The levonorgestrel-releasing intrauterine system for atypical endometrial hyperplasia

Atypical endometrial hyperplasia commonly develops into endometrial carcinoma, which is the most common gynaecologic cancer in the world. The levonorgestrel-releasing intrauterine system (LNG-IUS) is thought to reduce the risk of endometrial hyperplasia. However, this review of the evidence found no randomised controlled studies (RCTs) of the efficacy and safety of the LNG-IUS for treating women with a diagnosis of atypical endometrial hyperplasia. RCTS are required in this area.

Authors' conclusions: 

There is no evidence available from randomised controlled trials regarding the efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) for atypical endometrial hyperplasia. RCTS are required to determine whether the LNG-IUS is safe and effective for treating atypical endometrial hyperplasia.

Read the full abstract...
Background: 

Endometrial carcinoma is the most common gynaecologic malignancy in the world and develops through preliminary stages of endometrial hyperplasia. Typical endometrial hyperplasia suggests a significant pre-malignant state with frank progression to endometrial carcinoma. Because atypical endometrial hyperplasia tends to occur at a young age, it has become increasingly important and necessary to find a safe and effective fertility-sparing treatment with better tolerability and fewer side effects than the options for treatment that are currently available. The levonorgestrel-releasing intrauterine system has already been used to provide endometrial protection in women with breast cancer who are on adjuvant tamoxifen. The antiproliferative function of levonorgestrel is thought to reduce the risk of endometrial hyperplasia.

Objectives: 

To determine the efficacy and safety of the levonorgestrel-releasing intrauterine system in reversing atypical endometrial hyperplasia.

Search strategy: 

In November 2012 we searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library; MEDLINE; EMBASE; and the China National Knowledge Infrastructure for relevant trials. Attempts were made to identify trials from references in published studies. We also searched for ongoing trials in five major clinical trials registries.

Selection criteria: 

Randomised controlled trials (RCTs) of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus progestin therapy in women with a confirmed histological diagnosis of simple or complex endometrial hyperplasia with atypia.

Data collection and analysis: 

No eligible study was found.

Main results: 

We did not identify any studies which met our full inclusion criteria.

Share/Save