A modern view of fertility preservation in patients with atypical endometrial hyperplasia and early endometrial cancer. A review

For a long time, the primary approach to treating atypical hyperplasia (AEH) and early-stage endometrial cancer (EC) was radical surgery, including panhysterectomy with or without lymphadenectomy, which provided the highest survival rates. In view of the tendency to postpone motherhood against the background of the demographic crisis the issue of preserving fertility in young patients has become paramount, in the case of safety, efficacy and proper control of organ-preserving therapy. Hormonal AEH and early EC therapy is not currently a novel or revolutionary method; however, in recent years this approach has seen significant development. Currently, more than five hormonal treatment regimens are available due to medical literature data, but evidence on their comparative effectiveness are ambiguous, and not all of them are reflected in Russian clinical guidelines. Basic regimens of organ-preserving hormone therapy: 1) continuous oral administration of medroxyprogesterone acetate at doses of 160–480 mg per day or 250–500 mg per day; 2) insertion of an intrauterine system with levonorgestrel (LNG-IUD); 3) subcutaneous injections of gonadotropin-releasing hormone agonists (AGNRH) at a dose of 3.75 mg Q28 days; 4) oral administration of gestagens in combination with LNG-IUD; 5) oral administration of gestagens in combination with subcutaneous injections of AGNRH. This review summarizes the latest data on the clinical efficacy and reproductive outcomes of hormonal AEH and early EC therapy, alone or in combination, and the pharmacogenetic biomarkers of treatment response.