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Levonorgestrel-Releasing Intrauterine System vs. Oral Progestins for Treatment of Endometrial Hyperplasia
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Am Fam Physician. 2016 Jun 1;93(11):948-949.
In women with endometrial hyperplasia without atypia, is the levonorgestrel-releasing intrauterine system (Mirena) or oral progestin therapy more effective in achieving complete resolution?
The levonorgestrel-releasing intrauterine system achieves significantly higher resolution rates of endometrial hyperplasia without atypia compared with cyclic oral progestins (68% to 100% vs. 48% to 69%, respectively). (Strength of Recommendation [SOR]: A, based on consistent randomized controlled trials [RCTs].) Treatment with continuous oral progestins for six months is also more effective than cyclic progestins (96% vs. 69%) and is comparable to the levonorgestrel-releasing intrauterine system. (SOR: B, based on an RCT.)
Researchers randomized 120 premenopausal women with abnormal uterine bleeding and non-atypical simple or complex endometrial hyperplasia to receive a levonorgestrel-releasing intrauterine system (n = 59) or oral norethindrone (n = 61).1 Endometrial hyperplasia was initially diagnosed by dilation and curettage; endometrial biopsy was performed for follow-up. Women in the norethindrone
1. Abu Hashim H, Zayed A, Ghayaty E, El Rakhawy M. LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial. J Gynecol Oncol. 2013;24(2):128–134.
2. Dolapcioglu K, Boz A, Baloglu A. The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study. Clin Exp Obstet Gynecol. 2013;40(1):122–126.
3. Orbo A, Vereide A, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG. 2014;121(4):477–486.
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