The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia—A long-term follow-up study

Varma, Rajesh; Soneja, Hemi; Bhatia, Kalsang; Ganesan, Raji; Rollason, T. P.; Clark, T. Justin; Gupta, Janesh

doi:10.1016/j.ejogrb.2008.02.022

Cited by 110 publications

(83 citation statements)

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“…Endometrial hyperplasia without atypia and select cases of complex atypical hyperplasia and grade 1 EC can be managed with progestin therapy if patients desire fertility preservation. [16][17][18][19] The safety of systemic progestins is unknown in women with a history of breast cancer. Synthetic progestins appear to increase the risk of breast cancer development, 20 but data regarding the use of medroxyprogesterone acetate in breast cancer survivors are lacking.…”

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

“…Thus, more localized progestin therapy (eg, the levonorgestrel intrauterine device [LNG-IUD]) is a new, effective, and popular option, but patients require counseling about unknown risks of breast cancer recurrence. 18 Another cause of AUB is uterine fibroids, which are clinically apparent in up to 25% of women. 7 Many treatment options are available for symptomatic fibroids.…”

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

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Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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“…Twelve patients participating in this study had presented (10) Values are presented as mean (range) or number (%). SH: simple hyperplasia without atypia, CHA: atypical complex hyperplasia, CH: complex hyperplasia without atypia, SD: stromal pseudodecidualization, AG: atrophic glands, IG: inactive glands, PE: consistent with Progeterone effect.…”

Section: Methodsmentioning

confidence: 99%

“…Compared with oral progesterone, LNG-IUS has been reported to have less systemic side effects and higher efficacy for the treatment of EH in many studies targeting the women of western countries. [6][7][8][9][10][11][12] LNG-IUS has been regarded as a beneficial conservative treatment modality for non-atypical and atypical EH. [8][9][10][11][12] But none of these studies have targeted Korean women.…”

Section: -4mentioning

confidence: 99%

“…Compared with oral progesterone, LNG-IUS has been reported to have less systemic side effects and higher efficacy for the treatment of EH in many studies targeting the women of western countries. [8][9][10][11][12] To our knowledge, there has been no study reporting the effectiveness of LNG-IUS in treating Korean women with EH. Considering the variation of treatment responses among the variable ethnicity, we investigated the effectiveness of LNG-IUS in treating non-atypical and atypical EH in Korean women.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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.

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Fertility Preservation in Gynecologic Malignancies

Richter

Schwartz

2011

Fertility Preservation

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The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia—A long-term follow-up study

Cited by 110 publications

References 26 publications

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

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

Fertility Preservation in Gynecologic Malignancies

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