P-157: A Comparison of The Effect of Levonorgestrel IUD with Oral Medroxyprogesterone Acetate on Abnormal Uterine Bleeding with Simple Endometrial Hyperplasia and Fertility Preservation

Background: Endometrial hyperplasia is important clinically, because it can lead to abnormal uterine bleeding (AUB) which itself can precede to endometrial cancer. Endometrial carcinoma is the most common malignancy of the female genital tract, occurring about 75-85% in younger, perimenopousal women as hyperplasic endometrial. The treatment is hysterectomy or hormone therapy with progesterone. The aim of this study was, therefore, to compare the effect of levonorgestrel IUD (Mirena) with medroxyprogesterone acetate on simple endometrial hyperplasia for fertility preservation. Materials and Methods: Forty women in reproductive age(22-47) with AUB that their endometrial biopsies reports were simple hyperplasia were enrolled in this study and then randomly divided into two groups. All patients presented with designed special checklist which was filled with satisfaction. Complete history and physical examination especially BP, BMI, breast examination, bimanual vaginal examination and trans vaginal sonography (to measure the thickness of endometrial and exclude the other pathologic lesions) were performed. In first group, treatment was performed with medroxyprogestron (20mg/daily) for 10 days and in other group Levonorgestrel IUD was prescribed. After 3 months, Trans vaginal sonography and biopsy of endometrium were done. Therefore; status of AUB and side effects of two methods along with the rate of satisfactory were evaluated. Results: Our findings showed the significant differences in the treatment of simple hyperplasia between two groups (levonorgestrel IUD group vs. MPA group) (p<0.047). Recovery of AUB in the group of Mirena was enhanced (p<0.047). Endometrial thickness was reduced in both groups (p<0.001), but reduction of endometrial in Mirena group was even more. Also, Mirena was tolerated more than MPA. Side effects of MPA was more and reached significance (p<0.003).The rate of satisfactory with Mirena was higher than medroxyprogesterone acetate and reached significance (p<0.048). Conclusion: The results of this study show that levonorgestrel IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities.