Eficacia de la monoterapia versus terapia combinada para el tratamiento de la hiperplasia endometrial: revisión sistemática.

Abstract

Background: Endometrial hyperplasia is an abnormal proliferation of the endometrium that, if left untreated, can progress to endometrial carcinoma. Therapeutic management includes monotherapy with progestins and combination therapy with other agents, such as metformin. However, the most effective strategy to reduce histologic progression, recurrence rates, and adverse effects is still under debate. Objective: To evaluate the efficacy of combination therapy with progestins plus metformin compared to progestin monotherapy for the treatment of endometrial hyperplasia through a systematic review of scientific literature. Methods: A systematic review was conducted following PRISMA guidelines. Studies were retrieved from databases including PubMed, Scopus, Cochrane Library, and LILACS. Clinical trials and observational studies comparing monotherapy and combination therapy in patients with endometrial hyperplasia without atypia or with atypia were included. Results: Endometrial hyperplasia is a premalignant lesion with a high incidence and a significant risk of progression to endometrial cancer. This systematic review compared the efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) versus combination therapy with megestrol and metformin, revealing a higher regression rate with the LNG-IUD (91.15% vs. 81.74%). The therapeutic response was more favorable in cases of hyperplasia without atypia, and no significant differences were found based on patient age. Keywords: endometrial hyperplasia, megestrol, levonorgestrel, metformin, treatment outcome