This study evaluated the long-term results of treating premalignant endometrial pathology with a frameless levonorgestrel-releasing intrauterine system (LNG-IUS). Over 10 years, 72 patients underwent diagnostic procedures and 36 patients with endometrial hyperplasia or polyps were treated with the LNG-IUS. For the one patient with complex non-atypical hyperplasia, the LNG-IUS was removed after 3 years with no further issues. The patient with atypical complex hyperplasia was followed for 12 years with the LNG-IUS replaced twice and no detected pathology. Hysterectomy was only required for 3 patients, indicating the LNG-IUS limited hysterectom

1. COGI 2013- Abstract submission
Gynecology
COGI13-ABS-1228
TREATMENT OF PREMALIGNANT PROLIFERATIVE ENDOMETRIAL PATHOLOGY
WITH A FRAMELESS LNG-IUS. LONG-TERM RESULT OF A PILOT STUDY.
Dirk R.G. Janssens
Gynaecologische Dienst, Turnhout, Belgium
Problem statement: The prevention of endometrial carcinoma by
long-term treatment of selected patients with levonorgestrel
(LNG) releasing intrauterine systems (IUS) remains rather
experimental, especially when cellular atypia has been found in
the endometrial biopsy specimen. We present the long-term result
of a pilot study, conducted in a provincial outpatient
gynaecological centre, started in 2001 and finished ten years
later, by adding (only) one such case.
Methods: Out of a consecutive series of 72 patients submitted to
diagnostic hysteroscopy and uterine curettage, endometrial
hyperplasia was diagnosed in 13 patients, 11 of them showing
‘simple hyperplasia‘(SH), 1 case of ‘complex non-atypical
hyperplasia’(CNAH) and 1 case of ‘atypical complex
hyperplasia'(ACH). Benign endometrial polyps were found in 23
patients. These 36 patients were treated by the insertion of an
experimental type of LNG-IUS, the FibroPlant R (Contrel Research,
Belgium), aiming at preventing recurrence or worsening of
endometrial pathology, and followed regularly avoiding mutilating
hysterectomy as much as possible.
Results: In the patient with CNAH the LNG-IUS was removed after
three years (end of trial). No bleeding or sign of endometrial
pathology was observed during further follow-up for five years.
The patient with ACH was followed-up till present for almost 12
years after the first LNG-IUS, which since then has been renewed
twice. No endometrial pathology was detected during follow-up.
Hysterectomy was eventually performed in only 3 patients, one
with SH and two with benign polyps.
Conclusion: Treatment of benign or premalignant endometrial
proliferation with a LNG-IUS limited the incidence of
hysterectomy to less than 10%. Our personal experience,
summarizing one decade of clinical investigation, is limited but
the results are encouraging and indicate that a large-scale and
multicentre evaluation of this therapeutic option is warranted.
Disclosure of Interest: None Declared