Efficacy of drug treatment in patients with endometrial hyperplasia with or without atypia: a systematic review and network meta-analysis

During follow-up, some endometrial hyperplasia has progressed to endometrial cancer. Prompt treatment is crucial to improve the overall prognosis of these patients.

The authors searched PubMed, ClinicalTrials.gov and Embase for studies published from inception to 31 March 2023. The methodological quality of each study was assessed in accordance with the Cochrane Collaboration's risk of bias assessment tool. RevMan5.3 software provided by the Cochrane Collaboration was used for direct statistical analysis of meta-analyses. The relative risk and 95% confidence interval, as well as the mean difference and 95% confidence interval, were used as evaluation indices.

The authors included 21 randomised controlled trials involving a total of 2276 women with endometrial hyperplasia, 6 studies were of high quality and 15 were of moderate quality. Blinding of subjects and intervention providers was identified as the main source of potential bias.

Six treatments were studied: medroxyprogesterone acetate, metformin, norethisterone, levonorgestrel-releasing intrauterine system, megestrol acetate and other drugs.

CONCLUSION: Medroxyprogesterone acetate combined with metformin is the most effective treatment for endometrial hyperplasia. For patients who have difficulty taking their medication regularly, the levonorgestrel-releasing intrauterine system combined with metformin is an effective alternative treatment.