Background: The conservative management of atypical endometrial hyperplasia(AEH)using different management strategies will be important in females who want to conceive. However, complete data were lacking regarding selection criteria of the patients, optimal therapeutic strategies and follow-up periods.
The aim of this study was to evaluate feasibility, safety, effectiveness fertility and long-term outcomes of hysteroscopic endometrial resection in combination with Levonorgerstrel Intrauterine Device(LNG-IUD)as fertility-sparing strategies of management of premenaupausal young female with AEH.
Patients and methods: We prospectively evaluated clinical files of 35 patients with AEH who underwent hysteroscopic resection of the lesion with insertion of LNG-IUD. LNG-IUD maintenance in its site was made for 12 months then removal of it was made for women with complete response (CR) then she allowed conceiving naturally. Patients with recurrent, progressive or resistant disease will undergo definitive surgical management by total hysterectomy and bilateral salpigooophorectomy.
Results: we found that about 31(88.5%)patients achieved and maintained a CR and LNG-IUD removed. 20 out of the 31 patients (64.5%) who had removed LNG-IUD became pregnant after natural conception in the following twelve months. 13(65%)babies were born by Caesarean section at 39 weeks of gestation, and seven(35%)were born at term spontaneously. We found no recurrence in the 24 months of follow-up.
Conclusions: We showed that combination of hysteroscopic superficial endometrial resection followed by insertion of LNG-IUD was considered safe and effective management procedure for young female with AEH who desired to preserve her fertility due to negligible progression and recurrence rates with accepted pregnancy and life births rates.