Predictors of recurrent course of endometrial hyperplasia without atypia in women of reproductive age

Abstract

Aim. To establish predictors of recurrent course of endometrial hyperplasia (EH) without atypia in women of reproductive age. Material and methods. A retrospective analysis of 180 patients of reproductive age was performed on the basis of the Department of Obstet-rics and Gynecology with a course of perinatology at the Patrice Lumumba Peoples' Friendship University of Russia in Semashko Clinical Hospital "RZD-Medicine" in 2020–2023. During the study, two cohorts of patients were formed depending on the course of EH: group 1 – the main group (n=95) was represented by patients with morphologically verified recurrent EH without atypia during a year of follow-up (1 or more episodes of relapse), group 2 – comparison (n=85) – patients with morphologically verified EH without a history of atypia, with no recurrence of hyperplasia during the year. The average age of patients in the studied cohort was 43±3.0 years (comparison groups – 40±2.0 years). Results. In a cohort of patients suffering from morphologically confirmed recurrent EH without atypia, a high incidence of the following predic-tors was established during the year: refusal/absence of medication in the anamnesis – 32.2%, duration of therapy (less than 6 months) – 23.2%, cyclic mode of progestogen use (from the 14th to the 26th day of menstrual cycle – MC/from 16 on the 26th day of the MC) – 15.8%. Patients with recurrent EH were significantly more likely to be obese in 45.3%, arterial hypertension – 38.9%, severe vitamin D deficiency – 32.6%, vitamin D deficiency – 40%, chronic endometritis – 41.1%. Conclusion. Predictors of recurrent course of EH without atypia in women of reproductive age are: refusal/absence of taking medication in anamnesis (odds ratio – OR 39.909; 95% confidence interval – CI 4.899–278.068), duration of therapy less than 6 months (OR 12.507; 95% CI 2.843–55.015), cyclic mode of progestogen use – from the 14th to the 26th day of the MC/from the 16th to the 26th day of the MC (OR 8.893; 95% CI 1.966–40.229). Patients with recurrent EH were significantly more likely to have severe vitamin D deficiency (OR 13.466; 95% CI 5.323–34.068), chronic endometritis (OR 4.237; 95% CI 2.032–8.833), hypertension (OR 3.881; 95% CI 1.858–8.801), obesity (OR 2.368; 95% CI 1.259–4.453), vitamin D deficiency (OR 1.574; 95% CI 0.814–3.045). Prevention of non-atypical hyperplasia with progestogens and lifestyle mod-ification carries a wide range of benefits, including those associated with a favorable fertility prognosis.

Keywords

• recurrence of endometrial hyperplasia without atypia
• proliferative endometrial diseases
• endometrial cancer
• endometrial hyper-plasia
• progestins.