Weight loss boosts response to intrauterine progestin

Among women with obesity and atypical hyperplasia or low-risk endometrial cancer, weight loss during conservative management with intrauterine progestin improves treatment outcomes, according to a study.

The analysis included 71 women (median age 58 years, mean body mass index [BMI] 48 kg/m²) who were offered bariatric surgery or, for those who declined, encouraged to lose weight by a low-calorie diet. Researchers evaluated uptake of bariatric surgery, weight lost during progestin treatment, and the impact of >10 percent total body weight loss on progestin treatment response at 12 months.

Of the women, 23 (32 percent) had bariatric surgery on an average of 5 months following the initiation of progestin treatment. Weight change during progestin treatment was greater among women who underwent bariatric surgery than those who adopted a low-calorie diet (−33.4 kg, 95 percent confidence interval [CI], −42.1 to −24.7 vs −4.6 kg, 95 percent CI, −7.8 to −1.4; p<0.001).

More than half of the population (61 percent) responded to progestin, about a third (32 percent) achieved disease stabilization, and 7 percent progressed. Progression occurred at 3 (n=2) or 6 months (n=3) and was managed by hysterectomy (n=4) or primary radiotherapy (n=1).

Neither age nor baseline BMI predicted response to progestin. Meanwhile, women with hyperplasia were more likely to respond with progestin than those with cancer (adjusted odds ratio [OR], 3.52, 95 percent CI, 1.1 to 11.0; p=0.03).

In an analysis that excluded the five women who progressed, losing >10 percent of the total body weight correlated with almost a fourfold higher likelihood to respond to progestin (adjusted OR, 3.95, 95 percent CI, 1.3 to 12.5; p=0.02).

The findings suggest that weight loss may improve oncological outcomes in women with obesity-associated endometrial neoplastic abnormalities treated with progestin. More studies are needed to establish how best to accomplish weight loss, given its added benefits for fertility, cardiovascular health, and quality of life.