Low-risk endometrial hyperplasia: hysteroscopy and histologic evaluation after treatment with LH-RH analogue

Abstract

Endometrial hyperplasia is an endometrial pathologic condition often found at perimenopausal age. Abnormal uterine bleeding (A.U.B.) is the most frequent symptom of endometrial hyperplasia. The combination of hysteroscopy and endometrial biopsy is the most suitable approach for the diagnosis of endometrial hyperplasia in symptomatic patients. We have studied endometrial modifications due to LHRH-analogue in 75 patients with AUB and with a hysteroscopic and histologic picture of low-risk endometrial hyperplasia. LHRH analogue is a valid treatment for all estrogen induced pathologies, because of its suppressive action on hypothalamic-hypophysary gonadotropins. The administration of LHRH for 4 months induced an improvement of the menstrual cycle within the first month of treatment in 53.3% of cases. At the end of treatment 100% of the patients were in amenorrhea. The hysteroscopic follow-up at 3 months showed an endometrial thinning with a tendency to hypoatrophy of the mucosa in 72% of cases. Three months after the end of treatment 20 patient had regular menstrual cycles and hysteroscopic and a histologic picture of normal endometrium. Only 30 patients had persistent amenorrhea with a consequent hysteroscopic and histologic picture of endometrial hypoatrophy. The use of LHRH analogue seems to have a great impact on the management of estrogen-dependent gynaecological benign diseases.