EFFICACY OF GONADOTROPIN-RELEASING HORMONE AGONISTS TREATMENT OF THE SIMPLE ENDOMETRIAL HYPERPLASIA IN WOMEN OF REPRODUCTIVE AGE WITH OBESITY

This prospective, randomized, open comparative study evaluated the efficacy and safety of gonadotropin-releasing hormone agonist therapy (buserelin-depot) versus progestin (norethisterone) versus combined estrogen–progestin oral contraceptives in 105 reproductive-age women with obesity and histologically verified simple endometrial hyperplasia (without atypia), assessing outcomes at 3, 6, 12, and 24 months. Primary endpoints included absence of bleeding and morphological improvement at 6 months, while secondary endpoints were endometrial hyperplasia recurrences at 12 and 24 months, with safety monitored for 6 months; all groups also received lifestyle recommendations for obesity. Clinical and morphological effectiveness at 6 months was 100% with buserelin-depot versus 63.6% with norethisterone and 50.0% with combined oral contraceptives, with significantly smaller endometrial ultrasound thickness in the buserelin-depot group. Recurrences were absent at 12 months and low at 24 months after buserelin-depot (6.5%) but were much higher with norethisterone (45.4% at 12 months; 48.5% at 24 months) and combined oral contraceptives (64.3% at both time points), and buserelin-depot was also associated with improved weight and carbohydrate/lipid parameters, though the paper’s open design and attrition (loss of 13 participants) limit certainty. This paper is centrally about endometriosis and/or adenomyosis only tangentially—adenomyosis is mentioned as a comorbidity in the small subset undergoing surgery after treatment failure, but the main focus is simple endometrial hyperplasia in women with obesity.

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