INTRAUTERINE EFFECTS OF LEVONORGESTREL IN ENDOMETRIAL HYPERPLASIA: CLINICAL AND MORPHOLOGICAL ASPECTS

Objective. To clinically and morphologically evaluate the intrauterine effects of levonorgestrel in different forms of endometrial hyperplasia (EH). Subjects and methods. One hundred and twenty-eight patients with EH were followed up. After histological verification of the diagnosis, the Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) was inserted in all the patients. Clinical and laboratory indicators were monitored at baseline and after LNG-IUS insertion: the authors assessed hormonal and echographic parameters at a 3-month interval and endometrial morphology and immunohistochemical evidence at a 6-month interval. Results. After 6 months of LNG-IUS use, 118 (95.2%) patients had no morphological signs of EH, 6 (4.8%) preserved hyperplastic endometrial foci classified as simple EH. Therapeutic efficiency was found to be determined by the signs of endometrial glandular cellular atypia rather than a patient’s age. Thus, a complete morphological effect was achieved in all patients with simple and complex EH and only in 76.2% of those with atypical EH. Conclusion. The results obtained during the study enable one to consider it justifiable to use intrauterine LNG as a highly effective procedure for the treatment of simple and complex EH and as an alternative to that of atypical EH in reproductive-age women who are interested in becoming pregnant and to regard LNG-IUS as a method for the secondary prevention of EH.

endometrial hyperplasia, Mirena levonorgestrel-releasing intrauterine system