Progression of Atypical Endometrial Hyperplasia to Adenocarcinoma Despite Intrauterine Progesterone Treatment With the Levonorgestrel-Releasing Intrauterine System

Abstract

Although there is a need for uterine-sparing treatment for atypical endometrial hyperplasia and early adenocarcinoma, especially in the setting of desired fertility, caution should be exercised. We do not recommend using the levonorgestrel-releasing intrauterine system as a treatment for atypical hyperplasia or adenocarcinoma until further studies demonstrate the efficacy of this treatment.

The Levonorgestrel Intrauterine System Is an Effective Treatment in Selected Obese Women with Abnormal Uterine Bleeding

“…In their three cases who had hysterectomy for persistent atypical hyperplasia, uterine histopathologic study indicated atypical hyperplasia in two cases and stage IA endometrial cancer in the third case [34]. Additional cases of persistent atypical hyperplasia or progressing into cancer in the presence of LNG-IUS have been reported [35,36]. These observations together with the two cases of endometrial cancer raise the question of whether the LNG-IUS should be used in the presence of atypical endometrial hyperplasia.…”

The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: An Australian study and systematic review

“…Papers were included if they reported histological follow up of women diagnosed with endometrial hyperplasia and treated with a LNG‐IUS. After excluding one paper 15 which appeared to be an earlier report of a study that was later reported in full, 7 one that was second report 9 from the same study population 16 and one that reported on the effects of Progestasert®, a 65‐µg releasing device no longer available, and used unspecified criteria for histologic diagnosis, 17 we identified nine studies 7,8,10–14,16,18 and three case reports 19–21 that met the criteria for inclusion. There were no randomised controlled trials of a LNG‐IUS used for the treatment of endometrial hyperplasia.…”

Hormonal contraception and risk of endometrial cancer: a systematic review

“…However, even endometrial protection against tamoxifen-stimulated endometrial changes by using LNG-IUS was demonstrated in several studies (Gardner et al 2000, Chan et al 2007, Kesim et al 2008). All in all, it can be concluded that LNG-IUS is a promising alternative to hysterectomy for the treatment of endometrial hyperplasia, although data are too sparse to recommend treatment of early endometrial cancer, and case reports are controversial (Parazzini et al 1994, Sturgeon et al 1997, Varila et al 2001, Giannopoulos et al 2004, Dhar et al 2005, Kresowik et al 2008.…”