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Management of Endometrial Hyperplasia With a Levonorgestrel-Releasing Intrauterine System: A Korean Gynecologic-Oncology Group Study
  1. Mi Kyoung Kim, MD,
  2. Seok Ju Seong, MD, PhD,
  3. Jae-Weon Kim, MD, PhD,
  4. Seob Jeon, MD, PhD,
  5. Ho Sun Choi, MD, PhD,
  6. In-Ho Lee, MD, PhD,
  7. Jong Hak Lee, MD, PhD,
  8. Woong Ju, MD, PhD,
  9. Eun Seop Song, MD, PhD,
  10. Hyun Park, MD, PhD,
  11. Hee-Sug Ryu, MD, PhD,
  12. Chulmin Lee, MD, PhD and
  13. Soon-Beom Kang, MD, PhD
  1. * Departments of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University;
  2. Seoul National University College of Medicine, Seoul;
  3. Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan;
  4. § Chonnam National University Medical School, Gwangju;
  5. Cheil General Hospital and Women’s Healthcare Center, Dankook University College of Medicine, Seoul;
  6. Gyeongsang National University School of Medicine, Jinju,;
  7. # Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul;
  8. ** Inha University College of Medicine, Incheon;
  9. †† CHA Bundang Medical Center, CHA University, Bundang;
  10. ‡‡ Ajou University School of Medicine, Suwon;
  11. §§ Sanggye Paik Hospital, Inje University College of Medicine; and
  12. ∥∥ Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  1. Address correspondence and reprint requests to Seok Ju Seong, MD, PhD, Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul 135-081, Republic of Korea. E-mail: sjseongcheil{at}naver.com.

Abstract

Objective The aim of the study was to evaluate the efficacy of the levonorgestrel intrauterine system (LNG-IUS) for treatment of endometrial hyperplasia (EH).

Methods A prospective multicenter study was conducted from November 2010 to March 2014. Patients with histologically confirmed EH were treated with LNG-IUS. At 3, 6, and 9 months after LNG-IUS insertion, follow-up endometrial aspiration biopsies with the LNG-IUS in the uterus were undertaken. At the 12th month of follow-up, endometrial tissues were obtained via 2 methods: endometrial aspiration biopsy with the LNG-IUS in the uterus, followed by dilatation and curettage (D&C) after LNG-IUS removal. The primary outcome was the regression rate at 12 months after LNG-IUS insertion, and the secondary outcome was the consistency of the results between the endometrial aspiration biopsy and the D&C.

Results The study population comprised 75 patients, including 37 with simple hyperplasia without atypia; 3 with atypical simple hyperplasia; 23 with complex hyperplasia without atypia, and 12 with atypical complex hyperplasia. Of these patients treated with the LNG-IUS, 38 (50.7%) were followed up at 12 months after LNG-IUS insertion. The complete regression rate at 12 months was 94.7% (36/38): 100% (6/6) of patients with atypical EH and 93.7% (30/32) with EH without atypia. In all of the cases (100%, 36/36), patients achieved complete regression within 3 months of LNG-IUS insertion. A comparison of the pathologic results from endometrial aspiration biopsy and D&C was carried out for 15 patients. In the histologic results by endometrial aspiration biopsy, 14 patients were diagnosed as “normal endometrium” and 1 as “insufficient tissue for pathologic evaluation.” Among the 14 cases of normal endometrium by endometrial aspiration biopsy, 1 was diagnosed as “residual EH” by D&C, and the 1 case with insufficient tissue was diagnosed as normal endometrium by D&C.

Conclusions Levonorgestrel intrauterine system is an effective and favorable method for treatment of EH.

  • Endometrial hyperplasia
  • Progesterone
  • LNG-IUS
  • Dilatation and curettage
  • Endometrial aspiration biopsy

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Footnotes

  • The authors declare no conflicts of interest.

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