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. 2024 Nov 1:16:1815-1828.
doi: 10.2147/IJWH.S477045. eCollection 2024.

Weight-Loss and Metformin-Use Improve the Reversal Rate in Patients with Endometrial Hyperplasia

Dan Kuai  1   2 , Jiayu Wei  1   2 , Mengying Li  1   2 , Lu Chen  3 , Dongcan Zhang  1   2 , Xiaoyan Li  1   2 , Ying He  1   2 , Shiqi Liu  1   2 , Huiying Zhang  1   2 , Wenyan Tian  1   2 , Yingmei Wang  1   2
Affiliations

Weight-Loss and Metformin-Use Improve the Reversal Rate in Patients with Endometrial Hyperplasia

Dan Kuai et al. Int J Womens Health. .

Abstract

Objective: To evaluate the therapeutic outcomes of weight loss and metformin use in patients with endometrial hyperplasia (EH), and to identify the factors influencing treatment efficacy.

Methods: This study included data from patients diagnosed with either EH or endometrial atypical hyperplasia (EAH). Patients selected a progestin treatment regimen based on their diagnosis. Those with concurrent obesity or insulin resistance received additional weight management support and metformin therapy. Follow-up assessments were conducted every 3-6 months.

Results: A total of 202 patients were included. The metformin group exhibited significantly greater improvement in abnormal uterine bleeding (91.5% vs 57.1%, p < 0.001) and in ultrasound findings (91.5% vs 66.7%, p < 0.001) than the non-metformin group. Patients who achieved >3% weight loss and those using metformin showed a significantly higher rate of disease reversal than those with ≤3% weight loss (91.2% vs 77.6%, p = 0.034) and the non-metformin group (93.2% vs 52.4%, p < 0.001). At follow-up durations exceeding 12 months, metformin use was associated with a significantly higher disease reversal rate (82.1% vs 42.9%, p = 0.048) and a lower recurrence rate (12.8% vs 28.6%, p = 0.048). Weight loss of >3% (odds ratio: 0.041, 95% confidence interval: 0.004-0.437, p = 0.008) and metformin use (odds ratio: 0.059, 95% confidence interval: 0.011-0.311, p = 0.001) were both independently associated with improved reversal rates in patients with EH/EAH.

Conclusion: Combining progestin therapy with weight loss and metformin is more effective in reversing EH than progestin alone. Regular metformin use, alongside weight loss, serves as a protective factor in EH management, with the protective effect of metformin increasing with longer use.

Keywords: comprehensive management; endometrial hyperplasia without atypia; metformin; weight management.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Therapeutic outcome of Weight loss in EH without atypia or EAH patients. (A and B) Effect of weight loss on AUB and Ultrasound performance in EH without atypia or EAH patients. (C) Reversal outcome of weight loss in EH without atypia or EAH patients. (D–F) Therapeutic outcome of weight loss at follow up 6, 12, and >12 months in EH without atypia or EAH patients.
Figure 2
Figure 2
Therapeutic outcome of Metformin-use in in EH without atypia or EAH patients. (A and B) Effect of metformin use on AUB and Ultrasound performance in EH without atypia or EAH patients. (C) Reversal outcome of metformin use in EH without atypia or EAH patients. (D–F) Therapeutic outcome of metformin use at follow up 6, 12, and >12 months in EH without atypia or EAH patients.
Figure 3
Figure 3
Reversal rate of different interventions in EH without atypia or EAH patients.
See this image and copyright information in PMC

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