A 45-year-old woman presents with irregular heavy menstrual bleeding for 8 months. Endometrial biopsy shows complex hyperplasia with atypia (endometrial intraepithelial neoplasia, EIN). She wishes to preserve fertility. The most appropriate medical management with evidence for regression of EIN is:

• A Oral medroxyprogesterone acetate 10 mg daily for 3 months
• B GnRH agonist (leuprolide) for 6 months to induce atrophy
• C LNG-IUS 52 mg (Mirena) inserted for at least 12 months ✓
• D Combined oral contraceptive pill for 6 months

Explanation

The LNG-IUS (levonorgestrel-releasing IUS, 52 mg) provides sustained high local progestogen concentration to the endometrium and has the strongest evidence for regression of endometrial hyperplasia with atypia (EIN) in women desiring fertility preservation, with regression rates of 85–90% at 12 months. Oral progestogens (MPA, norethisterone) are less effective locally and require high doses. GnRH agonists work temporarily but have significant side effects. Hysterectomy remains the definitive treatment for EIN in women who have completed childbearing due to the ~25–30% risk of concurrent endometrial carcinoma.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.