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Reverse of Progestin-Resistant Atypical Endometrial Hyperplasia by Metformin and Oral Contraceptives

Shen, Zong-Qi MD1; Zhu, Hui-Ting MD2; Lin, Jin-Fang MD1

doi: 10.1097/AOG.0b013e3181719b92
Case Reports
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BACKGROUND: Atypical endometrial hyperplasia usually is treated with high-dose progestin or hysterectomy, but the latter deprives the patient of future child bearing.

CASES: Two women with atypical endometrial hyperplasia complicating polycystic ovary syndrome (PCOS) had failed to respond to high-dose progestin therapy. They were both obese, insulin-resistant, and nulliparous with a desire to preserve fecundity. Metformin and oral contraceptives were administered as alternatives. Endometrial curettage performed 3 months later demonstrated a proliferative endometrium without evidence of residual pathology.

CONCLUSION: Insulin resistance might play a role in the occurrence of atypical endometrial hyperplasia complicating PCOS. Metformin and oral contraceptives could be an alternative treatment in the presence of progestin resistance.

Two cases of atypical endometrial hyperplasia complicating polycystic ovary syndrome, which did not respond to high-dose progestin therapy, were successfully treated with metformin and oral contraceptives.

From the 1Department of Reproduction and Endocrinology and the 2Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.

Corresponding author: Jin-Fang Lin, MD, Department of Reproduction and Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fang Xie Road, Shanghai 200011, China; e-mail: linjinfang@shmu.edu.cn.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists