J Gynecol Oncol.  2016 Jan;27(1):e8. 10.3802/jgo.2016.27.e8.

Therapeutic options for management of endometrial hyperplasia

• Chandra V
• Kim JJ
• Benbrook D
• Dwivedi A
• Rai R

• KMID: 2360238
• DOI: http://doi.org/10.3802/jgo.2016.27.e8

Abstract

Endometrial hyperplasia (EH) comprises a spectrum of changes in the endometrium ranging from a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle to irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma. Generally, EH is caused by continuous exposure of estrogen unopposed by progesterone, polycystic ovary syndrome, tamoxifen, or hormone replacement therapy. Since it can progress, or often occur coincidentally with endometrial carcinoma, EH is of clinical importance, and the reversion of hyperplasia to normal endometrium represents the key conservative treatment for prevention of the development of adenocarcinoma. Presently, cyclic progestin or hysterectomy constitutes the major treatment option for EH without or with atypia, respectively. However, clinical trials of hormonal therapies and definitive standard treatments remain to be established for the management of EH. Moreover, therapeutic options for EH patients who wish to preserve fertility are challenging and require nonsurgical management. Therefore, future studies should focus on evaluation of new treatment strategies and novel compounds that could simultaneously target pathways involved in the pathogenesis of estradiol-induced EH. Novel therapeutic agents precisely targeting the inhibition of estrogen receptor, growth factor receptors, and signal transduction pathways are likely to constitute an optimal approach for treatment of EH.

Keyword

Endometrial Hyperplasia; Progestins; Receptors, Estrogen; Therapy

MeSH Terms

Antineoplastic Agents, Hormonal/adverse effects
Disease Management
Disease Progression
Endometrial Hyperplasia/classification/etiology/*therapy
Female
Gonadotropin-Releasing Hormone/therapeutic use
Humans
Hysterectomy
Molecular Targeted Therapy/methods
Progesterone Congeners/therapeutic use
Risk Factors
Tamoxifen/adverse effects
Antineoplastic Agents, Hormonal
Gonadotropin-Releasing Hormone
Progesterone Congeners
Tamoxifen