Abstract
Objective
To compare the efficacy and safety of the levonorgestrel-releasing intrauterine device (LNG-IUD) with dydrogesterone applied for the same duration in patients having endometrial hyperplasia (EH) without atypia.
Materials and Methods
One hundred thirty eight women aged between 30 and 50 years with abnormal uterine bleeding and diagnosed as EH by transvaginal ultrasound were randomized to receive either LNG-IUD or dydrogesterone for 6 months. Primary outcome measures were regression of hyperplasia after 6 months of therapy. Secondary outcome measures were occurrence of side effects during treatment or recurrence of hyperplasia during follow-up period.
Results
After 6 months of treatment, regression of EH occurs in 96% of women in the levonorgestrel-releasing intrauterine system (LNG-IUS) group versus 80% of women in the oral group (P < .001). Adverse effects were relatively common with minimal differences between the 2 groups. Intermenstrual vaginal spotting and amenorrhea were more common in the LNG-IUD group (P value .01 and .0001). Patient satisfaction was significantly higher in the LNG-IUS group (P value .0001). Hysterectomy rates were lower in the LNG-IUS group than in the oral group (P = .001). Recurrence rate was 0% in the LNG-IUD group compared to 12.5% in the oral group.
Conclusion
In management of EH without atypia, LNG-IUS achieves a higher regression and a lower hysterectomy rate than oral progesterone and could be used as a first-line therapy.
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Lee TS, Seong SJ, Kim JW, Ryu HS, Song ES, Nam BH. Management of endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: single arm, prospective multicenter study: Korean gynecologic oncology group study (KGOG2006). J Clin Oncol. 2011;41(6):817–819.
Lacey JV, Jr, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas. 2009;63(1):39–44.
Varma R, Soneja H, Bhatia K, et al. The effectiveness of alevonorgestrel 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(2):169–175.
Wildemeersch D, Janssens D, Pylyser K, et al. Management of patients with non – atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up. Maturitas. 2007;57(2):210–213.
Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997;90(3):434–440.
Wildemeersch D, Dhont M. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol. 2003;188(5):1297–1298.
Speroff L, Darney P. A Clinical Guide for Contraception. 5th ed. Philadelphia, PA: Lippincott Williams; 2010.
Bahmondes L, Petta CA, Fernandes A, Monterio I. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, pelvic pain and dysmenorrhea. Contraception. 2007;75(suppl 6):S134–S139.
Lee SY, Kim MK, Park H, et al. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2): 102–105.
Clark TJ, Neelakantan D, Gupta JK. The management of endometrial hyperplasia: an evaluation of current practice. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):259–264.
Bese T, Vural A, Ozturk M, et al. The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia. Int J Gynecol Cancer. 2006;16(2):809–813.
Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997;90(3):434–440.
Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol. 2001;15(3): 393–405.
Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A. 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(3):526–533.
Gallos ID, Shehmar M, Thangaratinam S, et al. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(6):547.e1–547.e10.
Lee SY, Kim MK, Park H, et al. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2): 102–105.
Orbo A, Arnes M, Hancke C, Vereide AB, Pettersen I, Larsen K. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of and oral progestins versus observation only. Gynecol Oncol. 2008; 111(1):68–73.
Reed SD, Voigt LF, Newton KM, et al. Progestin therapy of complex endometrial hyperplasi with and without atypia. Obstet Gynecol. 2009;113(3):655–652.
Loose DS, Stancel GM. (2006). Estrogens and progestins. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill; 1541–1571.
Nick P, Haitham H, Roopen A, Michael S. The 2013 British menopause society & women’s health concern recommendations on hormone replacement therapy. Menopause Int. 2013;19(2): 59–68.
Demirkiran F, Yavuz E, Erenel H, Bese T, Arvas M, Sanioglu C. Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage(D&C). Arch Gynecol Obstet. 2012;286(5):1277–1282.
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El Behery, M.M., Saleh, H.S., Ibrahiem, M.A. et al. Levonorgestrel-Releasing Intrauterine Device Versus Dydrogesterone for Management of Endometrial Hyperplasia Without Atypia. Reprod. Sci. 22, 329–334 (2015). https://doi.org/10.1177/1933719114542014
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DOI: https://doi.org/10.1177/1933719114542014