الفهرس 
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Abstract
Abstract Endometrial hyperplasia (EH) is a pre-cancerous, non-physiological, non-invasive proliferation of the endometrium that results in increased volume of endometrial tissue with alterations of glandular architecture (shape and size) and endometrial gland to stroma ratio of greater than 1:1 (Daud et al., 2011), it is a common gynecological condition that affects women of all age groups. Whereas hysterectomy is the most preferred treatment option for complex endometrial hyperplasia with atypia, there is no consensus regarding the first-line management of women with hyperplasia without cytological atypia. Oral progestagen therapy was used with some success. However, its use associated with adverse effects in up to 84% of women. Metformin, has been shown in some human studies to reverse endometrial hyperplasia. However, the effectiveness and safety of metformin for treatment of endometrial hyperplasia remain uncertain. In this context, the present study aimed to evaluate the role of adding metformin to progestagens in the treatment of endometrial hyperplasia without atypia at Mansoura University Hospitals. The study recruited 50 EH patients. They were randomly allocated to one of equal treatment groups with 25 patients each. group 1 received only progestagen treatment while group 2 received metformin in addition. All participants were subjected to careful history taking and thorough clinical examination. Comparison between the studied groups regarding the basic characteristics including age, BMI, gravidity and parity revealed no statistically significant differences. This assures that both treatment groups are well-matched regarding these data. In our study, after 12 weeks of treatment, 19 patients (76.0 %) in the progestagen-treatment group reported control of abnormal uterine bleeding. In addition, there was significant reduction of endometrial thickness as evaluated by ultrasonography. In metformin-treated patients, 21 patients (84.0 %) had controlled bleeding with significant reduction in endometrial hyperplasia. However, comparison between the studied groups regarding treatment outcomes revealed no statistically significant differences. Regarding the failed cases, 6 patients in the control group reported failure of treatment due to organic lesions and treated with hysteroscopic endometrial polypectomy and hysterectomy. In metformin group 4 patients reported failure of treatment 3 patients due to organic lesions and 1 patient due to obesity with BMI < 34, cases treated by hysteroscopic endometrial polypectomy and hysterectomy. Regarding the reported side effects, the present study found Higher rate of epigastric pain, headache, breast pain in group 1 and significant higher rate of nausea, vomiting, diarrhea, and metallic taste in group 2. CONCLUSION : from our study, we concluded that no evidence to support or refute short-term use of metformin in combination with gestagen in treatment of endometrial hyperplasia without atypia and there is no increase in the success rate. RECOMMENDATIONS : A larger study is recommended to confirm results of the present study and to discover if some patients with endometrial hyperplasia may show better response to supplementary metformin treatment.