title: Progression of atypical endometrial hyperplasia to adenocarcinoma despite intrauterine progesterone treatment with the levonorgestrel-releasing intrauterine system.
abstract: BACKGROUND
  Intrauterine progesterone therapy has been proposed as a potential uterine-sparing treatment for atypical endometrial hyperplasia and adenocarcinoma.
  
  
  METHODS
  We present a case of an infertility patient with atypical endometrial hyperplasia who was treated with the levonorgestrel-releasing intrauterine system for 6 months. At follow-up, she was noted to have an increasing endometrial thickness on ultrasonography, and biopsy revealed progression of her lesion to adenocarcinoma.
  
  
  CONCLUSIONS
  Although there is a need for uterine-sparing treatment for atypical endometrial hyperplasia and early adenocarcinoma, especially in the setting of desired fertility, caution should be exercised. We do not recommend using the levonorgestrel-releasing intrauterine system as a treatment for atypical hyperplasia or adenocarcinoma until further studies demonstrate the efficacy of this treatment.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa 52242-1080, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kresowik
authors.forename: G L
authors.initials: GL
authors.lastname: Ryan
authors.forename: B J
authors.initials: BJ
authors.lastname: Van Voorhis
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000517:prevention & control; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D017211:Treatment Failure
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel