Objective: Most endometrial carcinomas are associated with hyperestrogenism
and endometrial hyperplasia. The aim of this study was to establish the ca
rcinogenic potential of endometrial hyperplasia with or without progestin t
herapy.
Methods: We reviewed endometrial curettage specimens from 538 patients with
complex or atypical endometrial hyperplasia over a 20-year period. Histolo
gic features were correlated with the clinical follow-up. 215 patients rece
ived progestins adjuvantly and 323 did not. There were no differences betwe
en the groups in age, obesity, estrogen pretreatment or menopausal status.
Results: Two thirds of the patients presented with postmenopausal bleeding
and 21 were premenopausal. Overall, 23.5% of patients had a history of estr
ogen replacement therapy and 86% were obese. Of the 215 patients treated wi
th progestins, 128 (59.5%) showed complete regression of hyperplasia, 77 (5
9.5%) had persisting hyperplasia, 5 (2.3%) had progression to higher grade
hyperplasia, and 5 (2.3%) had progression to carcinoma. Of 287 women not tr
eated with progestins, 153 (53.5%) had persisting hyperplasia, 36 (12.5%)ha
d progression to atypical hyperplasia, and 61 (21%) had progression to carc
inoma. Overall, 8 of the 390 patients with complex hyperplasia and 58 (52%)
of those with atypical hyperplasia developed carcinoma (P<0.01).
Conclusion: Complex endometrial hyperplasia can safely be treated with prog
estins. Atypical hyperplasia has a considerable risk of progression to carc
inoma and should be treated with hysterectomy.