Medroxyprogesterone Acetate Plus Metformin to Prevent Persistent Endometrial Hyperplasia

OBJECTIVE: To determine the effect of metformin on treatment response in simple endometrial hyperplasia without atypia. STUDY DESIGN: In this study, we identified 134 women with simple endometrial hyperplasia without atypia. Seventy two of these women were administered cylic oral medroxyprogesterone acetate 10 mg/day for 3 months, 62 of these women were also receiving metformin 1000 mg/day due to preexisting insulin resistance and and all subjects underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, luteal phase endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders, cigarette smoking. All parameters and metformin were assessed for the effects on treatment success. RESULTS: Out of 72 women who were administered medroxyprogesterone acetate 10 mg/day for 3 months, 15 of them were diagnosed as endometrial hyperplasia in control endometrial sampling while only 5 women had persistent endometrial hyperplasia in group with receiving both medroxyprogesterone acetate 10 mg/day and metformin 1000 mg/day (P0.05). CONCLUSION: Medroxyprogesterone acetate and metformin may be used as an adjunctive therapy for persistent endometrial hyperplasias especially in women with high body mass index.

Kaynakça

1. Ozdegirmenci O, Kayikcioglu F, Bozkurt U, Akgul MA, Haberal A. Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecol Obstet Invest 2011;72:10-4.

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3. Campagnoli C, Abbà C, Ambroggio S, Brucato T, Pasanisi P. Life-style and metformin for the prevention of endometrial pathology in postmenopausal women. Gynecol Endocrinol 2012 Sep 5. [Epub ahead of print]

4. Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012;125:477-82.

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

6. Heller DS, Mosquera C, Goldsmith LT, Cracchiolo B. Body mass index of patients with endometrial hyperplasia: comparison to patients with proliferative endometrium and abnormal bleeding. J Reprod Med 2011; 56:110-2.

7. Hanna RK, Zhou C, Malloy KM, Sun L, Zhong Y, Gehrig PA, Bae-Jump VL Metformin potentiates the effects of paclitaxel in endometrial cancer cells through inhibition of cell proliferation and modulation of the mTOR pathway. Gynecol Oncol 2012;125:458-69.

8. Liu B, Fan Z, Edgerton SM, Yang X, Lind SE, Thor AD. Potent anti-proliferative effects of metformin on trastuzumab-resistant breast cancer cells via inhibition of erbB2/IGF-1 receptor interactions. Cell Cycle 2011; 10:2959-66.

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