Oncological and Reproductive Outcomes in Premenopausal Women With Endometrial Hyperplasia with or without Atypia: A Meta-Analysis

Background: During follow-up, some patients with endometrial hyperplasia (EH) progress to endometrial cancer (EC) while others diagnosed with EH experience pathological escalation following hysterectomy. When treating premenopausal women, it is imperative to consider reproductive function, especially if they wish to preserve fertility. Methods: This study adhered to the Network Meta-Analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. We screened the PubMed, Web of Science, Cochrane Library, and Embase databases to identify relevant studies published from inception through July 31, 2023. The methodological quality of the studies was evaluated using the Cochrane Collaboration’s tool for evaluating risk of bias. RevMan version 5.3 software, provided by the Cochrane Collaboration, was used for statistical meta-analysis. Results: A total of 45 studies were selected for final analysis, including 9 randomized controlled trials. We identified a pooled complete response (CR) rate of 0.82 [95% confidence interval (CI): 0.78–0.86] among premenopausal patients with EH undergoing fertility preservation therapy. In addition, we identified a pooled assisted reproductive technology (ART) utilization rate of 0.30 (95% CI: 0.10–0.49) among premenopausal patients with EH receiving fertility preservation therapy. The pooled pregnancy rate and pooled live birth rate were 0.30 (95% CI: 0.24–0.37) and 0.24 (95% CI: 0.17–0.30), respectively. Finally, we performed a subgroup analysis in to investigate the outcomes associated with atypical forms of EH. Conclusions: Our analysis confirmed that fertility preservation in premenopausal patients with EH is effective. Following treatment, some patients achieved satisfactory fertility outcomes, while others required ART support. Despite these findings, natural conception remained the primary mode of conception. Registration: The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42023433030; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023433030).