title: Oral Progestogens Versus Levonorgestrel-Releasing Intrauterine System for Treatment of Endometrial Intraepithelial Neoplasia<sup/>.
abstract: Limited therapeutic guidelines exist regarding medical therapy, ideal dosing, duration of therapy, or recommendations for timing of endometrial reassessment for women with endometrial intraepithelial neoplasia (EIN) who desire fertility preservation or who are not optimal surgical candidates. We aimed to determine the effectiveness of oral progestogens (OP) versus the levonorgestrel-releasing intrauterine system (LNG IUS) in the medical treatment of EIN.
  
  
  
  We retrospectively identified women with EIN at our institution from 2007 through 2014 and compared the outcomes of those treated with OP versus LNG IUS.
  
  
  
  Among 390 women, 296 were initially treated with OP and 94 with LNG IUS. Baseline characteristics of the patient groups were comparable, except for higher median body mass index in the LNG IUS group versus the OP group (37 kg/m2vs. 31 kg/m2; p < 0.001). Among 332 women with follow-up endometrial biopsies (263 OP and 69 LNG IUS), EIN subcategory 1 (benign endometrial hyperplasia) resolved in 83% and 87% of patients, respectively (p = 0.31). Rates of resolution of EIN subcategory 2 (endometrial intraepithelial neoplasia) were also similar between groups (68% vs. 62%; p = 0.82). In women with EIN subcategory 3 (endometrial adenocarcinoma), 22% of those using LNG IUS and one of two women treated with OP had resolution of disease as of last follow-up.
  
  
  
  OP and LNG IUS offer similar endometrial protection for women with EIN. LNG IUS offers convenience, minimal adverse effects, reversibility, and long-term endometrial protection.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Marnach
authors.affiliation: 2 Division of Pelvic Reconstructive Surgery, Mayo Clinic Hospital , Phoenix, Arizona.
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Butler
authors.affiliation: 3 Division of Anatomic Pathology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Henry
authors.affiliation: 1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Hutz
authors.affiliation: 1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.|4 Division of Medical Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Langstraat
authors.affiliation: 5 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: 1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Petra M
authors.initials: PM
authors.lastname: Casey
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000627:therapeutic use; D004714:Endometrial Hyperplasia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D011372:Progestins / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D011372:Progestins; D016912:Levonorgestrel
keywords: endometrial adenocarcinoma; endometrial hyperplasia; endometrial intraepithelial neoplasia; levonorgestrel-releasing intrauterine system; oral progestogens