FPIN's Help Desk Answers

Levonorgestrel-Releasing Intrauterine System vs. Oral Progestins for Treatment of Endometrial Hyperplasia

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2016 Jun 1;93(11):948-949.

Clinical Question

In women with endometrial hyperplasia without atypia, is the levonorgestrel-releasing intrauterine system (Mirena) or oral progestin therapy more effective in achieving complete resolution?

Evidence-Based Answer

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

Address correspondence to Sarah Liegl, MD, at sarahliegl@centura.org. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

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.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.



 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article