50 Usha Verma and Neil Verma
LNG-IUD group compared to 12.5% in the oral group. LNG –IUD is highly
effective for the treatment of endometrial hyperplasia and it decreases the
hysterectomy rate [80].
In a prospective multicenter study, 75 patients with endometrial
hyperplasia were treated with LNG –IUD. One hundred percent of the patients
achieved complete regression of hyperplasia within 3 months after LNG-IUD
insertion. At 12 months complete regression rate overall was 94.7%: 100% of
patients with atypical endometrial and 93.7% with endometrial hyperplasia
without atypia [81].
As Adjunct to Estrogen replacement therapy
Hormone replacement therapy for menopausal symptoms requires
combined estrogen and progesterone treatment in the presence of the uterus.
Estrogen treatment is prescribed to relieve menopausal symptoms, but
progesterone is needed in order to offset the proliferative effect of estrogen on
the endometrium. The standard treatment is oral progestin in combination with
the estrogen. The side effects of oral regimen such as vaginal bleeding and
androgenic effects may make it unacceptable for women to continue the
treatment. In addition, studies have shown possible links with systemic
progesterone and increased cardiovascular risks in addition to increased breast
cancer risks [82, 83]. The LNG-IUD has been evaluated as an alternative
progestin method to provide endometrial protection with minimum adverse
systemic effects, due to its significantly low serum concentration. In one study
of 40 perimenopausal women with menopausal symptoms, authors evaluated
two treatment regimens: three-week cyclic treatments with 2 mg oral estradiol
(E2) valerate combined with 250 μg of oral LNG for the last 10 days of each
cycle versus 2 mg of E2 valerate continuously with the LNG-IUD. After one
year the subjective symptoms were improved in both groups, and none of the
women had endometrial proliferation. However, in the LNG-IUD group 15/18
women were amenorrheic, versus all women in the oral LNG group continued
with cyclic bleeding [84].
In a meta-analysis of 19 studies with a total of 826 subjects regarding
LNG-IUD in combination with estrogen, and with a duration of six months to
five years, none of the women developed endometrial hyperplasia throughout
the course of the study [85].
Hampton et al. evaluated 82 perimenopausal women treated with oral
estrogen and the LNG-IUD for long term protection of the endometrium.
There were no cases of hyperplasia throughout the entire 60 month period.