Treatment options for complex atypical hyperplasia of the endometrium

Last Modified: June 27, 2004

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Question

Dear OncoLink "Ask The Experts,"
I was first diagnosed with complex hyperplasia with atypical hyperplasia in the endometrium in June 2000. I was given Provera 30mg for 3 months. The biopsy results remained the same so I was subsequently given 100mg for another 3 months. Almost immediately at the end of the course, I managed to conceive without taking any fertility pills. The baby was delivered healthy at full term. However, in Dec 2003, I was diagnosed with complex atypical hyperplasia. I was advised to have a hysterectomy. My doctor said that I may have a genetic disorder & he believes that the imbalance of estrogen and progestrone may not cause the hyperplasia. I have read that some studies in Europe found that women with this problem can be cured by using the Mirena IUD tipped with progestrone. Please comment. 

Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

Currently, the standard treatment recommendation for women with complex atypical hyperplasia of the endometrium involves removal of the uterus. Studies have demonstrated that about 15-20% of women with complex atypical hyperplasia found on endometrial biopsy may either have concurrent endometrial cancer in their uterus (not detected by the biopsy) or go on to develop endometrial cancer if left untreated.

A recent study performed in Norway used a progesterone IUD. The specific type of progesterone used was called levonorgestrel. (This IUD is marketed in the United States under the trade name "Mirena".) In this small study, only 7 women with complex atypical hyperplasia were treated, and after only three months of follow up, were shown to have normal endometrium at the time of a second endometrial biopsy or D&C. While these results sound promising, three months is a very short follow up, and 7 patients is a very small number. Larger studies will definitely be needed to investigate the effectiveness of this treatment strategy.

Given the lack of large studies demonstrating the effectiveness of the IUD as a treatment for complex atypical hyperplasia, once women have completed childbearing, I would advise strong consideration to removal of the uterus. Please discuss your concerns with your physician.