The efficacy of levonorgestrel intrauterine device, medroxyprogesterone acetate, and norethisterone acetate in the treatment of endometrial hyperplasia without atypia

Abstract

Objectives: Pregestational treatments, which trigger apoptosis and suppress endometrium, are the gold standard therapy for endometrial hyperplasia without atypia. The levonorgestrel-intrauterine device is the first choice in current guidelines due to its low dose. Still, oral progestins have no clear evidence due to their lower regression rates and side effects. Here, we aimed to compare the regression rates, hysterectomy requirement, and the occurrence of side effects in the sixth month between the levonorgestrel-intrauterine device, norethisterone acetate, and medroxyprogesterone acetate treatment. Methods: A total of 60 patients were included. The study group was divided into three groups: levonorgestrel-intrauterine device group (n=20), norethisterone acetate group (n=20), and medroxyprogesterone acetate group (n=20). Demographic findings, body mass index, gravida, parity, comorbid diseases, regression, hysterectomy requirement, patient desire to continue treatment, and side effects such as amenorrhea, headache, weight gain, intermenstrual spotting, nausea, and breast tenderness were compared between three groups. Results: There was no statistically significant difference between the three groups regarding headache, weight gain, intermenstrual spotting, and breast tenderness. Regression rates were significantly higher in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.044) and norethisterone acetate group (p=0.020). Similarly, hysterectomy rates were significantly lower in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.031) and norethisterone acetate group (p=0.028). Amenorrhea was significantly more common in the levonorgestrel intrauterine device group than in other groups (p=0.020 for both), whereas nausea was rarer in the levonorgestrel intrauterine device group (p=0.047 for both). According to the patient’s satisfaction, the levonorgestrel intrauterine device was the most satisfactory treatment compared to medroxyprogesterone acetate and norethisterone acetate (p=0.028 and p=0.031). No significant difference was found between the medroxyprogesterone acetate and norethisterone acetate groups in terms of regression rates, hysterectomy requirements, amenorrhea, nausea, and patient satisfaction. Conclusion: Considering low hysterectomy requirement, high regression rates, and patient satisfaction, the levonorgestrel intrauterine device should be the first choice for endometrial hyperplasia without atypia as compared to oral progestins. Thus, patients must be informed about side effects and offered levonorgestrel intrauterine devices before oral progestins for endometrial hyperplasia without atypia.