J Gynecol Oncol.  2019 May;30(3):e49. 10.3802/jgo.2019.30.e49.

Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience

• Wang Y
• Nisenblat
• Tao L
• Zhang X
• Li H
• Ma C

• KMID: 2440514
• DOI: http://doi.org/10.3802/jgo.2019.30.e49

Abstract

OBJECTIVE
To evaluate the effectiveness of oral contraceptive pill (OCP) as therapy for endometrial hyperplasia (EH) without atypia in reproductive-aged women compared with oral progestin.
METHODS
A retrospective cohort study was carried out in our reproductive center. Consecutive patients diagnosed with infertility and non-atypical EH identified through electronic database who met inclusion criteria (n=309). Patients were assigned to two treatment groups: OCP (n=216) and oral progestin (n=93); clinical and reproductive outcomes were recorded.
RESULTS
Reversal of EH to normal endometrium, clinical pregnancy, live birth and miscarriage rate. Women in OCP group were younger, had higher prevalence of Polycystic Ovary Syndrome and other uterine pathology and longer duration of infertility than women in progestin group. Reversal of EH was observed in 93.52% women on OCP and in 86.02% women on progestin (p=0.032; adjusted odds ratio [aOR]= 2.35; 95% confidence interval [CI]=1.06-5.21) after the initial course of treatment for 2 to 6 months. Cyclic OCP (n=184) resulted in better response to treatment compared to continuous OCP (n=32) (95.11% vs. 84.38%; p=0.039; aOR =3.60; 95% CI =1.12-11.55). Clinical pregnancy rate in OCP group was marginally higher than progestin group (87/208, 41.83% vs. 27/90, 30.00%; p=0.054). Miscarriage (25.29% vs. 29.63%; p=0.654) and live birth rate (31.25% vs. 21.11%; p=0.074) were comparable between the groups.
CONCLUSION
For the first time we demonstrate that OCP is an effective therapy for non-atypical EH and is associated with higher remission rate compared with oral progestin. Reproductive outcomes are reassuring and comparable between the two groups.

Keyword

Endometrial Hyperplasia; Contraceptives, Oral, Combined; Progestins; Drug Therapy; Infertility; Reproductive History

MeSH Terms

Abortion, Spontaneous
Cohort Studies
Contraceptives, Oral, Combined
Drug Therapy
Endometrial Hyperplasia*
Endometrium
Female
Humans
Infertility
Live Birth
Odds Ratio
Pathology
Polycystic Ovary Syndrome
Pregnancy
Pregnancy Rate
Prevalence
Progestins
Reproductive History
Retrospective Studies
Contraceptives, Oral, Combined
Progestins