trelstar and Endometrial-Hyperplasia

Endometrial hyperplasia is thought to be caused by the prolonged, unopposed oestrogenic stimulation of the endometrium. The regression of hyperplastic back to normal endometrium is the main purpose of any conservative treatment in order to prevent development of adenocarcinoma. The aim of this study was to evaluate the regression of hyperplastic to normal endometrium in patients with various forms of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue (GnRHa) triptorelin for 6 months. Fifty-six patients with endometrial hyperplasia were enrolled in this trial; 39 patients (group I) presented simple hyperplasia, 14 (group II) complex hyperplasia and three (group III) atypical complex hyperplasia. All patients were treated with triptorelin for 6 months. Bleeding control during treatment was excellent. A post-treatment curettage for estimation of endometrial histology was performed on 54 out of 56 patients 100.1 +/- 44.7 days after the last triptorelin dose, following the restoration of pituitary function. Regression of hyperplastic to normal endometrium was observed in 32 (86.5%) out of 37 patients in group I and in 12 (85.7%) out of 14 in group II. Persistence of simple hyperplasia was found in five (14.5%) out of 37 patients in group I. Persistence of complex hyperplasia was found in 1 (7.1%) out of 14 patients and progression to atypical complex hyperplasia in another one (7.1%) woman in group II. In some of these cases, the presence of risk factors such as obesity, diabetes mellitus and ovulatory disturbances may contribute to the disease persistence despite therapy. On the other hand, in group III, none of the three patients had normal post-treatment endometrial histology. It seems, therefore, that in cases of endometrial hyperplasia without atypia, the administration of the GnRHa triptorelin is associated with high regression rates to normal endometrium. Conversely, the presence of atypia seems to be a poor prognostic factor. Treatment tolerance and bleeding control during therapy is excellent.

Topics: Adult; Endometrial Hyperplasia; Endometrium; Female; Gonadotropin-Releasing Hormone; Humans; Middle Aged; Prospective Studies; Treatment Outcome; Triptorelin Pamoate; Uterine Hemorrhage

The aim of this study was to assess the long-term effect of gonadotropin-releasing hormone analogues (GnRH-a) in combination with high-dose progestogens in the treatment of atypical endometrial hyperplasia in selected surgical high-risk patients and in women desiring reproductive potential. We hypothesized that this therapy is effective for most couples.. In the Department of Gynecology of a university hospital, a conservative treatment was offered to a series of 22 patients with atypical endometrial hyperplasia who had a surgical or anesthetic risk history or wished to preserve their fertility potential. After informed consent, they were treated with 500 mg norethisterone acetate weekly for 3 months and 3.75 mg Triptorelin depot every month for 6 months. Three patients failed to complete the study, so the group finally consisted of 19 subjects. They were prospectively followed for 5 years by hysteroscopy and multiple selected biopsies every 6 months.. At a 5-year follow-up, regression was noted in 16 patients (84.2%), persistence in 1 (5.1%), recurrence in 1 (5.1%), and progression in 1 (5.1%).. Consistent with our hypothesis, combined treatment with progestogens and GnRH-a is an effective alternative in selected patients with atypical endometrial hyperplasia.

Topics: Adult; Aged; Endometrial Hyperplasia; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Middle Aged; Norethindrone; Norethindrone Acetate; Progestins; Prospective Studies; Time Factors; Triptorelin Pamoate

On the basis of the recently reported observation that gonadotropin-releasing hormone agonists (GnRH-a) can affect endometrial cell proliferation, both indirectly, through the hormonal axis, and directly, by acting on the GnRH-a receptors, we investigated how far GnRH-a can be used as a new treatment mode for endometrial hyperplasias. Forty-two women, aged 28-60 years, with histologically confirmed simple (n = 30) or complex (n = 12, 2 with atypias) hyperplasia of the endometrium were involved in the study. According to the protocol they were treated for 6 months with GnRH-a (leuprolide acetate or triptorelin), and each patient underwent uterine curettage in the third and the sixth month of treatment, and 6 and at least 12 months after cessation of the treatment, for histological examination and morphometric and DNA-cytometric evaluation of the endometrium (mean pathological follow-up, 19.2 months; mean clinical follow-up, 30.7 months). During treatment, most of the women first revealed endometrial atrophy, and, after cessation of the treatment, again an atrophic or mainly functional endometrium; in 7 women, all with initial diagnosis of simple hyperplasia, the endometrial hyperplasia reappeared, which led in all 7 cases to hysterectomy. The mean values of almost all morphometric and DNA-cytometric parameters during and after treatment showed statistically significant changes in relation to pretreatment values, indicating a decrease in the proliferative activity of the endometrial cells; the GnRH-a antiproliferative effect was still active for a long time after cessation of the therapy. Our results, based for the first time not only on histological but also on serial nuclear morphometric and DNA-cytometric examinations of the endometrial cells and on the longest follow-up time, support the view that in cases of endometrial hyperplasia, especially of complex type, the use of GnRH agonists, which decrease the proliferative tendency of endometrial cells, could represent an alternative conservative therapeutic approach, which, however, requires close monitoring of the endometrium.

Topics: Adult; Cell Division; Cell Nucleus; DNA; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Endometrium; Female; Flow Cytometry; Gonadotropin-Releasing Hormone; Humans; Image Processing, Computer-Assisted; Leuprolide; Middle Aged; Time Factors; Triptorelin Pamoate

Untreated hormonal disturbances connected with unbalanced estrogen serum concentrations can influence on pathological proliferation of endometrium. The aim of the study is to assess the effect of GnRH agonists on endometrium in women consulted due to simple hyperplasia endometrium.. 15 women in the mean age 48.5 +/- 3.5 years with the histopathological diagnosis of simple hyperplasia were treated with trioptorelin during 3 months. After therapy all patients were undergone transvaginal ultrasonography and endometrial biopsy.. Atrophic endometrium were observed in all women after a 3-month therapy. The thickness of endometrium decreased from 10.21 +/- 3.2 mm to 3.94 +/- 1.56 mm.. The efficacy of the therapy of simple hyperplasia in women with GnRH agonist was 100%.

Topics: Antineoplastic Agents, Hormonal; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Endometrium; Female; Gonadotropin-Releasing Hormone; Humans; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity; Time Factors; Treatment Outcome; Triptorelin Pamoate; Ultrasonography

Hyperestrogenism is a powerful factor inducing the development of endometrial hyperplasia that in its turn may represent the first step in the natural history of endometrial carcinoma. During menopause it is possible to have a condition to relative hyperestrogenism induced by a residual hormonal activity and by aromatisation of androgens in the adipose tissue. Therapeutical approach in this pathology aims to control hyperplastic development of the endometrial mucosa and to exclude menometrorrhagia. This study has been performed according to an open uncontrolled design in 14 women (4 menopausal women) with abnormal uterine bleeding and hysteroscopic endometrial cystic or adenomatous hyperplasia. At the beginning and at the end of treatment all patients underwent routine biohumoral blood-tests, hysteroscopy and diagnostic curretage. The GnRH analogue (tryptorelin) 3.75 mg 1 ampoule i.m. every 28 days was administered during a 6-month treatment cycle. At the end of therapy bleeding had disappeared in all menopausal women; in the premenopausal group 8 patients have shown a normal menstrual cycle while 2 are still amenorrhoic. The final hysteroscopic evaluation displayed atrophic endometrium in 9 patients and simple proliferative endometrium in 5 cases. Safety was excellent: 3 cases of slight increase of systolic blood pressure and 1 case of slight increase of weight took place. Our results demonstrate therapeutic efficacy of GnRH analogues in the treatment of endometrial hyperplasia with menometrorrhagia either in premenopausal or menopausal women.

Topics: Aged; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Female; Gonadotropin-Releasing Hormone; Humans; Menopause; Menorrhagia; Metrorrhagia; Middle Aged; Premenopause; Triptorelin Pamoate

Endometrial hyperplasia is a frequent pathology during menopause and involves the risk of malignant transformation of the lesions. In an attempt to avoid radical surgery, this study proposes the use of triptorelin which was used to treat 56 patients with histologically confirmed symptoms of endometrial hyperplasia without atypia. GnRH-analog was administered using the intramuscular route every 28 days for 6 months. Histological controls were carried out 30 days after the last injection and showed the resolution of histological symptoms, confirmed after three months.

Topics: Adult; Ambulatory Care; Endometrial Hyperplasia; Female; Gonadotropin-Releasing Hormone; Humans; Middle Aged; Triptorelin Pamoate

Endometrial hyperplasia is a endometrial condition often found in perimenopausal age. AUB 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. The Authors have studied endometrial modifications due to LH-RH analogue, a depot formula, in 60 perimenopausal patients with AUB and with hysteroscopic and histologic picture of low-risk endometrial hyperplasia. They report the result of treatment efficacy (disappearance of symptoms and tendency to hypoatrophy of the mucosa). The use of LH-RH A seems to have a good result in the management of oestrogen-dependent gynaecological benign diseases.

Topics: Adult; Aged; Biopsy; Endometrial Hyperplasia; Endometrium; Female; Gonadotropin-Releasing Hormone; Humans; Hysteroscopy; Middle Aged; Treatment Outcome; Triptorelin Pamoate