Treatment options for complex atypical hyperplasia of the endometrium
Dear OncoLink "Ask The Experts,"
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.