title: Fertility-preserving treatment in complex atypical hyperplasia and early endometrial cancer in young women with oral progestin: Is it effective?
abstract: OBJECTIVE
  The aim of this study is to assess the effectiveness of oral progestin treatment in women diagnosed with complex atypical hyperplasia (CAH) or grade 1 endometrial cancer (G1EC), who desire to preserve their fertility, as alternative treatment to a hysterectomy.
  
  
  METHODS
  We reviewed the medical records of women younger than 45 years old that had been diagnosed with CAH or G1EC, who expressed a desire to preserve their fertility using alternative treatment at our institution. Women without evidence of myometrial invasion on pelvic magnetic resonance imaging scans were included. The study period was between 2004 and 2014. Endometrial biopsies were taken at follow-up appointments.
  
  
  RESULTS
  We identified 31 young women with CAH or G1EC. The median age was 33 years old (range, 20 to 41), and the median period of time undertaking the treatment was 5 months (range, 1 to 12). Twenty-three patients (74.2%) achieved complete remission (CR; median time to CR was 3 months; range, 1 to 22), 16 patients (88.9%) with CAH and 7 (53.8%) with G1EC achieved CR. 6 patients (26.1%) who had achieved CR, had recurrence of the disease (median time from CR to recurrence was 12.5 months; range, 4 to 18). Eight patients (25.8%) finally underwent a hysterectomy.
  
  
  CONCLUSIONS
  Oral progestin therapy is an alternative treatment for women with CAH or G1EC who desire fertility preservation. However, more prospective studies are needed for standard progestin regimen. Also, there still remains a risk of disease progression and recurrence. Therefore, close follow-up is important during treatment and after CR. In addition, a hysterectomy is recommended as a definitive treatment after completion of childbearing.
authors: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors: Ji Sun
authors: JS
authors: Baek
authors: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors: Wan Ho
authors: WH
authors: Lee
authors: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors: Woo Dae
authors: WD
authors: Kang
authors: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors: Seok Mo
authors: 0000-0003-2318-0334
authors: SM
authors: Kim
keywords: Endometrial cancer; Endometrial hyperplasia; Fertility; Progestins