title: LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: a long-term comparative cohort study.
abstract: OBJECTIVE
  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)?
  
  
  CONCLUSIONS
  The LNG-IUS achieves higher regression and lower hysterectomy rates than oral progestogens in the treatment of complex and atypical hyperplasia.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  This comparative cohort study included 344 women recruited from August 1998 until December 2010.
  
  
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The observational design cannot exclude residual confounding from unmeasured variables.
  
  
  CONCLUSIONS
  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.
authors: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK.
authors: Ioannis D
authors: ID
authors: Gallos
authors: Preeti
authors: P
authors: Krishan
authors: Manjeet
authors: M
authors: Shehmar
authors: Raji
authors: R
authors: Ganesan
authors: Janesh K
authors: JK
authors: Gupta
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007434:Intrauterine Devices / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D003271:Contraceptive Agents, Female; D011372:Progestins; D016912:Levonorgestrel
keywords: LNG-IUS; endometrial hyperplasia; oral progestogens; prospective cohort study