Premenopausal patient with persistent EH with atypia

EH: endometrial hyperplasia; D&C: dilation and curettage; EC: endometrial carcinoma; EMBx: endometrial biopsy; REI: reproductive endocrinology and infertility; LNG: levonorgestrel.
* Progestin therapy is not given to patients trying to conceive a pregnancy and may be contraindicated in some patients with thrombotic and/or hepatic disorders or with progestin receptor-positive breast cancer. In addition, some patients decline therapy because they cannot tolerate progestins or they prefer to avoid hormonal therapy.
¶ The 52 mg LNG-releasing intrauterine device (Mirena or Liletta; LNG 52) appears to be the most effective progestin treatment, is easy to comply with, is well-tolerated, and provides contraception. Oral progestins may also be used.
Δ Hysterectomy is not an option in some patients with comorbidities or who decline hysterectomy; consult a gynecologic oncologist for further management.
◊ Options for progestin maintenance therapy are the same as for initial treatment. The duration of maintenance therapy may be indefinite and is typically at least 2 years. Decisions about discontinuing therapy are based on whether abnormal uterine bleeding is present and the risk of recurrent or progressive disease.