Clinical application of photodynamic therapy in endometrial hyperplastic diseases: a review

Endometrial hyperplasia (EH) is a common precancerous condition in gynecology. Conventional treatments are limited by recurrence, side effects, and fertility concerns. Photodynamic therapy (PDT), a minimally invasive and lesion-selective treatment, has emerged as a promising alternative. This review will summarize the clinical applications of PDT in EH and evaluate its diagnostic and therapeutic potential.

Literature was systematically retrieved from PubMed, Embase, and ClinicalTrials.gov using the search terms 'endometrial hyperplasia', 'endometrial hyperplasia disease', 'endometrial disease', 'photodynamic therapy', and 'photodynamic diagnosis'. Articles related to PDT or photodynamic diagnosis (PDD) published between 1978 and 2025 were collected. Additionally, the bibliographies of relevant papers were manually screened to identify further eligible studies.

Of the 11 included articles on endometrial hyperplasia diseases, 7 were therapeutic studies and 4 were diagnostic studies. PDT using various photosensitizers (Photogem, 5-ALA, and Photoditazin) demonstrated complete remission rates ranging from 68 % to 94 %, with recurrence rates between 6 % and 33 %. Among 17 patients who attempted pregnancy after PDT, 4 achieved 7 pregnancies resulting in 6 live births. In addition, hysteroscopic PDD demonstrated high diagnostic value in distinguishing endometrial lesions and guiding targeted intervention.

Photodynamic therapy offers a minimally invasive, fertility-preserving alternative for the management of endometrial hyperplastic diseases. Its ability to integrate diagnosis and treatment, adapt to personalized regimens, and be combined with other modalities positions PDT as a promising strategy in gynecologic precision medicine. Continued innovation, standardization of treatment parameters, and expansion of clinical evidence are essential for routine adoption.