الفهرس 
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Chapter 1 : Endometrial hyperplasiaOnly 14 pages are availabe for public view
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Abstract
Introduction Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium which may present with abnormal uterine bleeding and considered an important risk factor for the development or even co-existence of endometrial cancer, so careful monitoring and treatment of women with this disorder is essential. Endometrial hyperplasia is an estrogen-dependent disease, Anti-estrogenic medications such as progestin and gonadotropin-releasing hormone agonists have been shown to reverse endometrial hyperplasia However, several reports had reported the potentially unfavorable vascular effects of progestin, elevation of lipid and lipoprotein levels, weight gain, mood changes as well as failure of treatment .When compared to gestagen, letrozole was found to have promising results in management of endometrial hyperplasia with less side effects.Estrogen is synthesized from cholesterol, with the final step requiring the enzyme aromatase to convert testosterone to oestrogen. Aromatase inhibitors block the aromatase cytochrome p450 enzyme, therefore reduces oestrogen concentrations. In view of the controversies surrounding treatment of endometrial hyperplasia with letrozole and the apparent lack of consensus regarding its optimum dose for overall management The aim of work: To study the outcomes of two-doses different regimens of letrozole as a therapeutic agent in management of case of endometrial hyperplasia without atypia not responding to gestagen therapy. Research Plan: A total of 46 women diagnosed with simple endometrial hyperplasia without atypia with failed gestagen therapy (for at least one year) were enrolled. Eligible participants who met the inclusion and exclusion criteria were randomly assigned to either group A included 20 patients who received letrozole in a dose of 2.5 mg daily for 3 months by non-stop regimen or group B included 20 patients who received letrozole in a dose of 5 mg daily for 3 months by non-stop regimen. Initially, all participants were evaluated by Transvaginal ultrasound to determine the uterine size, endometrial thickness and any associated uterine or adnexal pathology and first time office hysteroscopy The following data were recorded in both groups (Demographic data, risk factors, Presenting symptoms ,The method of initial diagnosis, the type of endometrial hyperplasia, Initial treatment). Assessment for patients receiving randomized treatment was made at monthly intervals by the same gynaecologist for 3 months. During and after treatment all women were followed up by:Interview and clinical evaluation,TVS for measuring endometrial thickness.Repeated endometrial biopsies if indicated (Hysteroscopy and/or D&C). Results: Significant thinning of the endometrium was observed in both groups after 3 months as compared with baseline, however, overall mean of endometrial thickness is not statistically significant between the two groups. Complete resolution occurred in 17 patients in group A (89.5 %) and 17 patients in group B (94.4 %). Static disease occurred in 3 patients, 2 from group A (10.5 %) and 1 patient from group B. These 3 patients were advised to continue on the same regimen for another 3 months, one of them (from group A) underwent hysterectomy on her own request, also the other two patients did not improve after that and underwent hysterectomy. . group B has significant higher side effects than group A. Conclusion patients with simple endometrial hyperplasia without atypia with failed Gestagen therapy can be managed successfully with Letrozole. Both dose regimens used succeeded in management of simple endometrial hyperplasia without atypia with no significant difference between them as regard the clinical, radiological or histological outcome. However, the second dose group B (5 mg) was associated with higher side effects, failure rates, cost and less patient compliance, so, group A (2.5 mg) is preferred, however further RCT are warranted to prove or disprove this.