Reverse of Progestin-Resistant Atypical Endometrial Hyperplasia by Metformin and Oral Contraceptives

In Brief BACKGROUND: Atypical endometrial hyperplasia usually is treated with high-dose progestin or hysterectomy, but the latter deprives the patient of future child bearing. CASES: Two women with atypical endometrial hyperplasia complicating polycystic ovary syndrome (PCOS) had failed to respond to high-dose progestin therapy. They were both obese, insulin-resistant, and nulliparous with a desire to preserve fecundity. Metformin and oral contraceptives were administered as alternatives. Endometrial curettage performed 3 months later demonstrated a proliferative endometrium without evidence of residual pathology. CONCLUSION: Insulin resistance might play a role in the occurrence of atypical endometrial hyperplasia complicating PCOS. Metformin and oral contraceptives could be an alternative treatment in the presence of progestin resistance. Two cases of atypical endometrial hyperplasia complicating polycystic ovary syndrome, which did not respond to high-dose progestin therapy, were successfully treated with metformin and oral contraceptives.