Atypical endometrial hyperplasia treatment with progestogens and gonadotropin-releasing hormone analogues: Long-term follow-up

Objective. The aim of this study was to assess the long-term effect of gona dotropin-releasing hormone analogues (GnRH-a) in combination with high-dose progestogens in the treatment of atypical endometrial hyperplasia in selec ted surgical high-risk patients and in women desiring reproductive potentia l. We hypothesized that this therapy is effective for most couples. Methods. In the Department of Gynecology of a university hospital, a conser vative treatment was offered to a series of 22 patients with atypical endom etrial hyperplasia who had a surgical or anesthetic risk history or wished to preserve their fertility potential. After informed consent, they were tr eated with 500 mg norethisterone acetate weekly for 3 months and 3.75 mg Tr iptorelin depot every month for 6 months. Three patients failed to complete the study, so the group finally consisted of 19 subjects. They were prospe ctively followed for 5 years by hysteroscopy and multiple selected biopsies every 6 months. Results. At a 5-year follow-up, regression was noted in 16 patients (84.2%) , persistence in 1 (5.1%), recurrence in 1 (5.1%), and progression in 1 (5. 1%). Conclusion. Consistent with our hypothesis, combined treatment with progest ogens and GnRH-a is an effective alternative in selected patients with atyp ical endometrial hyperplasia. (C) 1999 Academic Press.