Fertility-Sparing Management of Early Stage Endometrial Cancer: A Narrative Review of the Literature

Objectives: The incidence of endometrial cancer (EC) is rising largely due to the increasing levels obesity along with an ageing population. This has led increase in premenopausal women EC. 5% cases are patients less than 40 years old, 70% which nulliparous at diagnosis. Therefore, fertility considerations must be taken into account when managing these patients. objectives this review present fertility-sparing management options available. Mechanism: A detailed computerized literature search PubMed and MEDLINE up 1st June 2022 was carried out order survey evidence for treatment. Studies including hyperplasia early-stage EC undergoing were included. Findings Brief: Progestin acts by downregulating oestrogen receptors, thereby suppressing growth. Oral progestins levonorgestrel-releasing intrauterine system (IUS) have therefore been used as non-surgical hormonal treatment Megestrol acetate (MA) shown produce highest remission rates compared other a systematic meta-analysis, but medroxyprogesterone exhibited lower recurrence rates. IUS atypical (AH) showed that majority responded 3 months’ use. minimum duration AH 6 months advocated, based on randomised studies showing greater efficacy meta-analysis assessing both oral intra-uterine higher pooled complete response (CR) alone. Metformin, gonadotrophin-releasing hormone agonists weight loss also added progestin regimes variable results regression. Hysteroscopic resection allows targeted excision EC, risk perforation so not recommended British Gynaecological Cancer Society or European Oncology. Assisted reproduction (ART) may quickest way achieve pregnancy once CR achieved. Pregnancy varied from 32–100%, live birth varying 17.9–43.8%. Conclusions: population average first age parenthood. Fertility-sparing should considered where desired.