Treatment of Endometrial Hyperplasia: Mirena is Superior to Oral Progesterone

Author: John
Time: 2019/8/20 16:51:20

Endometrial hyperplasia can be divided into four types according to histological manifestations: simple hyperplasia, complex hyperplasia, simple atypical hyperplasia, and complex atypical hyperplasia. 

Untreated endometrial hyperplasia may develop into endometrial cancer, simple hyperplasia usually does not develop into endometrial cancer (the risk is 1%), but complex atypical hyperplasia has an endometrial cancer risk of about 25%.

The incidence of endometrial cancer ranked second among female genital tumors, about 25.7/100000. Most endometrial carcinomas are endometrioid adenocarcinomas with precancerous lesions.


There are several known risk factors for endometrial hyperplasia and endometrial cancer: excessive estrogen (whether increased synthesis in obese women or ingestion of non-antagonistic estrogen can lead to changes in gland proliferation), diabetes, unproductive women and polycystic ovary syndrome.

If the main symptom of the patient is irregular vaginal bleeding, endometrial lesions should be suspected. Ultrasonography can help exclude other lesions (polyps, uterine leiomyomas) and assess the thickness and status of the endometrium.

Endometrial tissue samples can further assist in diagnosis, clinicians can obtain tissue samples by diagnostic curettage, Pipelle biopsy or hysteroscopy. However, the above methods may miss diagnosis and produce false-negative results. Once diagnosed as endometrial hyperplasia, surgery or medication is required. If drug treatment is considered, which drug treatment is more effective?

Professor Hashim, Department of Obstetrics and Gynecology, University of Mansoura, Egypt, summarized the research on the efficacy of levonorgestrel intrauterine device (LNG-IUS) and oral progesterone in the treatment of endometrial hyperplasia without atypical hyperplasia and published the results in Am J Obestet Gynecol.


The systematic review includes the results of seven randomized controlled trials. The study included only patients without atypical hyperplasia who were treated with LNG-IUS or oral progesterone and followed up for 3-24 months. Results analysis included 766 patients (329 patients treated with LNG-IUS and 437 patients treated with oral progesterone includes medroxyprogesterone acetate, norethisterone acetate, and dydrogesterone acetate).

The study found that patients treated with LNG-IUS were significantly better than those treated with oral progesterone. The longer the follow-up time is, the more obvious the advantage of LNG-IUS will be. At 24 months, OR was 7.46. LNG-IUS is superior to oral progesterone in the treatment of simple or complex hyperplasia. 

However, there was no significant difference in the frequency of irregular vaginal bleeding between the two groups. The LNG-IUS group was significantly less likely to require hysterectomy than the oral progesterone group.

The specific treatment of endometrial hyperplasia is a hysterectomy, but surgical treatment is not suitable for all patients. Some patients still want to retain their reproductive capacity, while others are physically unable to withstand the surgical treatment. In these cases, patients can be given long-term high-dose progesterone treatment. 

Progesterone has an anti-proliferative effect and can also reduce further gland mutation. Patients can also take Fuyan Pill which is natural and safe without side effects. It has the functions of activating blood circulation and removing blood stasis, clearing away heat and dampness. It can effectively treat endometrial hyperplasia, repair your endometrium, balance Qi and blood.


LNG-IUS has several advantages over oral preparations. Firstly, the compliance is better than oral preparation. Secondly, because LNG-IUS is administered locally rather than systemically, compared with oral preparations, the local concentration of progesterone significantly increased to achieve the effect of intrauterine treatment, the treatment effect is better.

In conclusion, LNG-IUS is superior to oral progesterone in the treatment of simple or complex endometrial hyperplasia. However, randomized trials only included patients without atypical hyperplasia. The follow-up time of most studies is less than one year, the long-term follow-up effect still needs further study. Because there is no data to show that LNG-IUS is effective in patients with atypical hyperplasia, such cases still need to be treated with caution.

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