A 52-year-old woman is diagnosed with endometrial intraepithelial neoplasia (atypical hyperplasia). She desires fertility preservation. Hysteroscopy confirms a focal 1.5 cm grade 1 endometrioid adenocarcinoma with no myometrial invasion on MRI. She is counselled about fertility-sparing management. Which progestogen is MOST commonly used as first-line for fertility-sparing treatment of endometrial carcinoma?

• A Tamoxifen 20 mg daily
• B Medroxyprogesterone acetate (MPA) 400-600 mg daily ✓
• C Goserelin acetate 3.6 mg monthly
• D Letrozole 2.5 mg daily

Explanation

Medroxyprogesterone acetate (MPA) at 400-600 mg daily or megestrol acetate at 160-320 mg daily are the most commonly used oral progestins for fertility-sparing management of well-differentiated, Stage IA endometrioid adenocarcinoma without myometrial invasion. Complete response rates of 55-75% are reported. Tamoxifen is contraindicated as it is oestrogenic on the endometrium. GnRH agonists and aromatase inhibitors are sometimes used as adjuncts or second-line but are not first-line agents.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.