Hormonal and metabolic predictors of recurrent endometrial hyperplasia in women of late reproductive age

Abstract

DOI: 10.52705/2788-6190-2025-4-10
УДК 618.14-007.61-02:616.379-008.64-07-08

Endometrial hyperplasia is one of the most common gynecologic pathologies in women of late reproductive age and is characterized by a high recurrence rate, which is associated with infertility and precancerous transformations. Hormonal and metabolic disturbances-particularly hyperestrogenism, progesterone deficiency, insulin resistance, and obesity-play a key role in the recurrence of the disease.
The objective: to determine the characteristics of hormonal and metabolic homeostasis disorders in women of late reproductive age with recurrent endometrial hyperplasia (REH).
Materials and methods. A total of 90 women aged 36–45 years were examined and divided into three groups: 60 patients with REH, 20 women with newly diagnosed non-recurrent endometrial hyperplasia, and 10 practically healthy controls. Clinical parameters (BMI, waist circumference, blood pressure), hormonal profile (FSH, LH, estradiol, progesterone, prolactin, testosterone), metabolic indicators (glucose, insulin, HOMA-IR, lipid profile), as well as histological and ultrasound findings were evaluated. Statistical analysis included the t-test, χ2 -test, ANOVA, and Pearson correlation analysis (p < 0.05).
Results. Women with REH demonstrated significantly higher BMI values (29.8 ± 4.2 kg/m2) compared with those with primary hyperplasia (27,1 ± 3,8 kg/m2, p = 0,032) and controls (23,5 ± 2,6 kg/m2, p < 0.001). Abdominal obesity (waist > 88 cm) was identified in 68,3% of REH patients versus 40,0% and 10,0% in comparison and control groups, respectively (p < 0,001). The hormonal profile showed pronounced hyperestrogenism (E2: 210 ± 56 pmol/L, p < 0.05) and progesterone deficiency (5,2 ± 1.1 nmol/L, p < 0.01). Significant metabolic abnormalities were revealed: fasting insulin (18,5 ± 5,1 μU/mL) and HOMA-IR (4,1 ± 1,3) were higher than in primary hyperplasia (p < 0.05) and controls (p < 0.001). The most pronounced dyslipidemia was observed in the REH group (triglycerides 2,1 ± 0,5 mmol/L, HDL-C 1,0 ± 0,2 mmol/L, p < 0,05). A direct correlation was found between HOMA-IR and recurrence frequency (r = 0,46; p < 0,001), estradiol levels and endometrial thickness (r = 0,37; p = 0,014), and an inverse correlation between progesterone and proliferative changes (r = –0,44; p < 0,01).
Conclusions. Recurrent endometrial hyperplasia in women of late reproductive age is associated with combined hormonal and metabolic disturbances, supporting the role of metabolic syndrome as a leading pathogenetic factor in recurrence. Optimization of management strategies must include not only hormonal therapy but also targeted correction of metabolic abnormalities.