Endometrial hyperplasia. Risks, recognition and the search for a safe hormone replacement regimen

Area of Science:

• Gynecology
• Endocrinology
• Oncology

Background:

• Unopposed estrogen replacement therapy (ERT) is linked to endometrial hyperplasia, with atypical complex hyperplasia posing the highest risk for progression to carcinoma.
• Synthetic progestins added to ERT mitigate endometrial risk but cause side effects and negate some estrogen benefits.
• Natural micronized progesterone offers an alternative to synthetic progestins, potentially reducing side effects and preserving cardiovascular benefits.

Purpose of the Study:

• To evaluate the endometrial safety and tolerability of a cyclic combined regimen of estrogen and natural micronized progesterone.
• To compare the efficacy of natural micronized progesterone with synthetic progestins in preventing ERT-induced endometrial hyperplasia.

Main Methods:

• A cyclic combined regimen using estrogen and 100 mg of natural micronized progesterone administered on days 1-25 of the cycle.
• Evaluation of endometrial safety, bleeding patterns, and patient tolerability in a European cohort.

Main Results:

• The cyclic regimen demonstrated endometrial safety, effectively preventing hyperplasia.
• Absence of unscheduled bleeding was observed in a significant proportion of patients.
• The treatment regimen showed a high rate of patient tolerability.

Conclusions:

• Cyclic combined therapy with estrogen and natural micronized progesterone provides endometrial protection during ERT.
• This regimen is a well-tolerated alternative to synthetic progestins, minimizing adverse effects and bleeding issues.