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

Buttini, Melissa; Jordan, Susan J.; Webb, Penelope M.

doi:10.1111/j.1479-828x.2009.00981.x

Cited by 42 publications

(26 citation statements)

References 21 publications

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“…The exception to this was in the setting where the biopsy reported hyperplasia, there was clear documentation that the patient was treated with progestogen in the interim, and the hysterectomy histology was normal. In that case, due to the known effectiveness of progestogen in treating endometrial hyperplasia, 15 then the original biopsy result was considered the final outcome.…”

Section: Methodsmentioning

confidence: 99%

Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women

Wise

Gill

Lensen

et al. 2016

American Journal of Obstetrics and Gynecology

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Obesity is an important risk factor for complex endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding who had an endometrial biopsy in a secondary gynecology service. As over half of women with the outcome in this study were age <45 years, deciding to biopsy primarily based on age, as currently recommended in national guidelines, potentially misses many cases or delays diagnosis. Body mass index should be the first stratification in the decision to perform endometrial biopsy and/or to refer secondary gynecology services.

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Section: Methodsmentioning

confidence: 99%

Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women

Wise

Gill

Lensen

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Treatment options for women who have hyperplasia without atypia include cyclic medroxyprogesterone acetate at 10 mg per day for 14 days per month, continuous megestrol (Megace) at 40 mg per day, or the levonorgestrel-releasing intrauterine system [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Cyclic versus continuous medroxyprogesterone acetate for treatment of endometrial hyperplasia without atypia: a 2-year observational study

Emarh

2015

Arch Gynecol Obstet

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“…During the recent decades the levonorgestrel-impregnated intrauterine system (LNG-IUS) has been introduced as an alternative to oral therapy for endometrial hyperplasia and cohort studies as well as case reports have shown promising results (7)(8)(9)(10)(11)(12). The endometrial mucosal progestin concentration observed in LNG-IUS 63 mg users has been measured hundred-fold higher than in oral progestin users (13).…”

mentioning

confidence: 99%

Low-dose LNG-IUS as Therapy for Endometrial Hyperplasia. A Prospective Cohort Pilot Study

Sletten

Arnes

Vereide

et al. 2018

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Abstract. Background/Aim: Progestin therapy has been accepted as therapy for low-and medium-risk endometrial hyperplasia. The aim of this study was to investigate the efficacy of the low-dose levonorgestrel-impregnated intrauterine system (LNG-IUS) 13.5 mg (JaydessEndometrial carcinoma (EC) is presently the most frequent genital malignancy in women, showing a constant rise all over the Western world (1, 2). Endometrial hyperplasia, the preliminary stage of EC, undergoes malignant transformation in up to 29% of cases if left untreated (3). Women with atypical endometrial hyperplasia (AH), have been proven to have the highest risk of co-existent or future EC, have routinely been treated by hysterectomy (3-6). In contrast, conservative management with progestin therapy has been used in clinical practice for women with non-atypical endometrial hyperplasia (low-and medium risk), although consensus regarding optimal progestin agent, dose and therapy duration has never been established.During the recent decades the levonorgestrel-impregnated intrauterine system (LNG-IUS) has been introduced as an alternative to oral therapy for endometrial hyperplasia and cohort studies as well as case reports have shown promising results (7-12). The endometrial mucosal progestin concentration observed in LNG-IUS 63 mg users has been measured hundred-fold higher than in oral progestin users (13). A recent randomized national multicentre study comparing the high-dose LNG-IUS 52 mg (Mirena ® , Bayer Pharmaceuticals, Berlin, Germany) with oral progestin as therapy for low-and medium risk endometrial hyperplasia, reported 100% therapy response for LNG-IUS Mirena after 6 months therapy duration (14). Lower response rates were found for cyclic (67%) and continuous (96%) oral progestin (14).In selected cases progestin therapy has also been recommended for women with AH (high-risk). It has also been considered as an option for women desiring fertility preservation and for non-ideal surgical candidates. Recent results have demonstrated resolution of high-risk endometrial hyperplasia in 66%-85.6% after use of progestin therapy, intrauterine therapy being superior to oral administration (15)(16)(17). However, the ideal mucosal concentration of progestin for reversal of low-and medium versus high-risk endometrial hyperplasia is still unknown.

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

Abstract: These data contribute further evidence that LNG-IUS is a safe and effective method for treating non-atypical EH. Whether LNG-IUS could provide a safe and cost-effective alternative to hysterectomy for atypical EH warrants further examination.

Cited by 42 publications

References 21 publications

Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women

Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women

Cyclic versus continuous medroxyprogesterone acetate for treatment of endometrial hyperplasia without atypia: a 2-year observational study

Low-dose LNG-IUS as Therapy for Endometrial Hyperplasia. A Prospective Cohort Pilot Study

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