Fertility-sparing treatment in a young patient with complex atypical hyperplasia of the endometrium

Abstract

Endometrial carcinoma is a common gynaecological malignancy in developed countries. It affects postmenopausal women predominantly, but 25% of cases occur in premenopausal women, 5% of whom are younger than 40 years of age.¹ Complex atypical hyperplasia (CAH) of the endometrium is a precursor to endometrial carcinoma, with a progression rate to carcinoma of 10%. Women with stage I, grade 1 endometrial carcinoma treated by hysterectomy, have a 99.2% five-year survival. The high cure rate of the disease shifts the treatment focus to issues of quality of life subsequent to successful treatment.² Young nulliparous women with CAH raise the possibility of fertility-sparing treatment. The treatment approach to CAH is viewed in the same light as that pertaining to early-stage endometrial carcinoma. In both scenarios, fertility-sparing treatment (with subsequent successful pregnancies) has been described. The conservative management of CAH poses several challenges with regard to adequate sampling of the endometrium, as well as optimal treatment and follow-up monitoring.³ The current case illustrates successful conservative management of CAH.