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LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: a long-term comparative cohort study.
- Source :
-
Human reproduction (Oxford, England) [Hum Reprod] 2013 Nov; Vol. 28 (11), pp. 2966-71. Date of Electronic Publication: 2013 Aug 23. - Publication Year :
- 2013
-
Abstract
- Study Question: What are the regression and hysterectomy rates for women treated with the levonorgestrel-releasing intrauterine system (LNG-IUS) compared with oral progestogens for endometrial hyperplasia (EH)?<br />Summary Answer: The LNG-IUS achieves higher regression and lower hysterectomy rates than oral progestogens in the treatment of complex and atypical hyperplasia.<br />What Is Known Already: The LNG-IUS and oral progestogens are both equally used to treat women with EH. There is uncertainty about whether the LNG-IUS is a better therapy for EH.<br />Study Design, Size, Duration: This comparative cohort study included 344 women recruited from August 1998 until December 2010.<br />Participants/materials, Setting, Methods: Women with complex non-atypical or atypical EH were treated with the LNG-IUS (n = 250) or oral progestogens (n = 94) in a tertiary referral hospital. We evaluated the proportion of women who regressed or underwent hysterectomy after treatment with the LNG-IUS compared with oral progestogens by logistic regression adjusting for confounding. The time from diagnosis to regression was explored through a survival analysis.<br />Main Results and the Role of Chance: The follow-up rate was 95.3%. The mean length of follow-up in the two groups was 66.9 ± SD 35.1 months for the LNG-IUS and 87.2 ± SD 45.5 months for the oral progestogen group. Regression of hyperplasia was achieved in 94.8% (237/250) of patients with the LNG-IUS compared with 84.0% (79/94) of patients treated with oral progestogens (adjusted odds ratio (OR) = 3.04, 95% CI 1.36-6.79, P = 0.001). Hysterectomy rates were lower in the LNG-IUS group during follow-up (22.1, 55/250 versus 37.2%, 35/94, adjusted OR = 0.48, 95% CI 0.28-0.81, P < 0.004). Endometrial cancer was diagnosed in 8 (33%) women who had hysterectomy because of a failure to regress to normal histology during follow-up (n = 24).<br />Limitations, Reasons for Caution: The observational design cannot exclude residual confounding from unmeasured variables.<br />Wider Implications of the Findings: In treating EH, LNG-IUS achieves higher regression rates and lower hysterectomy rates than oral progestogens and should be the first-line therapy. Failure to achieve regression carries a high risk of underlying endometrial cancer and hysterectomy is advised.
- Subjects :
- Administration, Oral
Adult
Cohort Studies
Contraceptive Agents, Female administration & dosage
Contraceptive Agents, Female adverse effects
Endometrial Hyperplasia pathology
Female
Humans
Hysterectomy
Intrauterine Devices adverse effects
Levonorgestrel administration & dosage
Levonorgestrel adverse effects
Logistic Models
Middle Aged
Odds Ratio
Progestins administration & dosage
Progestins adverse effects
Contraceptive Agents, Female therapeutic use
Endometrial Hyperplasia drug therapy
Levonorgestrel therapeutic use
Progestins therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2350
- Volume :
- 28
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Human reproduction (Oxford, England)
- Publication Type :
- Academic Journal
- Accession number :
- 23975691
- Full Text :
- https://doi.org/10.1093/humrep/det320