THE ENDOMETRIUM IN “ENDOMETRIAL HYPERPLASIA” AFTER THERAPY1

Functional meno-metrorrhagia in adolescent girls and in young women often presents a difficult clinical problem to the gynecologist who is charged with the responsibility of effective conservative therapy which avoids any possible impairment of the sexual and procreative functions of his patient. At times the radical measures of hysterectomy or large doses of x-ray or radium seem imperative to prevent exsanguination. A few fatal cases have been reported. Recently, we have encountered such a case in a colored girl, aged 15 years (1). A reliable yet innocuous method of curative therapy would fulfill a long awaited need. As the active endocrinal preparations, which have resulted from the intensive research work of the past decade, have become available to the clinical gynecologist, application of certain of these to the treatment of such patients has been studied. As we have indicated in previous reports (2,3,4), there has been no unanimity of opinion as to the merits of such therapy. Most of these studies have been concerned with the anterior pituitary-like principle of pregnancy urine (APL/PU). We (4), as well as others, have emphasized that, despite remissions of excessive bleeding and even the occurrence of regular bleeding following such treatments, the assumption is not warranted that the underlying ovarian and endometrial pathology has been corrected. The use of estrin has been avoided rather generally in this condition and the majority of clinicians, as we have noted previously (4), have warned against its employment. The assumption that the vast majority of such bleeding was due to endometrial hyperplasia, which is apparently due to a phase of prolonged estrin action, no doubt was responsible for this attitude. Progestin has been awaited anxiously with the anticipation that it would be of therapeutic value.