TREATMENT OF ENDOMETRIAL HYPERPLASIAS WITH GONADOTROPIN-RELEASING-HORMONE AGONISTS - PATHOLOGICAL, CLINICAL, MORPHOMETRIC, AND DNA-CYTOMETRIC DATA

On the basis of the recently reported observation that gonadotropin-re leasing hormone agonists (GnRH-a) can affect endometrial cell prolifer ation, both indirectly, through the hormonal axis, and directly, by ac ting on the GnRH-a receptors, we investigated how far GnRH-a can be us ed as a new treatment mode for endometrial hyperplasias. Forty-two wom en, aged 28-60 years, with histologically confirmed simple (n = 30) or complex (n = 12, 2 with atypias) hyperplasia of the endometrium were involved in the study. According to the protocol they were treated for 6 months with GnRH-a (leuprolide acetate or triptorelin), and each pa tient underwent uterine curettage in the third and the sixth month of treatment, and 6 and at least 12 months after cessation of the treatme nt, for histological examination and morphometric and DNA-cytometric e valuation of the endometrium (mean pathological follow-up, 19.2 months ; mean clinical follow-up, 30.7 months). During treatment, most of the women first revealed endometrial atrophy, and, after cessation of the treatment, again an atrophic or mainly functional endometrium; in 7 w omen, all with initial diagnosis of simple hyperplasia, the endometria l hyperplasia reappeared, which led in all 7 cases to hysterectomy. Th e mean values of almost all morphometric and DNA-cytometric parameters during and after treatment showed statistically significant changes i n relation to pretreatment values, indicating a decrease in the prolif erative activity of the endometrial cells; the GnRH-a antiproliferativ e effect was still active for a long time after cessation of the thera py. Our results, based for the first time not only on histological but also on serial nuclear morphometric and DNA-cytometric examinations o f the endometrial cells and on the longest follow-up time, support the view that in cases of endometrial hyperplasia, especially of complex type, the use of GnRH agonists, which decrease the proliferative tende ncy of endometrial cells, could represent an alternative conservative therapeutic approach, which, however, requires close monitoring of the endometrium. (C) 1997 Academic Press.