Document Detail


The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia--a long-term follow-up study.
MedLine Citation:
PMID:  18440693     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Medical treatment of non-atypical endometrial hyperplasia with oral progestogens has limited efficacy and poor compliance. A levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to successfully treat hyperplasia in small-sized studies. Our aim was to examine the effectiveness of LNG-IUS in a larger study with long-term follow up. STUDY DESIGN: Prospective observational study of 105 women diagnosed with endometrial hyperplasia and treated with LNG-IUS between 1999 and 2004 at a University Teaching hospital. Baseline characteristics and outpatient endometrial Pipelle sampling were undertaken at 3 and 6 months post LNG-IUS insertion and 6-monthly intervals thereafter in all cases. Outcome included histological data derived from both Pipelle and uterine histologies at 1 and 2 years LNG-IUS therapy. RESULTS: LNG-IUS achieved endometrial regression in 90% (94/105) of cases by 2 years, with a significant proportion (96%, 90/94) achieving this within 1 year. Regression occurred in 88/96 (92%) of non-atypical and 6/9 (67%) of atypical hyperplasias, and in all 22 cases of endometrial hyperplasia associated with HRT. Regression rates did not differ between histological types of hyperplasia. Twenty-three women (22%) underwent hysterectomy of which 13 were indicated and 10 were performed at patient request despite regressed endometrium. Two cases of cancer (one uterine and one ovarian) were identified. CONCLUSION: LNG-IUS is highly effective in treating endometrial hyperplasia. Beneficial effects are observed by the majority within 1 year. Treatment can be reliably monitored through regular 6-montly outpatient endometrial Pipelle surveillance. LNG-IUS treatment of non-atypical hyperplasias is likely to reduce the number of hysterectomies performed in this subgroup.
Authors:
Rajesh Varma; Hemi Soneja; Kalsang Bhatia; Raji Ganesan; Terence Rollason; T Justin Clark; Janesh K Gupta
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Publication Detail:
Type:  Journal Article     Date:  2008-04-28
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  139     ISSN:  0301-2115     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-01     Completed Date:  2008-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  169-75     Citation Subset:  IM    
Affiliation:
Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham B15 2TG, UK. r.varma@bham.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Aged
Aged, 80 and over
Contraceptive Agents, Female / administration & dosage*
Endometrial Hyperplasia / drug therapy*
Female
Follow-Up Studies
Humans
Hysterectomy
Intrauterine Devices, Medicated*
Levonorgestrel / administration & dosage*
Longitudinal Studies
Middle Aged
Progestins / administration & dosage,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Contraceptive Agents, Female; 0/Progestins; 797-63-7/Levonorgestrel

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