Cochrane · systematic review · CD012214
Metformin for endometrial hyperplasia
Shiwani, H, Clement, NS, Daniels, JP, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
23
current version
GRADE rated
17
No studies
5
Included studies
NR
No studies 5 · 21.7%Ungraded 1 · 4.3%Very low 16 · 69.6%Low 1 · 4.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table ‐ Metformin compared to megestrol for endometrial hyperplasia
Population: endometrial hyperplasia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regression of endometrial hyperplasia (with or without atypia) to proliferative, secretory, or atrophic endometrium Summary of findings table ‐ Metformin vs megestrol | OR 4.89 [1.56, 15.32] | 2 studies · 83 participants | Very low Downgraded: risk of bias, imprecision |
Recurrence of endometrial hyperplasia ‐ not reported Summary of findings table ‐ Metformin vs megestrol | no estimate extracted | 0 studies · 0 participants | Ungraded |
Progression of endometrial hyperplasia to endometrial cancer Summary of findings table ‐ Metformin vs megestrol | no estimate extracted | 2 studies · 2 participants | Very low Downgraded: risk of bias, imprecision |
Hysterectomy rate Summary of findings table ‐ Metformin vs megestrol | OR 0.91 [0.05, 15.52] | 2 studies · 85 participants | Very low Downgraded: risk of bias, imprecision |
Abnormal uterine bleeding Summary of findings table ‐ Metformin vs megestrol | OR 0.91 [0.05, 15.52] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Health‐related quality of life (HRQoL) ‐ not measured Summary of findings table ‐ Metformin vs megestrol | no estimate extracted | NR | No studies |
Adverse effects during treatment ‐ not reported Summary of findings table ‐ Metformin vs megestrol | no estimate extracted | NR | No studies |
Summary of findings table ‐ Metformin + megestrol compared to megestrol for endometrial hyerplasia
Population: endometrial hyerplasia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regression of endometrial hyperplasia (with or without atypia) to proliferative, secretory, or atrophic endometrium Summary of findings table ‐ Metformin + megestrol vs megestrol | OR 3.27 [1.65, 6.51] | 4 studies · 258 participants | Low Downgraded: risk of bias, imprecision |
Recurrence of endometrial hyperplasia Summary of findings table ‐ Metformin + megestrol vs megestrol | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Progression of endometrial hyperplasia to endometrial cancer Summary of findings table ‐ Metformin + megestrol vs megestrol | OR 7.96 [0.16, 402.02] | 3 studies · 156 participants | Very low Downgraded: risk of bias, imprecision |
Hysterectomy rate Summary of findings table ‐ Metformin + megestrol vs megestrol | OR 7.39 [0.15, 372.38] | 2 studies · 72 participants | Very low Downgraded: risk of bias, imprecision |
Abnormal uterine bleeding ‐ not measured Summary of findings table ‐ Metformin + megestrol vs megestrol | no estimate extracted | NR | No studies |
Health‐related quality of life (HRQoL) ‐ not measured Summary of findings table ‐ Metformin + megestrol vs megestrol | no estimate extracted | NR | No studies |
Adverse effects during treatment Summary of findings table ‐ Metformin + megestrol vs megestrol | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) compared to levonorgestrel intrauterine system for endometrial hyperplasia
Population: endometrial hyperplasia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regression of endometrial hyperplasia (with or without atypia) to proliferative, secretory, or atrophic endometrium Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 3.42 [0.13, 88.4] | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Recurrence of endometrial hyperplasia ‐ not reported Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | no estimate extracted | NR | No studies |
Progression of endometrial hyperplasia to endometrial cancer Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision |
Hysterectomy rate Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 0.12 [0.01, 1.95] | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Abnormal uterine bleeding Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 0.61 [0.16, 2.27] | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects during treatment ‐ all effects Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 4 [1.15, 13.9] | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects during treatment ‐ nausea Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 5.11 [1.21, 21.68] | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects during treatment ‐ heaviness in lower abdomen Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 1.38 [0.32, 5.85] | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects during treatment ‐ pain in abdomen Summary of findings table ‐ Metformin + levonorgestrel (intrauterine system) vs levonorgestrel intrauterine system | OR 0.83 [0.22, 3.18] | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Metformin compared with megestrol acetate for endometrial hyperplasia
Population: women with endometrial hyperplasia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regression of endometrial hyperplasia (with or without atypia) towards normal histology Assessed by histological examination Metformin vs megestrol acetate | OR 3.34 [0.97, 11.57] | 2 studies · 59 participants | Very low Downgraded: risk of bias, imprecision |
Recurrence of endometrial hyperplasia Metformin vs megestrol acetate | no estimate extracted | 0 studies · 0 participants | Ungraded |
Progression of endometrial hyperplasia to endometrial cancer Assessed by histological examination Metformin vs megestrol acetate | no estimate extracted | 2 studies · 59 participants | Very low Downgraded: risk of bias, imprecision |
Hysterectomy rate Metformin vs megestrol acetate | OR 0.91 [0.05, 15.52] | 2 studies · 61 participants | Very low Downgraded: risk of bias, imprecision |
Abnormal uterine bleeding Assessed by self‐report Metformin vs megestrol acetate | OR 0.91 [0.05, 15.52] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Health‐related quality of life (HRQL) Metformin vs megestrol acetate | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effects during treatment Metformin vs megestrol acetate | no estimate extracted | 0 studies · 0 participants | Ungraded |
Metformin plus megestrol acetate compared with megestrol acetate for endometrial hyperplasia
Population: women with endometrial hyperplasia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regression of endometrial hyperplasia (with or without atypia) towards normal histology Assessed by histological examination Metformin plus megestrol acetate vs megestrol acetate | OR 9 [0.94, 86.52] | 1 study · 16 participants | Very low Downgraded: risk of bias |
Recurrence of endometrial hyperplasia Metformin plus megestrol acetate vs megestrol acetate | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias |
Progression of endometrial hyperplasia to endometrial cancer Metformin plus megestrol acetate vs megestrol acetate | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias |
Hysterectomy rate Metformin plus megestrol acetate vs megestrol acetate | OR 0.29 [0.01, 8.37] | 1 study · 16 participants | Very low Downgraded: risk of bias |
Abnormal uterine bleeding Metformin plus megestrol acetate vs megestrol acetate | no estimate extracted | 0 studies · 0 participants | Ungraded |
Health‐related quality of life (HRQL) Metformin plus megestrol acetate vs megestrol acetate | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effects during treatment Assessed self‐report Metformin plus megestrol acetate vs megestrol acetate | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias |