J Gynecol Oncol.  2010 Jun;21(2):102-105. 10.3802/jgo.2010.21.2.102.

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women

• Lee SY
• Kim MK
• Park H
• Yoon BS
• Seong SJ
• Kang JH
• Jun HS
• Park CT

• KMID: 2009579
• DOI: http://doi.org/10.3802/jgo.2010.21.2.102

Abstract

OBJECTIVE
Levonorgestrel releasing intrauterine system (LNG-IUS) has been shown to treat patients with non-atypical & atypical endometrial hyperplasia (EH) successfully in many western studies. Our purpose was to examine the effectiveness of LNG-IUS in the treatment of Korean women with EH.
METHODS
We conducted a prospective observational study of 12 women diagnosed with EH and treated with LNG-IUS insertion between February 2007 and August 2009 at the Department of Gynecology of Gangnam CHA Hospital, CHA University School of Medicine. Baseline endometrial biopsies were done before insertion of LNG-IUS, and outpatient follow-up endometrial biopsies were undertaken at 3-month intervals after insertion of LNG-IUS. We investigated the regression rate and the time to regression.
RESULTS
Four patients had simple hyperplasia without atypia, 7 patients complex hyperplasia without atypia, and just 1 patient complex atypical hyperplasia. Complete regression of EH was achieved in all cases (100%, 12/12), with the significant proportion (66%, 8/12) achieving it within 3 months. The mean duration to regression was 4.5 months. All cases had regression within 9 months. In the case of complex atypical hyperplasia, the regression was attained at the 9th month after insertion of LNG-IUS. The mean follow-up duration was 12 months (range, 3 to 27 months). As long as LNG-IUS was maintained, the EH did not recur.
CONCLUSION
LNG-IUS appears to be as highly effective in treating Korean women with EH.

Keyword

Endometrial hyperplasia; LNG-IUS; Korean women; Progestin; Mirena

MeSH Terms

Biopsy
Endometrial Hyperplasia
Female
Follow-Up Studies
Gynecology
Humans
Hyperplasia
Levonorgestrel
Outpatients
Prospective Studies
Levonorgestrel

Reference

1. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia: a long-term study of "untreated" hyperplasia in 170 patients. Cancer. 1985. 56:403–412.

2. Tabata T, Yamawaki T, Yabana T, Ida M, Nishimura K, Nose Y. Natural history of endometrial hyperplasia: study of 77 patients. Arch Gynecol Obstet. 2001. 265:85–88.

3. Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K, et al. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynaecol Res. 1997. 23:223–230.

4. Clark TJ, Neelakantan D, Gupta JK. The management of endometrial hyperplasia: an evaluation of current practice. Eur J Obstet Gynecol Reprod Biol. 2006. 125:259–264.

5. Montgomery BE, Daum GS, Dunton CJ. Endometrial hyperplasia: a review. Obstet Gynecol Surv. 2004. 59:368–378.

6. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol. 2001. 15:393–405.

7. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol. 1989. 160:126–131.

8. Wildemeersch D, Janssens D, Pylyser K, De Wever N, Verbeeck G, Dhont M, et al. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up. Maturitas. 2007. 57:210–213.

9. Orbo A, Arnes M, Hancke C, Vereide AB, Pettersen I, Larsen K. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only. Gynecol Oncol. 2008. 111:68–73.

10. Varma R, Soneja H, Bhatia K, Ganesan R, Rollason T, Clark TJ, et al. The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia: a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol. 2008. 139:169–175.

11. Vereide AB, Kaino T, Sager G, Arnes M, Orbo A. Effect of levonorgestrel IUD and oral medroxyprogesterone acetate on glandular and stromal progesterone receptors (PRA and PRB), and estrogen receptors (ER-alpha and ER-beta) in human endometrial hyperplasia. Gynecol Oncol. 2006. 101:214–223.

12. Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A. Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol. 2003. 91:526–533.

13. Lurain JR. Berek JS, editor. Uterine cancer. Berek & Novak's gynecology. 2007. 14th ed. Philadelphia: Lippincott Williams & Wilkins;1343–1402.

14. Phillips V, Graham CT, Manek S, McCluggage WG. The effects of the levonorgestrel intrauterine system (Mirena coil) on endometrial morphology. J Clin Pathol. 2003. 56:305–307.

15. Jadoul P, Donnez J. Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma. Fertil Steril. 2003. 80:1315–1324.