title: Relapse risk of endometrial hyperplasia after treatment with the levonorgestrel-impregnated intrauterine system or oral progestogens.
abstract: OBJECTIVE
  To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia who were randomised to either a levonorgestrel-impregnated intrauterine system (LNG-IUS; Mirena(®) ) or two regimens of oral medroxyprogesterone acetate (MPA) after primary histological response.
  
  
  METHODS
  A multicentre randomised trial.
  
  
  METHODS
  Ten different outpatient clinics localised in hospitals and seven gynaecological private practices in Norway.
  
  
  METHODS
  One hundred and fifty-three women aged 30-70 years with low- or medium-risk endometrial hyperplasia met the inclusion criteria, and 153 completed the therapy.
  
  
  METHODS
  Patients were randomly assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral MPA administered for 10 days per cycle for 6 months; or 10 mg of oral MPA administered daily for 6 months. The women were followed for 24 months after ending therapy.
  
  
  METHODS
  Histological relapse of endometrial hyperplasia.
  
  
  RESULTS
  Histological relapse was observed in 55/135 (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In the multivariable analyses relapse was dependent on menopausal status (P = 0.0005) and estrogen level (P = 0.0007).
  
  
  CONCLUSIONS
  The risk of histological relapse of non-atypical endometrial hyperplasia is high within 24 months of ceasing therapy with either the LNG-IUS or oral MPA. Continued endometrial surveillance and prolonging progestogen therapy should be considered.
  
  
  CONCLUSIONS
  Relapse of endometrial hyperplasia after successful treatment is independent of therapy regime.
authors.affiliation: Department of Clinical Pathology, University Hospital of Tromsø, Tromsø, Norway.|Research Group for Gynaecologic Oncology, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Ørbo
authors.affiliation: Research Group for Gynaecologic Oncology, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Arnes
authors.affiliation: Department of Gynaecologic Oncology, Clinic for Surgery, Cancer and Women's Disease, University Hospital of Tromsø, Tromsø, Norway.
authors.forename: A B
authors.initials: AB
authors.lastname: Vereide
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Straume
mesh_terms: D000284:Administration, Oral; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000627:therapeutic use; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000627:therapeutic use; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003271:Contraceptive Agents, Female; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
keywords: Endometrial hyperplasia; levonorgestrel-impregnated intrauterine system; medroxyprogesterone acetate relapse of endometrial hyperplasia; recurrence of endometrial hyperplasia