Predictive approach to the management of women with endometrial hyperplasia without atypia

Mekan R. Orazov, Roman E. Orekhov, Л.М. Михалева, Irina A. Mullina
In: Medical alphabet · 2023 · pp. 8–13 · doi:10.33667/2078-5631-2023-3-8-13 · W4362555348
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review summarizes scientific literature on managing endometrial hyperplasia without atypia, finding combined oral contraceptives, particularly those with gestoden, effective for prevention and recurrence reduction.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

The paper analyzes and summarizes (2012–2022) literature on predictive approaches to managing women with endometrial hyperplasia without atypia, using searches across PubMed, Cochrane Library, ScienceDirect, eLibrary with keywords on pathogenesis, risk factors, and recurrence. It describes that hyperplasia without atypia is common in reproductive-age women and is linked to disrupted local hormonal homeostasis, with risk factors including age over 35, lack of prior pregnancy, obesity, genetic predisposition, diabetes, anovulatory cycles, and certain forms of hormone therapy without a progestin component, as well as immunosuppression; the review highlights the use of predictive medicine for risk identification and targeted follow-up, with an explicit limitation that the evidence is based on literature review rather than new patient-level outcomes. The review concludes that combined oral contraceptives, particularly gestodene-containing formulations, are discussed as having both contraceptive effectiveness and a pathogenetically justified role in prevention of endometrial hyperplasia without atypia and its recurrences, with efficacy described as similar to other progestins such as levonorgestrel. This paper is centrally about endometriosis and/or adenomyosis — it is not specifically focused on endometriosis or adenomyosis, but it relates to endometriosis/adenomyosis only indirectly through broader gynecologic hormone-responsive pelvic disease management themes and shared hormonal risk-pathway concepts, while the condition under review is endometrial hyperplasia without atypia.

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Abstract

Objective. Objective of this review is the systematic analysis and summarization the scientifc data available in the current literature on the predictive approach to the management of women with endometrial hyperplasia without atypia. Material and methods. Scientifc literature was searched in PubMed, CochraneLibrary, Science Direct, and ELibrary databases using the keywords,endometrial hyperplasia and cancer, pathogenesis, risk factors, and recurrence for 2012–2022. Framework. Endometrial hyperplasia (EH) is a common disease that affects women of reproductive age and is caused by a disturbance of the local hormonal homeostasis of the endometrium. Several factors, such as age over 35, lack of pregnancy history, obesity, genetic predisposition, diabetes mellitus, anovulatory cycles, hormone replacement therapy, including menopausal therapy (without the progestin component) and immunosuppression can lead to the development of this condition. Modern predictive medicine can be used to identify women at high risk for developing this condition and target screening and surveillance, as well as individualized treatment plans. Overall, the use of predictive in the management of endometrial hyperplasia without atypia may improve the treatment outcomes of the patients in the cohort studied. Conclusion. Combined oral contraceptives (COCs) have been proven to have not only high contraceptive effcacy, but also to be considered as a pathogenetically justifed prevention of EH without atypia and its recurrence. Gestoden-containing COCs are recognized as an effective means not only for the prevention of endometrial hyperplasia, but also for the prevention of endometrial carcinoma, while having absolutely similar effcacy to other progestins, such as levonorgestrel. Thus, OCs containing gestoden should be considered as an attractive option not only to prevent unwanted pregnancy with high contraceptive effcacy, but also to regulate the menstrual cycle, to minimize breakthrough bleeding and to prevent EH without atypia.

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