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- Title
The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: An Australian study and systematic review.
- Authors
Buttini, Melissa J.; Jordan, Susan J.; Webb, Penelope M.
- Abstract
Background: The levonorgestrel intrauterine system (LNG-IUS) provides effective contraception and treatment for menorrhagia and is used to prevent endometrial hyperplasia (EH) in women taking unopposed oestrogens. Aims: The aim of this study was to assess whether the LNG-IUS was also a safe and effective treatment for EH and to conduct a systematic review of the literature. Methods: A retrospective record review was undertaken in a private gynaecology practice in Brisbane, Australia, and included all women with EH treated with hysterectomy, oral progestins or LNG-IUS between January 2004 and April 2007. Histopathological findings from hysterectomy specimens or endometrial biopsies were used to calculate rates of regression of the EH. Results: Twenty-one women elected to have a hysterectomy and seven of those (33%) had no persisting hyperplasia at surgery. Twenty-six women had a LNG-IUS inserted at initial hysteroscopy dilatation and curettage or shortly afterwards; seven of those elected to proceed to hysterectomy when their diagnosis was known. Among ten women who used oral progestin treatment, 90% showed initial regression; two with recurrent EH were subsequently treated successfully with LNG-IUS. All 21 women (100%), including one with atypia, treated with LNG-IUS for more than seven weeks had normal endometrial histology on subsequent assessment. No women developed endometrial cancer. Pooled analysis of the published literature gave a 96% regression rate for non-atypical EH treated with LNG-IUS. Conclusions: 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.
- Subjects
LEVONORGESTREL intrauterine contraceptives; MENORRHAGIA treatment; HYPERPLASIA; HYSTERECTOMY; HISTOPATHOLOGY; ENDOMETRIOSIS; SYSTEMATIC reviews; PREVENTION
- Publication
Australian & New Zealand Journal of Obstetrics & Gynaecology, 2009, Vol 49, Issue 3, p316
- ISSN
0004-8666
- Publication type
Article
- DOI
10.1111/j.1479-828X.2009.00981.x