Duration-Dependent Histomorphological Alterations in Human Endometrium Following Progestin Therapy: Evidence from a Tertiary Care Center

Abstract

Objective: This research will assess the time varying histologic alterations in human endometrium during progestin therapy at a tertiary care hospital.

Materials and Methods: A retrospective observational study was at multiple tertiary care centers, in a span of three years. A total of 240 women who received progestin therapy as an indicator of different gynecological conditions were used as the sample on endometrial biopsy. The patients were stratified into four groups according to the duration of therapy: Group A (less than 3 months), Group B (3 -6 months), Group C (6 - 12 months) and Group D (more than 12 months). Blinded pathologists scored the histological parameters such as glandular atrophy, stromal decidualization, pseudosarcomatous changes and inflammatory infiltrate. ANOVA and Chi -square tests were used to conduct the statistical analysis.

Results: There were significant variations with time in all groups. Group A had a minimum of glandular atrophy (15%), whereas in Group D, the glandular atrop hy was mostly present (88.3, p<0.001). Group B (91.7) had the highest level of Stromal decidualization followed by a slow reduction in long -time treatment. Group C and D were the only groups with pseudosarcomatous stromal changes (p=0.002). The total histological score suggested that there was a progressive change in the morphology of the secretory to atrophic with the length of treatment (p<0.05).

Conclusion: Progestin treatment has specific time-contingent histomorphological changes on the endometrium. Short-term therapy is typified by decidualization, whereas the long-term exposure causes extensive atrophy in the glands and may cause stromal metaplasia. These temporal trends are critical in the process of diagnosing malignancy by pathologists to prevent a misdiagnosis of malignancy and to detect therapeutic outcomes by clinicians.