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Treatment of endometrial hyperplasia without atypia in peri- and postmenopausal women with a levonorgestrel intrauterine device

Haimovich, Sergio MD; Checa, Miguel A. MD, PhD; Mancebo, Gemma MD, PhD; Fusté, Pere MD; Carreras, Ramón MD, PhD

doi: 10.1097/gme.0b013e3181659837
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Objective: To assess the effectiveness of the Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) in peri- and postmenopausal women with endometrial hyperplasia without atypia.

Design: All consecutive women with histologically documented endometrial hyperplasia without atypia recruited during a 1-year period participated in an open, prospective, single-center study. They were followed for at least 2 years after levonorgestrel-releasing intrauterine system insertion. The pattern of uterine bleeding was evaluated on a 4-point qualitative scale (1 = amenorrhea, 2 = scarce, 3 = normal, 4 = abundant).

Results: The study population consisted of 15 women with a mean (SD) age of 49 (2.7) years. Compared with baseline, bleeding decreased quantitatively from a mean score of 3 at baseline (normal bleeding) to 2 (scarce) at 3and 6 months, and 1 (amenorrhea) at 24 months. Endometrial biopsies performed at 12 months revealed atrophicendometrium in 14 women (93.3%) and secretory endometrium in 1 (6.7%) (P < 0.001). At 24 months, endometrial atrophy was documented in 100% of women.

Conclusions: The levonorgestrel-releasing intrauterine system seems to be an effective and safe alternative in the treatment of peri- and postmenopausal women with (simple) endometrial hyperplasia without atypia.

In a clinical series of peri- and postmenopausal women with endometrial hyperplasia without atypia, the Mirena levonorgestrel-releasing intrauterine system was an effective and safe alternative to reduce bleeding substantially at 3 months of insertion, with complete absence of bleeding at 24 months.

From the Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Autonomous University of Barcelona, Barcelona, Spain.

Received November 12, 2007; revised and accepted December 17, 2007.

Financial disclosure: None reported.

Address correspondence to: Miguel A. Checa, MD, PhD, Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain. E-mail: macheca@imas.imim.es

©2008The North American Menopause Society