A 52-year-old woman with type 2 diabetes and BMI 38 kg/m² is found to have endometrial hyperplasia with atypia (EIN) on biopsy. She desires fertility preservation. The MOST appropriate medical management is:

• A Levonorgestrel-releasing intrauterine system (LNG-IUS) with 3-monthly repeat endometrial sampling ✓
• B Oral medroxyprogesterone acetate 10 mg daily for 6 months
• C Combined oral contraceptive pill continuously for 6 months
• D GnRH agonist for 6 months to induce endometrial atrophy

Explanation

Endometrial intra-epithelial neoplasia (EIN) / atypical hyperplasia is a pre-malignant condition with ~30% concurrent endometrial carcinoma risk. In women desiring fertility preservation who are not surgical candidates, the LNG-IUS (Mirena) achieves high local progestogen concentrations with superior regression rates (>90% at 12 months) compared to oral progestogens and with fewer systemic side effects. Three-monthly endometrial sampling monitors response. The standard management for women who have completed childbearing is hysterectomy.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.