Levonorgestrel-releasing intrauterine system versus oral progestogens for non-atypical endometrial hyperplasia: predictors for treatment failure
Keywords:Endometrial hyperplasia, Levonorgestrel, Medroxyprogesterone, Metrorrhagia, Norethisterone, Recurrence
Objective: This study aims to compare treatment outcomes of a levonorgestrel-releasing intrauterine system (LNG-IUS) or oral progestogens in women with non-atypical endometrial hyperplasia (EH). Additionally, the predictors for EH non-regression were determined.
Methods: Medical records of women diagnosed with non-atypical EH between April 2016 and March 2022 at Tuen Mun Hospital were retrieved. These patients were offered LNG-IUS as the first-line option or oral progestogens if they refused or had LNG-IUS contraindications such as submucosal fibroid distorting endometrial cavity. The rate of EH non-regression at 12 months and the rate of EH relapse at 24 and 36 months between groups were compared. Univariate and multivariate analyses were conducted to identify predictors for EH non-regression.
Results: The median follow-up duration was 24 months for the LNG-IUS group and 19 months for the oral progestogens group. The rate of EH regression at 12 months was higher in the LNG-IUS group (93.9% vs 71.2%, p<0.001). The rate of EH relapse was higher in the oral progestogens group at 24 months (21.1% vs 1.1%, p=0.003) and 36 months (33.3% vs 2.3%, p=0.014). The incidence of hysterectomy for treatment failure was higher in the oral progestogens group (13.7% vs 4.2%, p=0.005). No EH relapse occurred in either group after 36 months post-treatment. Predictors for EH non-regression were postmenopausal status (odds ratio=5.80, p=0.022) and oral progestogens treatment (odds ratio=7.51, p<0.001).
Conclusion: In women with non-atypical EH, treatment with LNG-IUS leads to a higher regression rate at 12 months, a lower relapse rate within 36 months, and a lower rate of hysterectomy due to treatment failure, compared with treatment with oral progestogens. Postmenopausal status and treatment with oral progestogens are risk factors for treatment failure. Regular endometrial surveillance should be provided to women at risk. Hysterectomy is recommended for postmenopausal women.
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