Dan Kuai,1,2 Jiayu Wei,1,2 Mengying Li,1,2 Lu Chen,3 Dongcan Zhang,1,2 Xiaoyan Li,1,2 Ying He,1,2 Shiqi Liu,1,2 Huiying Zhang,1,2 Wenyan Tian,1,2 Yingmei Wang1,2 

1Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 3Department of Gynecology and Obstetrics, The First People’s Hospital of Datong City, Datong, Shanxi, 037000, People’s Republic of China

Correspondence: Wenyan Tian; Yingmei Wang, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154, Anshan Road, He Ping District, Tianjin, People’s Republic of China, 300052, Tel +86 60362277; 86-022-60362255, Email tianwenyan1108@163.com; wangyingmei1978@126.com

Objective: To evaluate the therapeutic outcomes of weight loss and metformin use in patients with endometrial hyperplasia (EH), and to identify the factors influencing treatment efficacy.
Methods: This study included data from patients diagnosed with either EH or endometrial atypical hyperplasia (EAH). Patients selected a progestin treatment regimen based on their diagnosis. Those with concurrent obesity or insulin resistance received additional weight management support and metformin therapy. Follow-up assessments were conducted every 3– 6 months.
Results: A total of 202 patients were included. The metformin group exhibited significantly greater improvement in abnormal uterine bleeding (91.5% vs 57.1%, p < 0.001) and in ultrasound findings (91.5% vs 66.7%, p < 0.001) than the non-metformin group. Patients who achieved > 3% weight loss and those using metformin showed a significantly higher rate of disease reversal than those with ≤ 3% weight loss (91.2% vs 77.6%, p = 0.034) and the non-metformin group (93.2% vs 52.4%, p < 0.001). At follow-up durations exceeding 12 months, metformin use was associated with a significantly higher disease reversal rate (82.1% vs 42.9%, p = 0.048) and a lower recurrence rate (12.8% vs 28.6%, p = 0.048). Weight loss of > 3% (odds ratio: 0.041, 95% confidence interval: 0.004– 0.437, p = 0.008) and metformin use (odds ratio: 0.059, 95% confidence interval: 0.011– 0.311, p = 0.001) were both independently associated with improved reversal rates in patients with EH/EAH.
Conclusion: Combining progestin therapy with weight loss and metformin is more effective in reversing EH than progestin alone. Regular metformin use, alongside weight loss, serves as a protective factor in EH management, with the protective effect of metformin increasing with longer use.

Keywords: endometrial hyperplasia without atypia, comprehensive management, weight management, metformin