title: Complex atypical hyperplasia of the endometrium: differences in outcome following conservative management of pre- and postmenopausal women.
abstract: OBJECTIVE
  To compare the safety and regression rates of conservative treatments for complex atypical hyperplasia (CAH) between pre- and postmenopausal women.
  
  
  METHODS
  Historical cohort study of pre- and postmenopausal women with CAH managed conservatively at one center (Royal Women's Hospital, Melbourne, Australia) between September 1999 to June 2012.
  
  
  RESULTS
  Of the 153 women with CAH, 92 (60%) underwent hysterectomy and the remaining 61 were managed conservatively with oral or intrauterine progestogen: 42 were premenopausal and 19 were postmenopausal. Within 12 months, 32 (76%) premenopausal women demonstrated regression of CAH and none developed endometrial cancer. In contrast, only 4 (21%) postmenopausal women showed disease regression and 4 (21%) progressed to endometrial cancer. Over a median of 24 months, 3 premenopausal women relapsed with CAH and 2 developed endometrial cancer. Four premenopausal women had successful pregnancies.
  
  
  CONCLUSIONS
  Conservative treatment with progestogen in premenopausal women with CAH leads to high regression rates within the first 12 months. In contrast, postmenopausal women have high rates of ongoing disease and cancer progression and conservative therapy should be avoided.
authors: Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia fbrownfoot@student.unimelb.edu.au.
authors: Fiona C
authors: FC
authors: Brownfoot
authors: Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.
authors: Martha
authors: M
authors: Hickey
authors: Department of Gynaecology, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.
authors: W Catarina
authors: WC
authors: Ang
authors: Department of Gynaecological Oncology, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.
authors: Vivek
authors: V
authors: Arora
authors: Department of Gynaecological Oncology, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.
authors: Orla
authors: O
authors: McNally
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000639:trends; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects; D017697:Premenopause / Q000187:drug effects; D011372:Progestins / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011372:Progestins
keywords: complex atypical hyperplasia; menopause; progestogen