A 35-year-old nulliparous woman with grade 1 endometrioid adenocarcinoma limited to the endometrium (no myometrial invasion on MRI) wishes to preserve her fertility. The fertility-sparing treatment of choice is:
- A Progestogen therapy with medroxyprogesterone acetate 250 mg/day or levonorgestrel-IUD, with repeat biopsy at 3 months ✓
- B Hysteroscopic resection only
- C Endometrial ablation
- D Observation alone for 6 months
Correct answer: A. Progestogen therapy with medroxyprogesterone acetate 250 mg/day or levonorgestrel-IUD, with repeat biopsy at 3 months
Explanation
High-dose progestogen therapy (medroxyprogesterone acetate 250–600 mg/day, megestrol acetate 160 mg/day, or levonorgestrel-IUD) is the fertility-sparing approach for carefully selected patients with well-differentiated (grade 1) endometrioid carcinoma without myometrial invasion; response rates approach 75–80%. Serial endometrial biopsies at 3-month intervals are mandatory to confirm remission. Hysteroscopic resection alone has inadequate tissue sampling; endometrial ablation destroys the endometrium and prevents follow-up biopsy.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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