Use of Levonorgestrel-Releasing Intrauterine System in the Prevention and Treatment of Endometrial Hyperplasia

Abstract

Endometrial hyperplasia is a commonly seen gynecological condition that affects women of all age groups. Whereas hysterectomy is the most preferred treatment option for complex endometrial hyperplasia with atypia, there is no consensus regarding the first-line management of women with hyperplasia without cytological atypia. Oral progestogen therapy was used with some success. Nonetheless, it may be plausible to argue that women with endometrial hyperplasia need continuous treatment and high level of compliance to ensure complete regression, which may not be guaranteed with oral therapy. Observational studies suggested that levonorgestrel-releasing intrauterine system (LNG-IUS) has been successfully used to treat endometrial hyperplasia without cytological atypia and selected cases of atypical endometrial hyperplasia. Furthermore, there is strong evidence from randomized controlled trials that LNG-IUS prevents the development of endometrial hyperplasia in exogenous estrogen users; however, its protective role and safety in tamoxifen-treated breast cancer survivors remain uncertain. This article evaluates the current evidence for the use of LNG-IUS, releasing 20 μg of LNG per day, in the prevention and treatment of endometrial hyperplasia.

Target Audience: Obstetricians and gynecologists, family physicians

Learning Objectives: After completing this CME activity, phsicians should be better able to evaluate the current evidence for the use of LNG-IUS in the prevention and treatment of endometrial hyperlasia, and assess the current evidence as it relates to the endometrial protective role of LNG-IUS as an adjunct to tamoxifen in breast cancer survivors and as an adjunct to estrogen replacement therapy.