Abstract
Objective
The objective of this study was to evaluate the potential treatment of atypical and
non-atypical endometrial hyperplasia with the levonorgestrel intrauterine system (LNG-IUS).
Study design
A prospective observational study was undertaken at Queen's Medical Centre's menstrual
disorder clinic between 2001 and 2008. Women presenting with abnormal perimenopausal
and postmenopausal bleeding, underwent an endometrial biopsy followed by the insertion
of a levonorgestrel intrauterine system (LNG-IUS). The study population comprised
of 51 patients. The histology of 32 patients (Group A) showed complex hyperplasia
without atypia, and in 19 patients (Group B), biopsy revealed atypical endometrial
hyperplasia. These patients chose to be managed conservatively with repeat sampling
of the endometrium.
Results
Group A: 28 (87.5%) patients out of 32 had regression of their endometrial hyperplasia
within the first 12 months of follow-up. Three of the patients achieved regression
by 24 months increasing regression rate to 96.8% and the remaining one had a hysterectomy
due to a rare side effect. Group B: 16 (84.2%) of 19 patients had regression of the
atypical hyperplasia after treatment with the intrauterine system within 12 months
of treatment. One patient achieved regression of the hyperplasia by 24 months and
two patients went on to have surgical management due to persistent atypia and severe
atypia respectively.
Conclusion
This study contribute further evidence that illustrates that levonorgestrel intrauterine
systems have a potential role in patients requiring non-operative management although
close follow-up is essential.
Keywords
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References
- Histological typing of female genital tract tumours.WHO International histological classification of tumours. 2nd ed. Springer-Verlag, Berlin1994
- A long term study of untreated hyperplasias in 170 patients.Cancer. 1985; 56: 403-412
- Regression of endometrial hyperplasia after treatment with the gonadotrophin – releasing hormone analogue Triptorelin: a prospective study.Hum Reprod. 1999; 14: 479-484
- Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone.Gynecol Oncol. 2003; 91: 526-533
- Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD.Clin Endocrinol (Oxf). 1982; 17: 529-536
Mirena. Summary of product characteristics, UK. Schering Health Care Ltd; February 2001.
- Intrauterine 10 microg and 20 microg levonorgestrel systems in postmenopausal women receiving oral oestrogen replacement therapy: clinical, endometrial and metabolic response.BJOG. 2002; 109: 136-144
- Use of the levonorgestrel-releasing intrauterine system and breast cancer.Obstet Gynecol. 2006; 107: 207-208
- Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up.Maturitas. 2007; 57: 210-213
- Noncontraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS) – a systematic enquiry and overview.Eur J Obstet Gynecol Reprod Biol. 2006; 125: 9-28
- Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices.Acta Eur Fertil. 1987; 18: 137-140
- Levo-norgestrel-nova- T and precancerous lesions of the endometrium.Eur J Gynaecol Oncol. 1988; 9: 284-286
- Effect of levonorgestrel IUD and oral medroxyprogesterone acetate on glandular and stromal progesterone receptors (PRA and PRB), and estrogen receptors (ER-alpha and ER-beta) in human endometrial hyperplasia.Gynecol Oncol. 2006; 101: 214-223
- Treatment of nonatypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system.Am J Obstet Gynecol. 2003; 188: 1297-1298
- The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia – a long-term follow-up study.Eur J Obstet Gynecol Reprod Biol. 2008; 139: 169-175
- Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery.Hum Reprod Suppl. 2000; 3: 162-172
- The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia.Am J Obstet Gynecol. 1989; 160.
- Treatment of endometrial hyperplasia without atypia in peri- and postmenopausal women with a levonorgestrel intrauterine device.Menopause. 2008; 15: 1002-1007
- Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only.Gynecol Oncol. 2008; 111: 68-73
- Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis.Am J Obstet Gynecol. 2010; 203: e1-10
Article info
Publication history
Published online: June 27, 2011
Accepted:
June 9,
2011
Received in revised form:
June 3,
2011
Received:
December 13,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
