
A study examined the efficacy of adding metformin to progestin-based hormone therapy for treating atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC). Out of 280 studies, nine were eligible, involving 1104 patients. Those receiving metformin (408 patients) showed a significantly higher complete response (CR) rate for AEH (RR = 1.10, 95% CI 1.02−1.20, p = 0.02). While relapse rates did not significantly differ (RR = 0.62, 95% CI 0.33−1.17, p = 0.14), metformin correlated with increased pregnancy rates (RR = 1.28, 95% CI 1.04−1.57, p = 0.02) without notable differences in live birth rates (RR = 0.56, 95% CI 0.29−1.10, p = 0.09). These findings suggest the effectiveness of combined therapy for AEH, highlighting metformin's potential for enhancing CR and pregnancy rates, warranting further clinical investigation for determining optimal fertility-sparing treatments
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