Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
J Obstet Gynaecol Res. 2024 Apr;50(4):633-638. doi: 10.1111/jog.15872. Epub 2023 Dec 28.
Medroxyprogesterone acetate (MPA) is one of the treatments of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) to preserve the fertility. Efficacy of MPA therapy and fertility and obstetric outcomes after remission were evaluated in EC or AEH patients.
Among patients diagnosed with EC or AEH at Tokushima University Hospital between January 2002 and October 2020, we retrospectively analyzed patients, ages range from 26 to 40, who underwent conservative management using MPA (400-600 mg/day).
In total, 19 patients underwent MPA therapy. The 18 (94%) patients achieved complete response (CR), and 1 (5%) patient achieved partial response (PR). Relapse occurred in 6 (32%) patients who had achieved CR. Of the patients who relapsed, 4 patients resumed MPA therapy and were in remission. Among 19 patients, 13 patients attempted pregnancy after CR. All of them underwent ovulation induction or assisted reproductive technology. As a result, 20 pregnancies in 10 (77%) patients and 12 live births in 9 (69%) patients were achieved. Rate of spontaneous abortion was 35% (7/20).
MPA therapy can produce a high remission rate, and be considered an effective treatment for patients who wish fertility preservation. Around 70% patients who attempt to pregnancy can have at least one baby by infertility treatments. Because recurrence rate after MPA therapy is high, it may be desirable to aim for early pregnancy by active intervention.
醋酸甲羟孕酮（MPA）是治疗非典型子宫内膜增生（AEH）和子宫内膜癌（EC）以保留生育能力的方法之一。本研究评估了 MPA 治疗 EC 或 AEH 患者的疗效以及缓解后的生育和产科结局。
在 2002 年 1 月至 2020 年 10 月期间于德岛大学医院诊断为 EC 或 AEH 的患者中，我们回顾性分析了年龄在 26 至 40 岁之间、接受 MPA（400-600mg/天）保守治疗的患者。
共有 19 例患者接受了 MPA 治疗。18 例（94%）患者完全缓解（CR），1 例（5%）患者部分缓解（PR）。6 例（32%）CR 患者复发。在复发的患者中，4 例恢复 MPA 治疗并缓解。在 19 例患者中，有 13 例在 CR 后尝试妊娠。所有患者均接受排卵诱导或辅助生殖技术。结果，10 例（77%）患者中有 20 例妊娠，9 例（69%）患者中有 12 例活产。自然流产率为 35%（7/20）。
MPA 治疗可产生较高的缓解率，可考虑作为有生育保存愿望的患者的有效治疗方法。尝试妊娠的患者中约有 70%可以通过不孕治疗至少生育一个孩子。由于 MPA 治疗后的复发率较高，积极干预以实现早期妊娠可能是可取的。
