Fertility-Sparing Management of Endometrial Intraepithelial Neoplasia and Endometrial Cancer: A Comparison of the Levonorgestrel-Releasing Intrauterine Device vs Systemic Therapy

    December 2025 in “ Fertility and Sterility ”
    Bonnie B. Song, Aaron D. Masjedi, Zachary S. Anderson, Katherine Erickson, Christian Pino, Zaira N. Chavez Jimenez, Christina E. Dancz, Intira Sriprasert, Koji Matsuo, Richard J. Paulson
    TLDR Both LNG-IUD and systemic progestins are effective for fertility-sparing treatment, but close monitoring is needed due to recurrence risk.
    This study compared the effectiveness of the levonorgestrel-releasing intrauterine device (LNG-IUD) and systemic progestin therapy in treating endometrial intraepithelial neoplasia (EIN) and low-grade stage IA1 endometrioid endometrial carcinoma (EMCA) in a fertility-sparing context. Among 116 patients, 80.4% achieved disease clearance, with no significant difference in clearance rates or time-to-clearance between the LNG-IUD and systemic therapy groups. However, recurrence was common, occurring in 23.3% of those who initially cleared the disease. The study highlights the importance of close follow-up and routine surveillance due to the risk of recurrence and progression, supporting the use of both LNG-IUD and systemic progestins as effective fertility-sparing options.
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