J Gynecol Oncol.  2018 May;29(3):e35. 10.3802/jgo.2018.29.e35.

Insulin resistance and overweight prolonged fertility-sparing treatment duration in endometrial atypical hyperplasia patients

Affiliations
  • 1Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. xiaojunchen2013@sina.com, xuezhenluo2013@163.com
  • 2Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.

Abstract


OBJECTIVE
Our previous study showed that insulin resistance (IR) was related to endometrial hyperplasia as well as endometrial cancer. But the exact impact of IR on fertility-sparing treatment in endometrial hyperplasic disease is unclear. This study investigated how IR affects fertility-sparing treatment in endometrial atypical hyperplasia (EAH) patients.
METHODS
The 151 EAH patients received fertility-sparing treatment were retrospectively investigated. All patients received high-dose progestin combined with hysteroscopy. Therapeutic effects were evaluated by hysteroscopy every 3 months during the treatment.
RESULTS
The median age was 33.0 years old (range, 21-54 years old). Sixty-one patients (40.4%) were insulin resistant. Three patients were excluded from the analysis because they chose hysterectomy within 3 months after initiation of progestin treatment. The 141 out of 148 (95.3%) patients achieved complete response (CR). No difference was found in cumulative CR rate between those with or without IR (90.2% vs. 95.6%, p=0.320). IR significantly affected therapeutic duration to achieve CR (8.1±0.5 months with IR vs. 6.1±0.4 months without IR, p=0.004). Overweight (body mass index [BMI]≥25 kg/m2) was associated with higher risk of treatment failure (odds ratio=5.61; 95% confidence interval=1.11-28.35; p=0.040) and longer therapeutic duration to achieve CR (7.6±0.5 months vs. 6.3±0.4 months, p=0.019). EAH patients with both IR and overweight (IR+BMI+) had the longest therapeutic time compared with other patients (8.8±0.6 months vs. 5.6±0.7, 6.3±0.4, and 6.4±0.8 months for IR−BMI+, IR−BMI−, and IR+BMI−, respectively, p=0.006).
CONCLUSION
IR and overweight were associated with longer therapeutic duration in EAH patients receiving progestin-based fertility-sparing treatment.

Keyword

Endometrial Hyperplasia; Conservative Treatment; Overweight; Insulin Resistance

MeSH Terms

Endometrial Hyperplasia
Endometrial Neoplasms
Female
Humans
Hyperplasia*
Hysterectomy
Hysteroscopy
Insulin Resistance*
Insulin*
Overweight*
Retrospective Studies
Therapeutic Uses
Treatment Failure
Insulin
Therapeutic Uses
Full Text Links
  • JGO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr