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Effectiveness of progestin-based therapy for morbidly obese women with complex atypical hyperplasia

  • Marcia A. Ciccone
  • Stephanie A. Whitman
  • Charlotte L. Conturie
  • Niquelle Brown
  • Christina E. Dancz
  • Begum Özel
  • Koji MatsuoEmail author
General Gynecology
  • 16 Downloads

Abstract

Objective

While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes.

Methods

We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed.

Results

Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30–39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30–39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09).

Conclusion

In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.

Keywords

Endometrial hyperplasia Progestins Obesity Intrauterine device 

Notes

Author contributions

MAC: conceptualization, data curation, funding acquisition, investigation, methodology, project administration, visualization, and writing (original draft). CLC: data curation and writing (review/edits). SAW: data curation and writing (review/edits). NB: formal analysis, software, visualization, and writing (review/edits). CED: conceptualization, supervision, and writing (review/edits). BO: conceptualization, supervision, and writing (review/edits). KM: funding acquisition, investigation, methodology, project administration, supervision, validation, and writing (review/edits).

Funding

Ensign Endowment for Gynecologic Cancer Research (K.M.). ARCS Foundation, Inc., Los Angeles founder chapter-Margaret Kersten Ponty Postdoctoral Fellowship (M.A.C.).

Compliance with ethical standards

Conflict of interest

Honorarium, Chugai (K.M.) not related to this study; none for others.

Ethical approval

The study involving human participants performed by authors is approved by Institutional Review Board, University of Southern California. This retrospective study of archived medical records waived to obtain informed consents from study participants.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesUSA

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