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Question clinique
What is the observed treatment response using a levonorgestrel-releasing intrauterine device versus systemic progestin therapy for patients with atypical hyperplasia of the endometrium?
L’Essentiel
In this relatively small observational study at a single institution, the levonorgestrel-releasing intrauterine device (LNG-IUD) resulted in higher rate of complete resolution of complex atypical endometrial hyperplasia than systemic progestin therapy. Complete resolution was more marked among obese women with a body mass index of at least 40 kg/m2. 2b
Référence
Plan de l'etude: Cohort (retrospective)
Financement: Unknown/not stated
Cadre: Outpatient (specialty)
Sommaire
Although the gold standard of treatment for complex atypical endometrial hyperplasia is still hysterectomy, progestin therapy has been used for women who prefer to avoid surgery and/or preserve fertility. This cohort study (N = 245) analyzed the outcomes for women from one institution who chose treatment with progestin therapy, comparing local progestin therapy with LNG-IUD (n = 69) with systemic progestin (n = 176). All women underwent suction curettage prior to initiation of progestin therapy. Systemic therapy was with oral medroxyprogesterone acetate for the majority of women (140/176; 79%). The majority of women were Hispanic (65%), obese (84%), and nulligravid (52%). During the follow-up period, 120 (49%) women eventually underwent hysterectomy, and 28 (11%) women progressed to endometrial cancer. All of the incident cancers were well-differentiated and did not recur after hysterectomy during follow-up for a median of 42 months. Complete resolution of complex atypical endometrial hyperplasia within 1 year favored the LNG-IUD group (78% vs 47%; P < .001). Similarly, the rate of progression to cancer was decreased in the LNG-IUD group (5% vs 16%; P = .006). Sensitivity analysis based on obesity classes indicated the morbidly obese group (body mass index of at least 40 kg/m2) had the most marked benefit (adjusted complete response rate 4.72; 95% CI 2.8 - 7.9). Of note is that the use of LNG-IUD rose markedly over the course of the study period.
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH