Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy

Objective: Endometrial hyperplasia, an entity considered a precursor to end ometrial carcinoma, frequently develops in women receiving unopposed estrog ens. Progestins used concomitantly with estrogens can largely prevent endom etrial hyperplasia and carcinoma. However, the ability of progestins to rev erse endometrial hyperplasia induced by estrogens is less well recognized. The purpose of this study was to assess the medical reversal rate of endome trial hyperplasia that develops in women receiving unopposed estrogen repla cement therapy (ERT). Design: Review of recent literature (1990-2000). Results: Based on four large series, more than 90% of endometrial hyperplas ia caused by ERT can be reversed by medical treatment. Discontinuation of e strogen and oral administration of 10 mg/day of medroxyprogesterone acetate continuously for 6 weeks or cyclically for 3 months (2 weeks of each month ) are the two regimens most widely used. Other progestins also have been sh own to be effective. Conclusions: Progestins are highly successful in reversing endometrial hype rplasia caused by ERT.