医学
子宫内膜癌
孕激素
生育率
保持生育能力
子宫内膜增生
怀孕
胰岛素抵抗
内科学
肿瘤科
子宫内膜
妇科
癌症
肥胖
人口
雌激素
环境卫生
生物
遗传学
作者
Caroline J. Violette,Ravi Agarwal,Rachel S. Mandelbaum,José Luis González,Kurt Hong,Lynda D. Roman,Maximilan Klar,Jason D. Wright,Paul M. Thompson,Andreas Obermair,Koji Matsuo
标识
DOI:10.1080/14737140.2023.2194636
摘要
Most patients diagnosed with endometrial hyperplasia or cancer are obese. Obesity, along with polycystic ovarian syndrome (PCOS) and type-2 diabetes mellitus (T2DM), may act synergistically to increase risk of malignant endometrial pathology. Incidence of malignant endometrial pathology is increasing, particularly in reproductive aged women. In patients who desire future fertility, the levonorgestrel intrauterine device (LNG-IUD) is often utilized. If the first-line progestin therapy fails, there is not an effective second-line adjunct option. Moreover, pregnancy rates following fertility-sparing treatment are lower-than-expected in these patients.This clinical opinion provides a summary of recent studies exploring risk factors for the development of malignant endometrial pathology including obesity, PCOS, and T2DM. Studies assessing efficacy of fertility-sparing treatment of malignant endometrial pathology are reviewed, and a potential new adjunct treatment approach to LNG-IUD is explored.There is an unmet-need for a personalized treatment approach in cases of first-line progestin treatment failure. Glucagon-like peptide 1 receptor agonists are a class of anti-diabetic agents, but may have a role in fertility-sparing treatment of obese patients with malignant endometrial pathology by reducing weight, decreasing inflammation, and decreasing insulin resistance; these changes may also improve chances of subsequent pregnancy. This hypothesis warrants further exploration.
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