Gonadotropin-Releasing Hormone Analog Combined with Depot Medroxyprogesterone Acetate in the Management of Endometrial Hyperplasia A Prospective Randomized Clinical Study.

OBJECTIVE: To compare the effectiveness of combined treatment of depot medroxyprogesterone acetate (MPA) with gonadotropin-releasing hormone (GnRH) analog and depot MPA alone in the management of simple endometrial hyperplasia without atypia among heavy bleeders. STUDY DESIGN: Thirty- four patients with endo- metrial hyperplasia with- out atypia were selected in this prospective randomized study. Group I consisted of 15 patients who were treated with depot MPA combined with GnRH analog. Group 2 consisted of 19 patients who were treated with depot MPA alone. Injections were applied at the beginning of the study and at the end of the 3rd month. Endometrial biopsies were performed at the end of the 6th month. Main outcome measures were endometrial response and reduction of duration and amount of menstrual bleeding. RESULTS: Total and mean duration of menstruation and total number of standardized pads used were signifi- cantly decreased in both groups. These parameters were also significantly lower in group 1 than in group 2 at the end of both the 3rd and 6th months of the study (p<0.01). Endometrial response rates were significant- ly higher in group I than in group 2 (100% vs. 44.4%, respectively, p <0.05). CONCLUSION: Management of endometrial hyper- plasia with GnRH analog in addition to depot MPA provides prompt endometrial response and rapid menstru- al cycle control.