The Outcome of Medical Treatment of Endometrial Hyperplasia

Endometrial hyperplasia (EH) poses significant challenges in clinical management, particularly concerning the choice of medical modalities and their efficacy in achieving symptom resolution and regression of hyperplastic changes. To address this, we conducted a retrospective study at Hospital Canselor Tuanku Muhriz (HCTM) to investigate the outcomes of various medical treatments for EH with/without atypia over a 10-year period from 2007 to 2017. Patient’s clinical background and endometrial tissue biopsy results were obtained from medical records and histopathological laboratory respectively. We analysed the type and duration of medical treatments, as well as symptoms regression and outcome of the treatments. A total of 86 women received treatment for EH with average age of 48.2 + 12.3 (median 46) years. Of these, 65 (75.6%) had EH without atypia, and 21 (24.4%) had atypical EH. All women had their symptoms resolved in less than 6 months of treatment, with varying duration depending on different regimes used. Levonogestrel-intrauterine system (LNG-IUS) had symptoms resolved by 3 to 6 months (p<0.01) while intramuscular Medroxyprogesterone Acetate (MPA)  (2 in 86) had resolution of symptoms in less than 3 months. Gonadotropin-releasing Hormone (GnRH) analogue and oral progestogen had different duration of response rate between 0-6 months. LNG-IUS failed to achieve endometrial regression in 12.5% and 23.3% with oral progestogen. LNG-IUS, GnRH analogue and MPA had acceptable regression rate of EH. Oral progestogen had the highest failure rate in achieving EH regression.  This is likely due to compliance issue with oral treatment.