Question:
What is the optimal follow up for patient with complex endometrial hyperplasia without atypia which has reverted to normal after MIRENA insertion. She has had 2 endometrial biopsies at 6 mths interval subsequently which are normal. Do we need to followup for 5 or more years?
Help us improve clinical query answers - just fill in a survey after reading this page
Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.
Answer:
No guidelines, systematic reviews or randomised controlled trials of length of follow-up after complex endometrial hyperplasia without atypia which has reverted to normal after MIRENA insertion were identified.
Five studies (1-5) have reported the follow-up of women after Mirena insertion, concentrating mostly on the time taken and rate of return to normal endometrium. Two of the studies report no cases of cancer during follow-up (1,3) and one study of 105 women reported two cases (2). One case was stage 1B ovarian cancer, which had been identified in a complex hyperplasia that had regressed at 3 months with LNG-IUS but had been under ultrasonographic surveillance for a persistent postmenopausal ovarian cyst. The other case was stage 1A endometrial cancer, which had been identified in a case of complex hyperplasia that had shown non-regression at 12 months with LNG-IUS and therefore underwent indicated hysterectomy.
(Evidence level III)
References:
1. Buttini MJ. Jordan SJ. Webb PM. The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: an Australian study and systematic review. [Review] [22 refs] Australian & New Zealand Journal of Obstetrics & Gynaecology. 49(3):316-22, 2009 Jun. Abstract
2. Varma R. Soneja H. Bhatia K. Ganesan R. Rollason T. Clark TJ. Gupta JK. The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia--a long-term follow-up study. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 139(2):169-75, 2008 Aug. Abstract
3. Orbo A. Arnes M. Hancke C. Vereide AB. Pettersen I. Larsen K. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only. Gynecologic Oncology. 111(1):68-73, 2008 Oct. Abstract
4. Haimovich S. Checa MA. Mancebo G. Fuste P. Carreras R. Treatment of endometrial hyperplasia without atypia in peri- and postmenopausal women with a levonorgestrel intrauterine device. Menopause. 15(5):1002-4, 2008 Sep-Oct. Abstract
5. Wildemeersch D. Janssens D. Pylyser K. De Wever N. Verbeeck G. Dhont M. Tjalma W. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up. Maturitas. 57(2):210-3, 2007 Jun 20. Abstract
Search date: March 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
This clinical query answer was produced following the clinical query protocol as described here.
The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the Query Bank.
