Marnach Mary L, Butler Kristina A, Henry Michael R, Hutz Catherine E, Langstraat Carrie L, Lohse Christine M, Casey Petra M
1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
2 Division of Pelvic Reconstructive Surgery, Mayo Clinic Hospital , Phoenix, Arizona.
J Womens Health (Larchmt). 2017 Apr;26(4):368-373. doi: 10.1089/jwh.2016.5774. Epub 2016 Nov 30.
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/m vs. 31 kg/m; 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.
对于希望保留生育功能或不适合手术的子宫内膜上皮内瘤变（EIN）女性，关于药物治疗、理想剂量、治疗持续时间或子宫内膜重新评估时间的建议等治疗指南有限。我们旨在确定口服孕激素（OP）与左炔诺孕酮宫内节育系统（LNG IUS）在EIN药物治疗中的有效性。
我们回顾性确定了2007年至2014年在我院诊断为EIN的女性，并比较了接受OP治疗与LNG IUS治疗的患者的结局。
390名女性中，296名最初接受OP治疗，94名接受LNG IUS治疗。除LNG IUS组的中位体重指数高于OP组（37kg/m²对31kg/m²；p<0.001）外，两组患者的基线特征具有可比性。在332名接受子宫内膜活检随访的女性中（263名接受OP治疗，69名接受LNG IUS治疗），EIN 1类（良性子宫内膜增生）分别在83%和87%的患者中得到缓解（p=0.31）。两组EIN 2类（子宫内膜上皮内瘤变）的缓解率也相似（68%对62%；p=0.82）。在EIN 3类（子宫内膜腺癌）女性中，截至最后一次随访，使用LNG IUS的患者中有22%疾病得到缓解，接受OP治疗的两名女性中有一名疾病得到缓解。
OP和LNG IUS为EIN女性提供了相似的子宫内膜保护。LNG IUS具有方便、不良反应少、可逆性和长期子宫内膜保护的特点。
