Unfer Vittorio, Dinicola Simona, Radici Sara, Gerli Sandro

Endometrial hyperplasia is a common gynecologic disease which typically occurs when progesterone levels fail to balance the effects of estrogens. This clinical picture is further complicated by insulin resistance and hyperinsulinemia, which stimulate the cellular proliferation of the hyperplastic tissues. Up to date, standard therapeutical approaches with progestogens and aromatase inhibitors aim to restore the hormonal balance, without affecting the altered metabolic pattern of these patients. Promising but yet inconclusive results emerged by combining the progestogen-based treatments with insulin sensitizers, which proved to shorten fertility-sparing treatments for endometrial hyperplasia (EH) in case of insulin resistant obese women.

On these premises and considering that D-chiro-inositol (DCI) acts both as insulin sensitizer and aromatase down-modulator, we put forward the hypothesis to consider its supplementation as a valid adjuvant approach for EH patients, especially when insulin resistance and obesity are present. In particular, we suggest associating DCI with progestogens to shorten the treatments with these medications. This could allow patients to benefit from a natural and well tolerated molecule which can contrast insulin resistance and rebalance the unopposed estrogens at the same time.