Endometrial hyperplasia treated by progestins.

This study of 16 patients compares treatment for adenomatous or atypical hyperplasia with one of three schedules of oral progestational drugs. Treatment of endometrial hyperplasia with megestrol, 80 mg daily for 6 weeks, was not satisfactory with the first 5 patients. Treatment was then prolonged to 9 weeks and 4 additional patients so treated. Another 7 patients were treated with medroxyprogesterone acetate (Provera), 80 mg daily for 6 weeks. All medication was given orally. Patients ranged from 36 to 60 years of age with parity from 0 to 10. Endometrial biopsies were done at intervals. All but 1 had a complete remission under therapy. This patient's endometrium progressed from atypica to carcinoma in situ. At hysterectomy glandular hyperplasia with focal carcinoma in situ in the endometrium, adenomyosis, and cellular leiomyomas were found. Remissions persisted only in 5, the longest period being 4 years. Hysterectomy was required in 6. None developed invasive carcinoma. Patients are mildly symptomatic. It is thought that continuous progestational treatment for indefinite periods may be necessary if hysterectomy is to be avoided.