Oral Presentations, FC8

Abstract

Objective The LNG-IUS and oral progestogens are both equally used to treat women with endometrial hyperplasia. There is uncertainty that LNG-IUS may be better therapy for endometrial hyperplasia. This study aims to define the regression, relapse and hysterectomy rate for women treated with Levonorgestrel-releasing intrauterine system (LNG-IUS) compared to oral progestogens for endometrial hyperplasia. Methods Comparative cohort study of 344 women recruited from for allowing a 5 year follow-up for the outcome of relapse. Women with complex non-atypical or atypical endometrial hyperplasia were treated with LNG-IUS (n = 250) or oral progestogens (n = 94) in a tertiary referral hospital. We evaluated the proportion of women that regressed or had hysterectomy after treatment with LNG-IUS compared to oral progestogens by logistic regression adjusting for confounding. The time from diagnosis to regression and from regression to relapse was explored through a survival analysis. Results Follow-up rate was 95.3%. Regression of hyperplasia was achieved in 94.8% (237/250) of patients with LNG-IUS compared with 84% (79/94) of patients treated with oral progestogens (OR = 3.46, 95% CI 1. 58-7.19). Hysterectomy rates were lower in the LNG-IUS group during follow up (22.1%, 55/250 versus 37.2%, 35/94, OR = 0.48, 95% CI 0.29-0.8). Endometrial cancer was diagnosed in 8 (33%) women that had hysterectomy (n = 24) because of failure to regress to normal histology during follow-up. Relapse of hyperplasia occurred in 13.7% (21/153) of women treated with LNG-IUS compared with 30.3% (20/66) of women treated with oral progestogens (OR = 0.37, 95% CI 0.18-0.73). Relapse rates over long term follow-up were lower for complex non-atypical hyperplasia compared to atypical hyperplasia for both LNG-IUS (12.7%, 18/142 versus 27.3%, 3/11) and oral progestogens (28.3%, 17/60 versus 50%, 3/6). There were no events of relapse after 48 months from regression with oral progestogens, but some women treated with LNG-IUS relapsed after 60 months when treatment was discontinued. Endometrial cancer was diagnosed in 2 (11.8%) women that had hysterectomy (n = 17) because of relapse. Conclusion LNG-IUS achieved higher regression and lower relapse rate in treating endometrial hyperplasia with lower hysterectomy rates than oral progestogens and should be the first-line therapy. Failure to achieve regression or relapse during follow up carries a high risk of underlying endometrial cancer and hysterectomy is advised. Funding This study was funded through a grant from Wellbeing of Women (ELS022). FC8.02Feasibility study of a randomised comparison of recovery, pelvic floor and sexual function following laparoscopic hysterectomy with that following laparoscopic sub-total (supracervical hysterectomy): the LaHoST study Background The widely publicised advantage of cervical conservation at the time of abdominal hysterectomy appears unfounded. There is paucity of data with regard to the laparoscopic approach. Despite numerous observational studies suggesting an advantage...