study comparing effect of LNG-IUD and oral progestins versus observation only. Gynecol Oncol. 2008;111(1):68–73.

    Article  Google Scholar 

  14. Ushijima K, Yahata H, Yoshikawa H, et al. Multicentre phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol. 2007;25(19):2798–2803.

    Article  CAS  Google Scholar 

  15. Gallos ID, Yap J, Rajkhowa M, Luesley D, Coomarasamy A, Gupta JK. Regression, relapse, and live birth rates with fertilitysparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. 2012;207(4):266.e1–e12.

    Article  Google Scholar 

  16. Gallos ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrelreleasing intrauterine system for endometrial hyperplasia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2010;203(6):547.e1–e10.

    Article  CAS  Google Scholar 

  17. Gallos ID, Ganesan R, Gupta JK. Prediction of regression and relapse of endometrial hyperplasia with conservative therapy. Am J Obstet Gynecol. 2013;121(6):1165–1171.

    Article  CAS  Google Scholar 

  18. Gallos ID, Krishan P, Shehmar M, Ganesan R, Gupta JK. Relapse of endometrial hyperplasia after conservative treatment: a cohort study with long term follow up. Hum Reprod. 2013;28(5):1231–1236.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Parkville, Melbourne, Victoria, 3052, Australia

    Fiona C. Brownfoot MBBS & Martha Hickey BA, MSc, MBChB, FRANZCOG, MD

  2. Department of Gynaecology, Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia

    W. Catarina Ang MBBS, DSHR, DUE, AFSA, Dip Epid FRANZCOG, MBS

  3. Department of Gynaecological Oncology, Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia

    Vivek Arora MBBS, MD, DNB, MRCOG, FRANZCOG & Orla McNally MB, BAO, BCh, FRCSI, MRCOG, FRANZCOG, CGO

Authors
  1. Fiona C. Brownfoot MBBS
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  2. Martha Hickey BA, MSc, MBChB, FRANZCOG, MD
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  3. W. Catarina Ang MBBS, DSHR, DUE, AFSA, Dip Epid FRANZCOG, MBS
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  4. Vivek Arora MBBS, MD, DNB, MRCOG, FRANZCOG
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  5. Orla McNally MB, BAO, BCh, FRCSI, MRCOG, FRANZCOG, CGO
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Corresponding author

Correspondence to Fiona C. Brownfoot MBBS.

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Brownfoot, F.C., Hickey, M., Ang, W.C. et al. Complex Atypical Hyperplasia of the Endometrium: Differences in Outcome Following Conservative Management of Pre- and Postmenopausal Women. Reprod. Sci. 21, 1244–1248 (2014). https://doi.org/10.1177/1933719114522517

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  • DOI: https://doi.org/10.1177/1933719114522517

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