Use of progestin therapy increasing for endometrial intraepithelial neoplasia

Key takeaways:

• From 2008 to 2020, primary progestin therapy for endometrial intraepithelial neoplasia increased from 44.2% to 63.4%.
• Among the progestin users, one-third ultimately had a hysterectomy and 10% developed cancer.

For premenopausal women with endometrial intraepithelial neoplasia, use of conservative treatment with progestin increased and hysterectomy declined from 2008 to 2020, researchers reported.

“Management of endometrial intraepithelial neoplasia is particularly challenging in patients of reproductive age who may desire future childbearing. As an alternative to hysterectomy, progestin therapy is commonly used in premenopausal patients who

desire fertility preservation,” Yukio Suzuki, MD, PhD, a postdoctoral research fellow at the Columbia University College of Physicians and Surgeons, the NewYork-Presbyterian Hospital and the Herbert Irving Comprehensive Cancer Center at Columbia University Irving Medical Center, and colleagues wrote.

“To date, there have been few data describing the patterns of care and outcomes of progestin-based therapy in premenopausal women with endometrial intraepithelial neoplasia. We analyzed the use and outcomes of progestin-based therapy in women younger than age 50 years with endometrial intraepithelial neoplasia,” the researchers wrote.

Suzuki and colleagues identified 3,947 women aged 18 to 50 years with endometrial intraepithelial neoplasia from 2008 to 2020 using the IBM Watson Health MarketScan Commercial Claims and Encounters Databases. The primary treatment in this patient population was hysterectomy (n = 2,149) or progestin-based therapy (n = 1,798). Among women who received progestin-based therapy, treatment was either systemic therapy or progestin-releasing IUD.

Results, published in Obstetrics & Gynecology, demonstrated that progestin use increased from 44.2% in 2008 to 63.4% in 2020 (P = .002). Among women receiving progestin therapy, 85.1% were treated with systemic progestin and 14.9% were treated with progestin-releasing IUD.

Among women who were treated with progestin, IUD use increased from 7.7% in 2008 to 35.6% in 2020 (P < .001). Thirty-six percent of women who received systemic progestins and 22.9% of women who received progestin-releasing IUD ultimately had hysterectomy (P < .001). Researchers documented subsequent uterine cancer among 10.5% of women who received systemic progestins compared with 8.2% of women who received progestin-releasing IUD by 108 months (P = .24).

In addition, researchers noted that venous thromboembolic complications occurred among 1.5% of women who received progestins, with similar rates observed for oral progestins and progestin-releasing IUD.

“Despite these encouraging data, nearly a third of progestin users required hysterectomy and 10% were diagnosed with uterine cancer, highlighting that primary hysterectomy remains the standard of care for patients who have completed childbearing,” the researchers wrote. “Among those treated with progestin-based therapy, a number of questions, including the optimal duration of treatment, schedule for follow-up evaluations and need for long-term monitoring and treatment, remain to be resolved.”