Safety and efficacy of levonorgestrel-releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer

J Obstet Gynaecol Res. 2022 Dec;48(12):3219-3225. doi: 10.1111/jog.15408. Epub 2022 Aug 29.

Abstract

Aim: To investigate the recurrence rate, live-birth rate, and treatment outcomes of levonorgestrel-releasing intrauterine device (LNG-IUD) for the management of atypical endometrial hyperplasia (AEH) or Grade-1 endometrial cancer (EC) in patients who desire fertility-sparing treatment and those seeking conservative treatment without fertility preservation.

Methods: We prospectively enrolled nine patients from a single institution between April 2009 and September 2013 who were followed up for 60 months after LNG-IUD insertion.

Results: The median patient age was 35 (range: 29-39) years. The overall recurrence rate was 56% (5/9). The median interval between removal of the LNG-IUD and recurrence was 20.5 (range: 2-30) months. Three of the nine patients had Grade-1 EC, and six had AEH. The response rates to the LNG-IUD in patients with Grade-1 EC and AEH were 66% and 100%, respectively. Four patients (three with AEH, one with Grade-1 EC) experienced recurrence 6 months after MPA treatment and all 4 (100%) had complete response. Eight patients desired fertility preservation, of which 37% (3/8) conceived after receiving fertility treatment and 25% (2/8) had a live birth; the remaining three had previously received MPA for 6 months and had a recurrence; of these, 1 had a live birth.

Conclusion: LNG-IUD is effective for the management of AEH and EC in young patients who desire fertility-sparing treatment, including those ineligible for MPA owing to the presence of comorbidities and those with recurrence after MPA treatment (6-month treatment), and patients seeking conservative treatment without fertility preservation.

Keywords: endometrial adenocarcinoma; endometrial hyperplasia; fertility; levonorgestrel-releasing intrauterine system; uterine cancer.

MeSH terms

  • Adult
  • Endometrial Hyperplasia* / drug therapy
  • Endometrial Neoplasms* / drug therapy
  • Endometrial Neoplasms* / etiology
  • Female
  • Fertility Preservation*
  • Humans
  • Intrauterine Devices, Medicated* / adverse effects
  • Levonorgestrel / adverse effects

Substances

  • Levonorgestrel