Conservative (fertility-sparing) management of well-differentiated endometrial carcinoma (Grade 1, Stage IA, no myometrial invasion) with progestogens is appropriate. The recommended progesterone therapy and response evaluation interval is:

• A Oral medroxyprogesterone acetate 500 mg daily; hysteroscopy biopsy at 3 months
• B Oral megestrol acetate 160 mg daily or LNG-IUS; hysteroscopy biopsy at 3–6 months ✓
• C LNG-IUS (levonorgestrel IUS) alone; hysteroscopy biopsy at 12 months
• D GnRH analogue monthly injection for 12 months; MRI assessment at 6 months

Explanation

For conservative management of Stage IA, Grade 1 endometrioid endometrial carcinoma in women wishing to preserve fertility, high-dose oral progestogens (megestrol acetate 160 mg/day or medroxyprogesterone acetate 400–600 mg/day) or LNG-IUS (alone or combined with oral progestogen) are used. Response evaluation with hysteroscopy and targeted biopsy should occur at 3–6 months to confirm complete histological response before attempting conception. GnRH analogues are not standard primary therapy for uterine preservation in endometrial carcinoma.

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

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Written and medically reviewed by the StethoPrep medical team.