[Conservative therapeutic possibilities in glandular or adenomatous endometrium hyperplasia]

For conservative therapy of endometrial hyperplasia drugs and local surgery measures are taken into consideration. For medical therapy the following drugs are considered: Gestagens, danazol, GnRH-agonists/antagonists and for medical post treatment gestagen dominant estrogen/gestagen-combination can be used. The above mentioned drugs have different ways of action. Basically the estrogen stimulation on the endometrium has to be interrupted or reduced. Therapeutic effects are depended on doses and length of therapy before with individual adjusted dosages a complete regression of the hyperplastic endometrium changes can be obtained. The effects persist also after cessation of therapy. While gestagens act via secretory transformation and decidualisation leading to atrophy. The use of danazol has a direct atrophic effect on the endometrium. This can be reached within short time. This effect also persists after cessation of danazol medication. The atrophic effects can also be obtained with the use of GnRH-agonists or GnRH-antagonists. The clinical experience with these compounds is limited. After cessation of medical therapy several points should be considered: 1. clinical and ultrasonic control, 2. hysteroscopic-histological control, 3. medical prophylaxsis with a gestagen dominant estrogen/gestagen combination. Besides medical therapy of endometrial abnormalities currettage and endometrial ablation represent conservative alternatives to hysterectomy. The therapeutic effect of currettage is about 60%. In premalignant changes of the endometrium endometrial ablation is contraindicated.