Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
You searched for:"Anaglória Pontes"
We found (10) results for your search.Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):562-568
DOI 10.1590/S0100-72032013001200006
PURPOSE: To assess the contribution of hyperandrogenism to the development of metabolic syndrome (MetS) in obese women with polycystic ovary syndrome (PCOS). METHODS: Retrospective cross-sectional study conducted on 60 obese women with classic PCOS phenotype - Rotterdam Consensus - and 70 non-PCOS obese women. MetS was diagnosed by the NCEP-ATP III criteria and obesity was defined by body mass index. The Ferriman-Gallwey score (mFG) was used to evaluate hirsutism. The following measurements were performed: total testosterone, dehydroepiandrosterone sulfate (DHEA-S), glucose and insulin, total cholesterol, HDL, and triglycerides. Insulin resistance was measured using the HOMA-IR and insulin sensitivity index of Matsuda and De Fronzo (ISI). Statistical analysis was performed using the Student's t-test, χ² test and multivariate logistic regression analysis (p<0.05). RESULTS: Obese women with PCOS had significantly higher mFG (15.4±6.1), waist circunference (105.6±11.4 cm), DHEA-S (200.8±109.2 µg/dL), testosterone (135.8±71.4 ng/dL), and HOMA-IR (8.4±8.5) values and lower ISI values (2.0±1.8) than non-obese PCOS women (3.2±2.1; 101.4±9.2 cm; 155.0±92.7 µg/dL; 50.0±18.2 ng/dL; 5.1±4.7 and 3.3±2.7, respectively) (p<0.05). The frequency of MetS was higher in PCOS obese (75%) than non-PCOS obese (52.8%) women (p=0.015). Multivariate analysis did not reveal the contribution of the variables IFG, testosterone, and DHEAS to the development of MetS (p>0.05). CONCLUSION: Obese women with PCOS have a higher frequency of metabolic syndrome than non-PCOS obese women, and hyperandrogenism does not contribute to the development of metabolic syndrome in this group of women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):562-568
DOI 10.1590/S0100-72032013001200006
PURPOSE: To assess the contribution of hyperandrogenism to the development of metabolic syndrome (MetS) in obese women with polycystic ovary syndrome (PCOS). METHODS: Retrospective cross-sectional study conducted on 60 obese women with classic PCOS phenotype - Rotterdam Consensus - and 70 non-PCOS obese women. MetS was diagnosed by the NCEP-ATP III criteria and obesity was defined by body mass index. The Ferriman-Gallwey score (mFG) was used to evaluate hirsutism. The following measurements were performed: total testosterone, dehydroepiandrosterone sulfate (DHEA-S), glucose and insulin, total cholesterol, HDL, and triglycerides. Insulin resistance was measured using the HOMA-IR and insulin sensitivity index of Matsuda and De Fronzo (ISI). Statistical analysis was performed using the Student's t-test, χ² test and multivariate logistic regression analysis (p<0.05). RESULTS: Obese women with PCOS had significantly higher mFG (15.4±6.1), waist circunference (105.6±11.4 cm), DHEA-S (200.8±109.2 µg/dL), testosterone (135.8±71.4 ng/dL), and HOMA-IR (8.4±8.5) values and lower ISI values (2.0±1.8) than non-obese PCOS women (3.2±2.1; 101.4±9.2 cm; 155.0±92.7 µg/dL; 50.0±18.2 ng/dL; 5.1±4.7 and 3.3±2.7, respectively) (p<0.05). The frequency of MetS was higher in PCOS obese (75%) than non-PCOS obese (52.8%) women (p=0.015). Multivariate analysis did not reveal the contribution of the variables IFG, testosterone, and DHEAS to the development of MetS (p>0.05). CONCLUSION: Obese women with PCOS have a higher frequency of metabolic syndrome than non-PCOS obese women, and hyperandrogenism does not contribute to the development of metabolic syndrome in this group of women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(6):249-254
DOI 10.1590/S0100-72032013000600003
PURPOSE: To evaluate the clinical, ultrasonographic, biochemical and metabolic alterations of adolescents with polycystic ovary syndrome (PCOS). METHODS: Retrospective observational study conducted on 44 adolescents aged 12 to 19 years, diagnosed with PCOS according to the Rotterdam Consensus. Metabolic changes were assessed according to the recommendations of the International Diabetes Federation, considering: waist circumference (WC) >90th percentile (10-15 years of age) or >80 cm (age >16 years), fasting glucose >100 mg/dL, triglycerides >150 mg/dL, HDL <40 mg/dL, and blood pressure >Hg 130/85 mm. RESULTS: Mean age was 16.7±2.2 years and age at menarche was 11.8±1.4 years. The menstrual irregularity most frequently observed was amenorrhea (72.7%) followed by oligomenorrhea (27.3%); hirsutism was observed in 86.4% and acne in 56.8%. Polycystic ovaries were observed by ultrasound only in 27.3%. Mean BMI was 30.3±6.6 kg/m². According to BMI, 52.3% of adolescents were obese, 13.6% were overweight and 6.8% had a healthy weight. Increased waist circumference (63.6%, 28/44) and the reduction of HDL-C (34.1%, 15/44) were the metabolic changes most frequently observed. Increased triglycerides were observed in 27.3% (12/44) and increased blood pressure and impaired fasting glucose were found in 9.1% (4/44) and 4.5% (2/44) of cases, respectively. Acanthosis nigricans was observed in 52.3% and insulin resistance in 62.8% of the adolescents with PCOS. Metabolic syndrome was identified in six children (13.6%), all of them obese or overweight. CONCLUSION: In the adolescents with PCOS studied here, menstrual irregularity and hirsutism were the most common clinical manifestations, while the sonographic findings consistent with polycystic ovaries were less prevalent. Obesity associated with insulin resistance predisposes these adolescents to a higher frequency of metabolic disorders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(6):249-254
DOI 10.1590/S0100-72032013000600003
PURPOSE: To evaluate the clinical, ultrasonographic, biochemical and metabolic alterations of adolescents with polycystic ovary syndrome (PCOS). METHODS: Retrospective observational study conducted on 44 adolescents aged 12 to 19 years, diagnosed with PCOS according to the Rotterdam Consensus. Metabolic changes were assessed according to the recommendations of the International Diabetes Federation, considering: waist circumference (WC) >90th percentile (10-15 years of age) or >80 cm (age >16 years), fasting glucose >100 mg/dL, triglycerides >150 mg/dL, HDL <40 mg/dL, and blood pressure >Hg 130/85 mm. RESULTS: Mean age was 16.7±2.2 years and age at menarche was 11.8±1.4 years. The menstrual irregularity most frequently observed was amenorrhea (72.7%) followed by oligomenorrhea (27.3%); hirsutism was observed in 86.4% and acne in 56.8%. Polycystic ovaries were observed by ultrasound only in 27.3%. Mean BMI was 30.3±6.6 kg/m². According to BMI, 52.3% of adolescents were obese, 13.6% were overweight and 6.8% had a healthy weight. Increased waist circumference (63.6%, 28/44) and the reduction of HDL-C (34.1%, 15/44) were the metabolic changes most frequently observed. Increased triglycerides were observed in 27.3% (12/44) and increased blood pressure and impaired fasting glucose were found in 9.1% (4/44) and 4.5% (2/44) of cases, respectively. Acanthosis nigricans was observed in 52.3% and insulin resistance in 62.8% of the adolescents with PCOS. Metabolic syndrome was identified in six children (13.6%), all of them obese or overweight. CONCLUSION: In the adolescents with PCOS studied here, menstrual irregularity and hirsutism were the most common clinical manifestations, while the sonographic findings consistent with polycystic ovaries were less prevalent. Obesity associated with insulin resistance predisposes these adolescents to a higher frequency of metabolic disorders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):122-127
DOI 10.1590/S0100-72032012000300006
PURPOSE: To compare the diagnostic accuracy of sonohysterography (HSN) and conventional transvaginal ultrasound (USG) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (ART). METHODS: Comparative cross-sectional study with 120 infertile women candidate to ART, assisted at Centro de Reprodução Assistida (CRA) of Hospital Regional da Asa Sul (HRAS), Brasília - DF, from August 2009 to November 2010. Sonohysterography was performed with saline solution infusion in a close system. The sonohysterography finding was compared to previous USG results. The uterine cavity was considered abnormal when the endometrium was found to be thicker than expected during the menstrual cycle and when an endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. The statistical analysis was done using absolute frequencies, percentage values and the χ², with the level of significance set at 5%. RESULTS: HSN revealed that 92 (76.7%) infertile women candidate to ART had a normal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%), 9 cases of abnormal shape of the uterine cavity (7.5%), 6 submucous myomas (5%), 4 cases of inadequate endometrial thickness for the menstrual cycle phase (3.3%), and 2 cases of uterine septum (1.7%); 5 women presented more than one abnormality (4.2%). While USG showed alteration in the cavity only in 5 (4.2%) women, the sonohysterography confirmed 4 out of the 5 abnormalities shown by USG and detected an abnormal uterine cavity in 24 other women, who had not been detected by USG. This means that sonohysterography was able to detect more abnormalities in the uterine cavity than USG, with a statistically significant difference (p=0.002). CONCLUSION: The sonohysterography was more accurate than USG in the assessment of the uterine cavity of this cohort of infertile women candidate to ART. The sonohysterography can be easily incorporated into the investigation of these women and contribute to reducing embryo implantation failures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):122-127
DOI 10.1590/S0100-72032012000300006
PURPOSE: To compare the diagnostic accuracy of sonohysterography (HSN) and conventional transvaginal ultrasound (USG) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (ART). METHODS: Comparative cross-sectional study with 120 infertile women candidate to ART, assisted at Centro de Reprodução Assistida (CRA) of Hospital Regional da Asa Sul (HRAS), Brasília - DF, from August 2009 to November 2010. Sonohysterography was performed with saline solution infusion in a close system. The sonohysterography finding was compared to previous USG results. The uterine cavity was considered abnormal when the endometrium was found to be thicker than expected during the menstrual cycle and when an endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. The statistical analysis was done using absolute frequencies, percentage values and the χ², with the level of significance set at 5%. RESULTS: HSN revealed that 92 (76.7%) infertile women candidate to ART had a normal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%), 9 cases of abnormal shape of the uterine cavity (7.5%), 6 submucous myomas (5%), 4 cases of inadequate endometrial thickness for the menstrual cycle phase (3.3%), and 2 cases of uterine septum (1.7%); 5 women presented more than one abnormality (4.2%). While USG showed alteration in the cavity only in 5 (4.2%) women, the sonohysterography confirmed 4 out of the 5 abnormalities shown by USG and detected an abnormal uterine cavity in 24 other women, who had not been detected by USG. This means that sonohysterography was able to detect more abnormalities in the uterine cavity than USG, with a statistically significant difference (p=0.002). CONCLUSION: The sonohysterography was more accurate than USG in the assessment of the uterine cavity of this cohort of infertile women candidate to ART. The sonohysterography can be easily incorporated into the investigation of these women and contribute to reducing embryo implantation failures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):128-132
DOI 10.1590/S0100-72032012000300007
PURPOSE: To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS. METHODS: A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose >140 mg/dL and <200 mg/dL), and the diagnosis of DM-2 was obtained by both the oral glucose tolerance test (DM: 120 minutes for plasma glucose >200 mg/dL) and fasting glucose using the criteria of the American Diabetes Association (impaired fasting glucose: fasting plasma glucose >100 and <126 mg/dL; DM: fasting glucose >126 mg/dL). A logistic regression model for repeated measures was applied to compare the oral glucose tolerance test with fasting plasma glucose. ANOVA followed by the Tukey test was used for the analysis of the clinical and biochemical characteristics of patients with and without GI and/or DM-2. A p<0.05 was considered statistically significant. RESULTS: PCOS patients had a mean age of 24.8±6.3, and body mass index (BMI) of 18.3 to 54.9 kg/m² (32.5±7.6). The percentage of obese patients was 64%, the percentage of overweight patients was 18.6% and 17.4% had healthy weight. The oral glucose tolerance test identified 14 cases of DM-2 (5.7%), while fasting glucose detected only three cases (1.2%), and the frequency of these disorders was higher with increasing age and BMI. CONCLUSIONS: The results of this study demonstrate the superiority of the oral glucose tolerance test in relation to fasting glucose in diagnosing DM-2 in young women with PCOS and should be performed in these patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):128-132
DOI 10.1590/S0100-72032012000300007
PURPOSE: To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS. METHODS: A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose >140 mg/dL and <200 mg/dL), and the diagnosis of DM-2 was obtained by both the oral glucose tolerance test (DM: 120 minutes for plasma glucose >200 mg/dL) and fasting glucose using the criteria of the American Diabetes Association (impaired fasting glucose: fasting plasma glucose >100 and <126 mg/dL; DM: fasting glucose >126 mg/dL). A logistic regression model for repeated measures was applied to compare the oral glucose tolerance test with fasting plasma glucose. ANOVA followed by the Tukey test was used for the analysis of the clinical and biochemical characteristics of patients with and without GI and/or DM-2. A p<0.05 was considered statistically significant. RESULTS: PCOS patients had a mean age of 24.8±6.3, and body mass index (BMI) of 18.3 to 54.9 kg/m² (32.5±7.6). The percentage of obese patients was 64%, the percentage of overweight patients was 18.6% and 17.4% had healthy weight. The oral glucose tolerance test identified 14 cases of DM-2 (5.7%), while fasting glucose detected only three cases (1.2%), and the frequency of these disorders was higher with increasing age and BMI. CONCLUSIONS: The results of this study demonstrate the superiority of the oral glucose tolerance test in relation to fasting glucose in diagnosing DM-2 in young women with PCOS and should be performed in these patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):74-79
DOI 10.1590/S0100-72032012000200006
PURPOSE: To analyze the prevalence of insulin resistance, according to different biochemical and anthropometric measurements in women with polycystic ovary syndrome. METHODS: A total of 189 patients with polycystic ovary syndrome were retrospectively analyzed. Insulin resistance diagnosis was performed using fasting insulin, HOMA-IR, QUICKI, insulin sensibility index and glucose/fasting insulin ratio. Body mass index and lipid accumulation product were used. Data were analyzed statistically by descriptive statistics, ANOVA, Tukey post-test, and Pearson's correlation. RESULTS: The polycystic ovary syndrome patients had a mean age of 24.9±5.2 and a mean body mass index of 31.8±7.6. The percentage of obese patients was 57.14%. Among the methods of insulin resistance investigation, the insulin sensibility index was the technique that most detected (56.4%) the presence of insulin resistance in women with polycystic ovary syndrome. The insulin resistance was detected in 87% of obese patients. The fasting glucose/fasting insulin ratio and insulin sensibility index were strongly correlated with lipid accumulation product. CONCLUSION: The prevalence of insulin resistance varied according to the method used, and it was greater the higher the body mass index. Lipid accumulation product was also related to insulin resistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):74-79
DOI 10.1590/S0100-72032012000200006
PURPOSE: To analyze the prevalence of insulin resistance, according to different biochemical and anthropometric measurements in women with polycystic ovary syndrome. METHODS: A total of 189 patients with polycystic ovary syndrome were retrospectively analyzed. Insulin resistance diagnosis was performed using fasting insulin, HOMA-IR, QUICKI, insulin sensibility index and glucose/fasting insulin ratio. Body mass index and lipid accumulation product were used. Data were analyzed statistically by descriptive statistics, ANOVA, Tukey post-test, and Pearson's correlation. RESULTS: The polycystic ovary syndrome patients had a mean age of 24.9±5.2 and a mean body mass index of 31.8±7.6. The percentage of obese patients was 57.14%. Among the methods of insulin resistance investigation, the insulin sensibility index was the technique that most detected (56.4%) the presence of insulin resistance in women with polycystic ovary syndrome. The insulin resistance was detected in 87% of obese patients. The fasting glucose/fasting insulin ratio and insulin sensibility index were strongly correlated with lipid accumulation product. CONCLUSION: The prevalence of insulin resistance varied according to the method used, and it was greater the higher the body mass index. Lipid accumulation product was also related to insulin resistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):467-472
DOI 10.1590/S0100-72032005000800006
PURPOSE: to evaluate the prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density (BMD) in postmenopausal women. METHODS: a cross-sectional study with survey of data from medical records of patients attended at a climacteric outpatient clinic. Inclusion criteria: postmenopausal women with measured thyroid-stimulating hormone (TSH) and free thyroxin (T4-L). Exclusion criteria: hyperthyroidism and thyroid cancer. Values of TSH >5.0 mIU/ml and normal T4-L were considered to be subclinical hypothyroidism. The 329 selected women (55.2±6.4 years) were divided into three groups: normal thyroid function (control) (n=208), subclinical hypothyroidism (n=53) and clinical hypothyroidism under treatment (n=59). Clinical data, hormonal therapy use, body mass index (BMI=kg/m²), lipid profile (total cholesterol, HDL, LDL, triglycerides) and BMD of lumbar column and femur were obtained. RESULTS: subclinical hypothyroidism was diagnosed in 16.1% of the cases. The groups were homogeneous regarding clinical features, BMI or lipidic profile. BMD in lumbar column and femur was lower in subclinical and clinical hypothyroidism than in euthyroidism (p<0.001). There was a negative correlation between values of TSH and BMD of lumbar column and femur (p<0.001). There was no correlation between TSH values and age, menopause time, BMI, and lipid profile. The total of hormonal therapy users was 65.1%, mean duration of 3.43±2.42 years, not differing between the groups. CONCLUSION: subclinical hypothyroidism with prevalence of 16.1% in postmenopausal women was associated with lower BMD, with no effects on lipid profile.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):467-472
DOI 10.1590/S0100-72032005000800006
PURPOSE: to evaluate the prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density (BMD) in postmenopausal women. METHODS: a cross-sectional study with survey of data from medical records of patients attended at a climacteric outpatient clinic. Inclusion criteria: postmenopausal women with measured thyroid-stimulating hormone (TSH) and free thyroxin (T4-L). Exclusion criteria: hyperthyroidism and thyroid cancer. Values of TSH >5.0 mIU/ml and normal T4-L were considered to be subclinical hypothyroidism. The 329 selected women (55.2±6.4 years) were divided into three groups: normal thyroid function (control) (n=208), subclinical hypothyroidism (n=53) and clinical hypothyroidism under treatment (n=59). Clinical data, hormonal therapy use, body mass index (BMI=kg/m²), lipid profile (total cholesterol, HDL, LDL, triglycerides) and BMD of lumbar column and femur were obtained. RESULTS: subclinical hypothyroidism was diagnosed in 16.1% of the cases. The groups were homogeneous regarding clinical features, BMI or lipidic profile. BMD in lumbar column and femur was lower in subclinical and clinical hypothyroidism than in euthyroidism (p<0.001). There was a negative correlation between values of TSH and BMD of lumbar column and femur (p<0.001). There was no correlation between TSH values and age, menopause time, BMI, and lipid profile. The total of hormonal therapy users was 65.1%, mean duration of 3.43±2.42 years, not differing between the groups. CONCLUSION: subclinical hypothyroidism with prevalence of 16.1% in postmenopausal women was associated with lower BMD, with no effects on lipid profile.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):305-309
DOI 10.1590/S0100-72032004000400007
OBJECTIVE: to develop a new preoperative classification of submucous myomas to evaluate the viability and the degree of difficulty of hysteroscopic myomectomy. METHODS: forty-four patients were submitted to hysteroscopic resection of submucous myomas. The possibility of total resection of the myoma, the surgery duration, the fluid deficit, and the incidence of complications were evaluated. The myomas were classified by the Classification of the European Society of Endoscopic Surgery (CESES) and by the classification proposed (CP) by our group, that besides the degree of penetration of the myoma in the myometrium, adds the parameters: extent of the base of the myoma as related to the uterine wall, the size of the myoma in centimeters and its topography at the uterine cavity. For statistical analysis the Fisher test, the Student t test and the analysis of variance were used. Statistic significance was considered when the p-value was smaller than 0.05 in the bicaudal test. RESULTS: in 47 myomas the hysteroscopic surgery was considered complete. There was no significant difference among the three levels (0, 1 and 2) by CESES. By CP, the difference among the number of complete surgeries was significant (p=0.001) between the two levels (groups I and II). The difference between the surgery duration was significant when the two classifications were compared. In relation to the fluid deficit, just CP presented significant differences among the levels (p=0,02). CONCLUSIONS: the proposed classification includes more clues about the difficulties of the hysteroscopic myomectomy than the standard classification. It should be noted that the number of hysteroscopic myomectomies used for that analysis was modest, being interesting to evaluate the performance of the proposed classification in larger series of cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):305-309
DOI 10.1590/S0100-72032004000400007
OBJECTIVE: to develop a new preoperative classification of submucous myomas to evaluate the viability and the degree of difficulty of hysteroscopic myomectomy. METHODS: forty-four patients were submitted to hysteroscopic resection of submucous myomas. The possibility of total resection of the myoma, the surgery duration, the fluid deficit, and the incidence of complications were evaluated. The myomas were classified by the Classification of the European Society of Endoscopic Surgery (CESES) and by the classification proposed (CP) by our group, that besides the degree of penetration of the myoma in the myometrium, adds the parameters: extent of the base of the myoma as related to the uterine wall, the size of the myoma in centimeters and its topography at the uterine cavity. For statistical analysis the Fisher test, the Student t test and the analysis of variance were used. Statistic significance was considered when the p-value was smaller than 0.05 in the bicaudal test. RESULTS: in 47 myomas the hysteroscopic surgery was considered complete. There was no significant difference among the three levels (0, 1 and 2) by CESES. By CP, the difference among the number of complete surgeries was significant (p=0.001) between the two levels (groups I and II). The difference between the surgery duration was significant when the two classifications were compared. In relation to the fluid deficit, just CP presented significant differences among the levels (p=0,02). CONCLUSIONS: the proposed classification includes more clues about the difficulties of the hysteroscopic myomectomy than the standard classification. It should be noted that the number of hysteroscopic myomectomies used for that analysis was modest, being interesting to evaluate the performance of the proposed classification in larger series of cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
