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Hormone Therapy Effects on the Uterus

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Hormonal Pathology of the Uterus

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1242))

Abstract

The uterus and especially the endometrium are sensitive targets for steroid sex hormones, capable to modify structure and function with promptitude and versatility in order to secure reproductive functions. Hormone therapy is used to counteract deprivation, abnormal, and deleterious functions of “natural” hormones. It is widely prescribed, being used by millions of women all over the world. It seems that most women would use at least some hormone therapy at some point of their life, as contraceptives, ovarian stimulation, replacement therapy, or hormone antitumoral therapy. The diagnosis of uterine tissue, mostly of the frequently performed endometrial biopsies taken from women undergoing hormone therapy, is often confusing and difficult to interpret due to the complexity of histologic changes. Permanently changing hormonal pharmaceutical products, regimens, dosages, as well as new concepts of therapy are challenges for both users and medical prescribers. This chapter addresses the most commonly issues arising from the gynecological pathology interpretation of hormonal therapy effects on the uterus.

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References

  1. Kase NG. The normal ovary part II: how steroid hormones work. In: Deligdisch L, Kase N, Cohen CJ, editors. Altchek’s diagnosis and management of ovarian disorders. 3rd ed: Cambridge University Press; 2013. p. 37–63.

    Google Scholar 

  2. Kelley HW, Miles PA, Buster JE, Scragg W. Adenocarcinoma of the endometrium in women taking sequentially oral contraceptives. Obstet Gynecol. 1976;47:200–2.

    Google Scholar 

  3. Silverberg SG, Makovski EL. Endometrial carcinoma in young women taking oral contraceptive agents. Obstet Gynecol. 1975;46:503–6.

    CAS  PubMed  Google Scholar 

  4. Mutter GL, Bergeron C, Deligdisch L, Ferenczy A, Glant M, Merino M, Williams AR, Blithe DL. The spectrum of endometrial pathology induced by progesterone receptor modulators. Mod Pathol. 2008;21:591–8.

    Article  CAS  Google Scholar 

  5. Kathpalia SK, Kapoor K, Sharma A. Complications in pregnancies after in vitro fertilization and embryo transfer. Med J Armed Forces India. 2016;72:211–4.

    Article  CAS  Google Scholar 

  6. Kushnir VA, Soloukis S, Sang-Moth-Vega MG, Albertini DF, Darmon SK, Deligdisch L, Barad DM, Gleicher N. Systemic inflammation and autoimmunity in women with chronic endometritis. Am J Reprod Immunol. 2016;75:672–7.

    Article  CAS  Google Scholar 

  7. Minig L, Franchi D, Boveri S, Casadio C, Bocciolone L, Sideri M. Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women. Ann Oncol. 2011;22:643–9.

    Article  CAS  Google Scholar 

  8. Deligdisch L, Hirschmann S, Altchek A. Pathologic changes in gonadotropin releasing hormone agonist analogue treated uterine leiomyomata. Fertil Steril. 1997;67:837–41.

    Article  CAS  Google Scholar 

  9. Donnez J, Tatarchuk TF, Bouchard P, et al. Ullipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012;366:409–20.

    Article  CAS  Google Scholar 

  10. Gusberg SB. Precursors of corpus carcinoma: estrogens and adenomatous hyperplasia. Am J Obstet Gynecol. 1974;54:905–27.

    Article  Google Scholar 

  11. Kistner R. Alterations associated with estrogen-and estrogen-progestin combinations. In: The uterus. Baltimore MD: The Williams and Wilkins Co.; 1973, Monograph No 14, Chapter 12.

    Google Scholar 

  12. Kase NG. A clinical approach to post-menopausal hormone therapy. In: Altchek’s diagnosis and management of ovarian disorders; 2013. p. 314–7. Chapter 20: Menopause.

    Google Scholar 

  13. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002;288:321–33.

    Article  CAS  Google Scholar 

  14. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24:728–53.

    Article  Google Scholar 

  15. Deligdisch L, Kase NG, Bleiweiss IJ. Endometrial cancer in elderly women: a histologic and steroid receptor study. Gerontology. 2000;46:17–21.

    Article  CAS  Google Scholar 

  16. Bereford SA, Weiss NS, Voigt LF, McKnight B. Risk of endometrial Cancer in relation to use of estrogen combined with cyclic progestogen therapy in post-menopausal women. Lancet. 1997;349:458–61.

    Article  Google Scholar 

  17. Zaino RJ, Brady WE, Todd W, Leslie K, Fischer EG, Horowitz NS, Mannel RS, Walker JL, Ivanovic M, Duska LR. Histologic effects of medroxyprogesterone acetate on endometrial adenocarcinoma: a Gynecologic Oncology Group study. Int Gynecol Oncol. 2014;33:543–53.

    CAS  Google Scholar 

  18. Patell B, Figueroa S, Thakore S, Dahoud W, Bedalwy M, Messiano S. Role of nuclear progesterone receptor isoforms in uterine pathophysiology. Hum Reprod Update. 2014;21:155–73.

    Article  Google Scholar 

  19. Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997;90:434–40.

    Article  CAS  Google Scholar 

  20. Falcone F, Laurelli G, Losito S, DiNapoli M, Granata V, Greggi S. Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer. J Gynecol Oncol. 2017;28(1):e2. https://doi.org/10.3802/jgo.2017.28.e2.

    Article  PubMed  Google Scholar 

  21. Inoue O, Hamatani T, Susumu N, Yamagami W, Ogawa S, Takemoto T, Hirasawa A, Banno K, Kuji N, Tanaka M, Aoki D. Factors affecting pregnancy in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia. Reprod Biol Endocrinol. 2016;14:2. https://doi.org/10.1186/s12958-015-0136-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. van Gent MD, Nicolae Cristea AR, de Kroon CD, Osse EM, Kagie MJ, Trimbos JB, Hazelbag HM, Smit VT, Bosse T. Exploring morphologic and molecular aspects of endometrial cancer under progesterone treatment in the context of fertility preservation. Int J Gynecol Cancer. 2016;26(3):483–90. https://doi.org/10.1097/IGC.0000000000000629.

    Article  PubMed  Google Scholar 

  23. Mentrikovsky MJ, Shah AA, Hanley KZ, Atkins KA. Assessing endometrial hyperplasia and carcinoma treated with progestin therapy. Am J Clin Pathol. 2012;138:524–34.

    Article  Google Scholar 

  24. Schlesinger C, Kamoi S, Ascher S, Kendell M, Lage JM, Silverberg SG. Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups. Int J Gynecol Pathol. 1998;17:302–11.

    Article  CAS  Google Scholar 

  25. Deligdisch L, Kalir T, Cohen CJ, De Latour M, Le Bouedec G, Penault-Llorca F. Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer. Gynecol Pathol. 2000;78:181–6. Selected for Breast Diseases: A Yearbook Quarterly 2001, publ. Mosby Yearbook Inc.

    CAS  Google Scholar 

  26. Dieudonne AS, Lambrechts D, Smeets D, Belmans A, Wildiers H, Paridaens R, Hyonil C, Timmerman D, Christiaens MR, Vergote I, Neven P. The rs 1800716 variant in CYP2D6 is associated with an increased double endometrial thickness in post-menopausal women on tamoxifen. Ann Oncol. 2014;25:90–5.

    Article  Google Scholar 

  27. Magriples U, Naftolin F, Schwartz PE, Carcangiu M. High-grade endometrial carcinoma in tamoxifen-treated breast cancer patients J. Clin Oncol. 1993;11:485–90.

    Article  CAS  Google Scholar 

  28. Clement PB, Oliva E, Young RH. Mullerian adenosarcoma of the uterine corpus associated with tamoxifen therapy: a report of six cases and a review of tamoxifen-associated lesions. Int J Gynecol Pathol. 1996;15:222–9.

    Article  CAS  Google Scholar 

  29. Robinson DC, Bloss JD, Schiano MA. A retrospective study of tamoxifen and endometrial cancer in breast cancer patients. Gynecol Oncol. 1995;59:186–90.

    Article  CAS  Google Scholar 

  30. Hrstka R, Podhorec J, Nenutil R, Sommerova L, Obacz J, Durech M, Faktor J, Bouchal P, Skoupilova H, Vojtesek B. Tamoxifen-dependent induction of AGR2 is associated with increased aggressiveness of endometrial cancer cells. Cancer Investig. 2017;35:313–24.

    Article  CAS  Google Scholar 

  31. Gizzo S, Gangi S, Bertocco A, Noventa M, Fagherazzi S, Ancona E, Saccardi C, Patrelli TS, D’Antona D, Nardelli GB. Levonogestrel intrauterine system in adjuvant tamoxifen treatment: balance of breast risks and endometrial benefits-systematic review of literature. Reprod Sci. 2014;21:423–31.

    Article  Google Scholar 

  32. Saccardi C, Gizzo S, Patrelli TS, Ancona E, Anis O, Di Gangi S, Vacillotto A, D’Antona D, Nardelli GN. Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study. Endocr Relat Cancer. 2013;20:455–62.

    Article  Google Scholar 

  33. Lee Y, Park YR, Kim HR, Lee JW. Event-free survival following early endometrial events in breast cancer patients treated with anti-hormonal therapy. A nationwide claims data study. Medicine (Baltimore). 2019;98:e13976.

    Article  CAS  Google Scholar 

  34. Deligdisch L. Hormonal pathology of the endometrium. Mod Pathol. 2000;13:285–94.

    Article  CAS  Google Scholar 

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Deligdisch-Schor, L. (2020). Hormone Therapy Effects on the Uterus. In: Deligdisch-Schor, L., Mareş Miceli, A. (eds) Hormonal Pathology of the Uterus . Advances in Experimental Medicine and Biology, vol 1242. Springer, Cham. https://doi.org/10.1007/978-3-030-38474-6_8

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