NEW YORK (Reuters Health) – Among women treated for endometrial hyperplasia, regression rates appear to be better with the levonorgestrel-releasing intrauterine system than with oral progestogen treatment, according to the results of a meta-analysis published in the American Journal of Obstetrics & Gynecology online October 9.
However, the findings are not definitive, the authors caution, because the studies available for the meta-analysis “are of observational design with mostly indirect comparisons between these 2 methods.”
They note that oral progestogens can induce regression of endometrial hyperplasia and prevent progression to cancer. Recently, the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) has been used to treat the condition.
To compare the two approaches, Dr. Janesh K. Gupta at Birmingham Women’s Hospital, UK, and colleagues identified 24 relevant studies, albeit “of low methodologic quality,” that included a total of 1001 women.
Pooled regression rates of simple hyperplasia were 89% with oral progestogens compared with 96% with LNG-IUS, a nonsignificant difference statistically, according to the report.
On the other hand, the team found, corresponding rates of regression were 66% vs 92% (p<0.01) for complex hyperplasia, and 69% vs 90% (p=0.03) for atypical hyperplasia.
So, which treatment should be prescribed for endometrial hyperplasia? “Although the differences seem to be large and suggest the use of Mirena coil, the data has to be cautiously interpreted as there were a lot of small and heterogeneous studies that gave the overall results,” Dr. Gupta responded in an email.
“To really address this issue of oral versus Mirena coil, there needs to be a large long-term randomized controlled trial carried out,” he pointed out. “Without this robust data the change in clinical practice is unlikely to be widespread.”
Dr. Gupta added, “For your information, I hold the world’s largest long-term database of women with hyperplasia treated with the Mirena coil. We are following-up these patients every 6 months for the first 2 years and then yearly thereafter to 5 years to ensure that hyperplasia remains regressed. It would be good to get other clinicians worldwide to participate in this wider data collection and would be very happy for their collaboration.”
Reference:
Am J Obstet Gynecol 2010
