title: Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women.
abstract: BACKGROUND
  The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women.
  
  
  METHODS
  Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists.
  
  
  RESULTS
  Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing.
  
  
  CONCLUSIONS
  In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type.
  
  
  CONCLUSIONS
  Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.
authors.affiliation: Obstetrics and Gynecology Shahid Sadoughi University of Medical Science, Yazd, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Tabatabaie
authors.affiliation: Gynecology Oncology Department, Reproductive Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Karimi Zarchi
authors.affiliation: Obstetrics and Gynecology Shahid Sadoughi University of Medical Science, Yazd, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Dehghani-Tafti
authors.affiliation: Internal Medicine, Islamic Azad University, Yazd, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Miratashi-Yazdi
authors.affiliation: Yazd Branch, Islamic Azad University, Yazd, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Teimoori
authors.affiliation: Obstetrics and Gynecology Shahid Sadoughi University of Medical Science, Yazd, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Dehghani
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D003475:Curettage; D004244:Dizziness / Q000139:chemically induced; D004714:Endometrial Hyperplasia / Q000097:blood / Q000188:drug therapy* / Q000473:pathology*; D004958:Estradiol / Q000097:blood; D005260:Female; D059247:Fertility Preservation; D006261:Headache / Q000139:chemically induced; D006801:Humans; D000077289:Letrozole; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects / Q000627:therapeutic use*; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014230:Triazoles; D004958:Estradiol; D000077289:Letrozole; D017258:Medroxyprogesterone Acetate