Older age, obesity, diabetes mellitus, and CAH are predictive of concurrent endometrial carcinoma in endometrial hyperplasia patients.

BACKGROUND: Though hysterectomy remains the standard treatment for complex atypical hyperplasia, patients who desire fertility or who are poor surgical candidates may opt for progestin therapy. However, the effectiveness of the levonorgestrel-releasing intrauterine device compared to systemic therapy in the treatment of complex atypical hyperplasia has not been well studied. OBJECTIVE: We sought to examine differences in treatment response between local progestin therapy with the levonorgestrel-releasing intrauterine device and systemic progestin therapy in women with complex atypical hyperplasia. METHODS: This single-institution retrospective study examined women with complex atypical hyperplasia who received progestin therapy between 2003 and 2018. Treatment response was assessed by histopathology on subsequent biopsies. Time-dependent analyses of complete response and progression to cancer were performed comparing the levonorgestrel-releasing intrauterine device and systemic therapy. A propensity score inverse probability of treatment weighting model was used to create a weighted cohort that differed based on treatment type but was similar with respect to other characteristics. An interaction-term analysis was performed to examine the impact of body habitus on treatment response, and an interrupted time-series analysis was employed to assess if changes in treatment patterns correlated with outcomes over time. RESULTS: A total of 245 women with complex atypical hyperplasia received progestin therapy (levonorgestrel-releasing intrauterine device n ¼ 69 and systemic therapy n ¼ 176). The mean age and body mass index were 36.9 years and 40.0 kg/m 2 , respectively. In the patient-level analysis, women who received the levonorgestrel-releasing intrauterine

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Both models significantly improved resident confidence (sponge, P = 0.017; tongue, P = 0.016) and knowledge (60% correct before intervention vs. 92% correct after intervention, P < 0.001). There was no difference detected between the 2 models. All participants preferred the tongue model to the sponge model. When performing both models, performing the tongue model after the sponge model resulted in a further increase in confidence (P = 0.008) CONCLUSIONS: Both models are excellent tools to aid in resident teaching of obstetric anal sphincter repair and significantly increase residents' knowledge and confidence.