The difference in efficacy between the LNG-IUS and systemic therapy is likely multifactorial, according to Dr. Mandelbaum. “First, local therapy may lead to higher levels of progestin at the level of the endometrium compared to systemic therapy,” she said. “Second, the LNG-IUS does not require daily patient compliance, which if poor, may drastically decrease the efficacy of oral therapies.”
The LNG-IUS is also reported to have an improved side effect profile compared to systemic formulations. “Weight gain, specifically, is a concern with systemic progestin formulations, as obesity is a major risk factor for hyperplasia and endometrial cancer,” Dr. Mandelbaum said.
Dr. Mandelbaum noted that inserting the LNG-IUS in endometrial hyperplasia patients is simple and easy. “Placement can be performed in the office and confirmed at subsequent visits on ultrasound or by verifying the presence of IUS strings,” she said. In addition, endometrial resampling can be scheduled at regular intervals around the IUS, leaving it in-situ.
“Moreover, once clearance of hyperplasia has been demonstrated, the device can be removed with nearly immediate return of fertility in patients who desire this option,” Dr. Mandelbaum said.
Adjunctive therapies with the LNG-IUS are of particular interest for future study, including antiestrogenic agents such as leuprolide or aromatase inhibitors, combination progestin therapy, and metformin, “which may have an antiproliferative effect on the endometrium,” she said.