Spontaneous endometrial hyperplasia. A 5 year follow-up of 82 patients after high-dose gestagen treatment.

Endometrial hyperplasia was proposed as a predecessor to endometrial carcinoma already at the end of the 19th century. However, there have been different opinions regarding this view. The treatment also varies, but generally cyclic progesterone at a dose of 10 mg a day is used. In order to investigate whether endometrial hyperplasia is a premalignant state and also whether a high-dose gestagen treatment would cure a high proportion of these patients, a prospective randomised study was started in 1982. We now present the 5 year follow-up consisting of 82 patients treated with high-dose gestagen. In this study 19 out of 82 patients had hysterectomies (2 due to hyperplasia and 11 due to bleeding), almost the same frequency as in a previous report with patients followed-up with abrasio only, but now mainly due to bleeding problems. In summary, no carcinoma developed and the hyperplasia was cured with 500 mg MPA i.m. twice weekly for three months. However, the bleeding problems, though almost always only spotting, remained, leading to a frequency of hysterectomy that was still too high. We find latter clinical problem an enigma. Further studies are therefore in progress in our group which try to identify other treatment modalities for those patients with bleeding problems or who redeveloped hyperplasia after abrasio, in order to avoid hysterectomies.