Complex hyperplasia with and without atypia: clinical outcomes and implications of progestin therapy.

OBJECTIVE: Limited data exist to inform clinicians and patients as to the likelihood of long-term endometrial hyperplasia response to progestin therapy, especially for atypical hyperplasia. We evaluated women with complex and atypical endometrial hyperplasia, comparing those prescribed progestin with those not prescribed progestin. METHODS: This retrospective cohort study was conducted in 1985-2005 among women aged 18-88 years at an integrated health plan in Washington State. Women were ineligible if they achieved an outcome (endometrial carcinoma, hysterectomy, or both) within 8 weeks of hyperplasia diagnosis. Exposure was progestin use for at least 14 days by duration and recency. Outcomes included rate of 1) endometrial carcinoma, 2) hysterectomy, or 3) both. Analyses performed included Kaplan-Meier, incident rate ratios, and Cox proportional hazard ratios. RESULTS: One thousand four hundred forty-three eligible women were identified. One thousand two hundred one had complex (n=164 no progestin) and 242 had atypical (n=62 no progestin) hyperplasia. During follow-up, a median of 5.3 years (range 8 weeks to 20.8 years), 71 women were diagnosed with endometrial carcinoma (35 complex, 36 atypia) and 323 underwent hysterectomy (216 complex, 107 atypia). Among women with complex and atypical hyperplasia, rates of endometrial carcinoma among progestin users were 3.6 and 20.5 per 1,000 woman-years, respectively (compared with women who did not use progestin, 10.8 and 101.4). Among women with complex and atypical hyperplasia, rates of hysterectomy among progestin users were 23.3 and 61.4 per 1,000 woman-years, respectively (compared with women who did not use progestin, 55.1 and 297.3). CONCLUSION: Endometrial carcinoma risk is diminished approximately threefold to fivefold in women diagnosed with complex or atypical endometrial hyperplasia and dispensed progestin; hysterectomy risk is also decreased. LEVEL OF EVIDENCE: II.

Effect of temporomandibular disorder pain duration on facial expressions and verbal report of pain.

This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non-verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non-verbal behavior would increase with duration of pain. Thirty-six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration < or = 2 months). Subjects completed questionnaires assessing depression, anxiety, somatization, daily hassles and pain coping strategies. They were videotaped during a resting baseline and 2 painful conditions: experimental cold pressor pain and the clinically relevant pain of palpation of the masticatory muscles and temporomandibular joint; tapes were coded for facial expression using the Facial Action Coding System. Visual analog scale (VAS) ratings of the aversiveness and intensity of ongoing TMD pain were collected at baseline, and similar ratings of cold pressor and clinical examination pain were gathered after the painful stimulus. Recent onset and chronic cases did not differ on self-report measures of anxiety, depression, somatization or daily stress. Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self-report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline.(ABSTRACT TRUNCATED AT 250 WORDS)