Skip to main content
SpringerLink
Log in

Levonorgestrel-Releasing Intrauterine Device Versus Dydrogesterone for Management of Endometrial Hyperplasia Without Atypia

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

Objective

To compare the efficacy and safety of the levonorgestrel-releasing intrauterine device (LNG-IUD) with dydrogesterone applied for the same duration in patients having endometrial hyperplasia (EH) without atypia.

Materials and Methods

One hundred thirty eight women aged between 30 and 50 years with abnormal uterine bleeding and diagnosed as EH by transvaginal ultrasound were randomized to receive either LNG-IUD or dydrogesterone for 6 months. Primary outcome measures were regression of hyperplasia after 6 months of therapy. Secondary outcome measures were occurrence of side effects during treatment or recurrence of hyperplasia during follow-up period.

Results

After 6 months of treatment, regression of EH occurs in 96% of women in the levonorgestrel-releasing intrauterine system (LNG-IUS) group versus 80% of women in the oral group (P < .001). Adverse effects were relatively common with minimal differences between the 2 groups. Intermenstrual vaginal spotting and amenorrhea were more common in the LNG-IUD group (P value .01 and .0001). Patient satisfaction was significantly higher in the LNG-IUS group (P value .0001). Hysterectomy rates were lower in the LNG-IUS group than in the oral group (P = .001). Recurrence rate was 0% in the LNG-IUD group compared to 12.5% in the oral group.

Conclusion

In management of EH without atypia, LNG-IUS achieves a higher regression and a lower hysterectomy rate than oral progesterone and could be used as a first-line therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee TS, Seong SJ, Kim JW, Ryu HS, Song ES, Nam BH. Management of endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: single arm, prospective multicenter study: Korean gynecologic oncology group study (KGOG2006). J Clin Oncol. 2011;41(6):817–819.

    Google Scholar 

  2. Lacey JV, Jr, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas. 2009;63(1):39–44.

    Article  Google Scholar 

  3. Varma R, Soneja H, Bhatia K, et al. The effectiveness of alevonorgestrel releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia–a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol. 2008;139(2):169–175.

    Article  CAS  Google Scholar 

  4. Wildemeersch D, Janssens D, Pylyser K, et al. Management of patients with non – atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up. Maturitas. 2007;57(2):210–213.

    Article  CAS  Google Scholar 

  5. Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997;90(3):434–440.

    Article  CAS  Google Scholar 

  6. Wildemeersch D, Dhont M. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol. 2003;188(5):1297–1298.

    Article  CAS  Google Scholar 

  7. Speroff L, Darney P. A Clinical Guide for Contraception. 5th ed. Philadelphia, PA: Lippincott Williams; 2010.

    Google Scholar 

  8. Bahmondes L, Petta CA, Fernandes A, Monterio I. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, pelvic pain and dysmenorrhea. Contraception. 2007;75(suppl 6):S134–S139.

    Article  Google Scholar 

  9. Lee SY, Kim MK, Park H, et al. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2): 102–105.

    Article  CAS  Google Scholar 

  10. Clark TJ, Neelakantan D, Gupta JK. The management of endometrial hyperplasia: an evaluation of current practice. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):259–264.

    Article  Google Scholar 

  11. Bese T, Vural A, Ozturk M, et al. The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia. Int J Gynecol Cancer. 2006;16(2):809–813.

    Article  CAS  Google Scholar 

  12. Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol. 1997;90(3):434–440.

    Article  CAS  Google Scholar 

  13. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol. 2001;15(3): 393–405.

    Article  CAS  Google Scholar 

  14. Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A. Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol. 2003;91(3):526–533.

    Article  CAS  Google Scholar 

  15. Gallos ID, Shehmar M, Thangaratinam S, et al. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(6):547.e1–547.e10.

    Article  CAS  Google Scholar 

  16. Lee SY, Kim MK, Park H, et al. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2): 102–105.

    Article  CAS  Google Scholar 

  17. Orbo A, Arnes M, Hancke C, Vereide AB, Pettersen I, Larsen K. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of and oral progestins versus observation only. Gynecol Oncol. 2008; 111(1):68–73.

    Article  Google Scholar 

  18. Reed SD, Voigt LF, Newton KM, et al. Progestin therapy of complex endometrial hyperplasi with and without atypia. Obstet Gynecol. 2009;113(3):655–652.

    Article  CAS  Google Scholar 

  19. Loose DS, Stancel GM. (2006). Estrogens and progestins. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill; 1541–1571.

    Google Scholar 

  20. Nick P, Haitham H, Roopen A, Michael S. The 2013 British menopause society & women’s health concern recommendations on hormone replacement therapy. Menopause Int. 2013;19(2): 59–68.

    Article  Google Scholar 

  21. Demirkiran F, Yavuz E, Erenel H, Bese T, Arvas M, Sanioglu C. Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage(D&C). Arch Gynecol Obstet. 2012;286(5):1277–1282.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, 00202, Zagazig, Egypt

    Manal M. El Behery MD, Hend S. Saleh MD, Moustafa A. Ibrahiem MD, Ebtesam M. Kamal MD, Gamal A. Kassem MD & Mohamed El Sayed Mohamed MD

Authors
  1. Manal M. El Behery MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hend S. Saleh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moustafa A. Ibrahiem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ebtesam M. Kamal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gamal A. Kassem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamed El Sayed Mohamed MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manal M. El Behery MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Behery, M.M., Saleh, H.S., Ibrahiem, M.A. et al. Levonorgestrel-Releasing Intrauterine Device Versus Dydrogesterone for Management of Endometrial Hyperplasia Without Atypia. Reprod. Sci. 22, 329–334 (2015). https://doi.org/10.1177/1933719114542014

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719114542014

Keywords

Search

Navigation