A 45-year-old woman with endometrial intraepithelial neoplasia (EIN/atypical endometrial hyperplasia) desires fertility preservation. The MOST appropriate progestin treatment and response monitoring approach is:

• A Oral medroxyprogesterone acetate 10 mg daily for 3 months, then D&C to assess response
• B Levonorgestrel-IUS (52 mg) as first-line with hysteroscopy-directed biopsy at 6–12 months to confirm remission ✓
• C Megesterol acetate 160 mg daily with repeat endometrial biopsy monthly until remission
• D Oral norethisterone 5 mg three times daily for 6 months followed by MRI assessment

Explanation

For fertility-sparing management of atypical endometrial hyperplasia (AEH/EIN), levonorgestrel IUS (52 mg) achieves remission rates of 70–90% and is considered the most effective progestin delivery method due to high local endometrial concentrations with minimal systemic side effects. Response is assessed with hysteroscopy-guided biopsy at 6–12 months. If remission is confirmed, assisted conception should be pursued promptly given ongoing risk. Oral progestogens (MPA, megesterol) are alternatives but have higher systemic side effects and lower compliance rates. Definitive hysterectomy remains the treatment of choice once childbearing is complete.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.