OBJECTIVE
To conduct a comparative assessment of the effectiveness of a two-stage treatment regimen (gonadotropin-releasing hormone agonist buserelin depot 3.75 mg + progestin levonorgestrel - LNH — 52 mg released into the uterine cavity from the intrauterine system — IUD — LNH—IUD 52 mg) in patients with endometrial hyperplasia compared with monotherapy with LNH-IUD 52 mg.
MATERIAL AND METHODS
47 patients of reproductive age (18—45 years old) with a histologically verified diagnosis of endometrial hyperplasia were prospectively examined. The patients of the main group (n=22) received combined therapy with gonadotropin-releasing hormone (GnRH) agonist (buserelin depot 3.75 mg) and LNH-IUD 52 mg, the patients of the control group (n=25) received monotherapy with LNH-IUD 52 mg. The follow-up period was 9 months.
RESULTS
In the combination therapy group (buserelin depot 3.75 mg + LNH IUD 52 mg), amenorrhea developed faster: by the end of the 3rd month of treatment, 95.5% had amenorrhea compared to 16% in the group of LNH-IUD monotherapy (p<0.001). By the 9th month, the indicators leveled off: 45.5% vs 40%, respectively (p>0.05). Intermenstrual spotting in the first 3 months was significantly less common in the combination therapy group (4.5% vs 64%, p<0.001), followed by an equalization of the indicators by the 6th month (18.1% vs 20%, p>0.05). By the 6th month, the effectiveness of both schemes was comparable according to histological examination data: endometrial atrophy was achieved in 92.1% of patients in the combination therapy group and 89.8% in the monotherapy group (p>0.05). In the main group, add-back therapy was more often required (16.7% vs 0%, p<0.05).
CONCLUSION
If it is necessary to achieve a rapid therapeutic effect, as well as if patients with endometrial hyperplasia refuse to use an intrauterine system, a two-stage scheme is recommended, taking into account the possible need for add-back therapy. In the absence of time constraints, LNH-IUD 52 mg monotherapy is an effective and sufficient treatment method. Both therapy regimens have shown good safety and tolerability.
