Wednesday, August 2, 2017

Adjunct Metformin helps reversal of atypical endometrial hyperplasia

Adjunct metformin treatment help reversal of atypical endometrial hyperplasia (AEH) and improves overall survival in endometrial cancer reports the result of a systematic review and meta-analysis published ahead of print in Journal of Gynecologic Oncology.

Metformin is named as ‘Magic Bullet’ by some researchers because of its new-found role in reversing aging to improving survival in many cancers, besides being in use as antidiabetic and cardioprotective drug since nearly 60 years.

Metformin was introduced for use as antidiabetic in UK in 1958.

Endometrial cancer (EC) is one of the most common gynecological cancer. The American Cancer Society estimates that about 61,380 new cases of EC of the uterus (uterine body or corpus) will be diagnosed in 2017 and about 10,920 women will succumb to the disease.

This systematic review and meta-analysis searched Cochrane, LILACS, PubMed, Scopus and Web of Science in January 2017 and included 19 eligible studies that included information about reversal of atypical endometrial hyperplasia, cellular proliferation biomarkers expression and overall survival in metformin-users compared to non-users.

In 5 studies, metformin led to reversion of AEH to a normal histology and decreased cell proliferation biomarkers staining, from 51.94% to 34.47%.

Patients on adjunct metformin had 18% increased odds of survival as compared to patients who were not diabetic and not on metformin. (HR = 0.82; CI: 0.70–0.95; p = 0.09, I2 = 40%).

Type 2 diabetes mellitus and insulin resistance is involved in the etiology of endometrial cancer (EC), so metformin may have both direct and indirect effect on tumor regression.

There was considerable heterogenicity observed between the studies but, despite that metformin was shown to be beneficial in reversal of AEH and improving overall survival in EC.

The authors call  upon future need of prospective trials regarding the anticancer effect of metformin and improving the clinical outcomes in EC.  

Primary source: Effects of metformin on endometrial cancer: Systematic review and meta-analysis

Meireles, Cinthia G. et al.
Gynecologic Oncology , Volume 0 , Issue 0 ,


  1. Q.1.How exactly the metformin acts at endometrial level? What is the phramacodynamics involving control cell proliferation at endometrial level-apoptosis?

    Q2. Is control of abnormal proliferation is - anyway related to reduce peripheral blood glucose-lowering effect induced by ingested metformin? If that is so, then can we infer that hyperglycemia itself induces hyperplasia?

    Q.3. is endometrial tissue / fluid glucose level is correlated with peripheral drum gl of the woman concern?? In many of such woman at this age of > 45 yrs  do have some mild renal impairment. Should we at all use the drug which is excreted by Kidneys just to check the progression of hyperplasia to neoplasia?
    Q. 4. Balancing the risk & benefit:-What % of Indian women with simple / complex hyperplasia with or without atypia will / may change to form hyperplasia to frank Ca- if left untreated-i.e. No metformin, no progesterone orally /Mirena?? : From drsrimantapal

  2. Z the endometrial atypia in Pcos n otherwise hav same response to metformin?

  3. Z the endometrial atypia in Pcos n otherwise hav same response to metformin?