Effectiveness of progestin-based therapy for morbidly obese women with complex atypical hyperplasia
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While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes.
We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed.
Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30–39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30–39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09).
In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.
KeywordsEndometrial hyperplasia Progestins Obesity Intrauterine device
MAC: conceptualization, data curation, funding acquisition, investigation, methodology, project administration, visualization, and writing (original draft). CLC: data curation and writing (review/edits). SAW: data curation and writing (review/edits). NB: formal analysis, software, visualization, and writing (review/edits). CED: conceptualization, supervision, and writing (review/edits). BO: conceptualization, supervision, and writing (review/edits). KM: funding acquisition, investigation, methodology, project administration, supervision, validation, and writing (review/edits).
Ensign Endowment for Gynecologic Cancer Research (K.M.). ARCS Foundation, Inc., Los Angeles founder chapter-Margaret Kersten Ponty Postdoctoral Fellowship (M.A.C.).
Compliance with ethical standards
Conflict of interest
Honorarium, Chugai (K.M.) not related to this study; none for others.
The study involving human participants performed by authors is approved by Institutional Review Board, University of Southern California. This retrospective study of archived medical records waived to obtain informed consents from study participants.
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