Fertility preservation of young women with endometrial carcinoma or complex atypical hyperplasia: Case series and literature review.

Introduction: Although endometrial cancer is primarily a postmenopausal disease, 25% of patients are in premenopausal age with 3-5% being 40 years old or younger who have infertility or desire to preserve their fertility. The younger groups of women with endometrial carcinoma are frequently null gravid with a history of infertility and strong desire to preserve fertility, which may pose a therapeutic dilemma for both patients and physicians. Materials and Methods: The study has been done within 2008-2014 in Gynecological Oncology Department and Research and Clinical Center for Infertility of Shahid Sadoughi University of Medical Science, Yazd, Iran. All of young women who were in reproductive age (15-45 years) and desired to preserve their fertility entered to the study. All of patients were diagnosed endometrial carcinoma or complex atypical hyperplasia. All of patients underwent pelvic MRI with and without contrast for evaluation of uterine involvement. If they had early stage endometrial carcinoma without myometrial invasion, we suggested hormonal therapy (megestrol 40-160 mg oral or Diphereline 3.75 mg 1M every 28 days for 3 months) after getting informs consent. All of them underwent dilatation and curettage after 3 months hormone therapy. We evaluated 12 young women with atypical complex hyperplasia or early-stage endometrial cancer that were treated with conservative hormone therapy. Results: The mean of age was 29.7 years (15-45). Two patients were virgin. Five patients had endometrial adenocarcinoma and seven had complex atypical endometrial hyperplasia. All of patients treated by megestrol (2-3 tablet in day) for 3 months firstly. One patient did not answer to one period of Megestrol and we followed treatment by 3 months Megestrol high dose (160 mg) and then Diphereline 3.75 IM for 3 months. These patients had normal pathology after 3 periods of 3 months treatment. All of patients had normal menstruation one of them who needed 4 times curettage. Unfortunately she had atrophic endometrial and for childbearing she was suggested to get uterine surrogacy. But the other patients did not have any problem in menstruation and one of them except had one baby after fertility preservation. Conclusion: Hormone therapy has been proposed for young women with endometrial cancer (grade 1) who wish to preserve their fertility. However, detailed evaluation including physical examination, history taking, performing D & C, examining the specimen by a skilled pathologist, using imaging techniques, especially contrast enhanced MR1 and for some patients explorative laparoscopy with sampling of peritoneal and lymph nodes, and evaluation of adnexa is necessary. Also for patients in stage 1/ grade 1, advisory sessions on the benefits and side-effects of high-dose progesterone with evaluation of the endometrium every three months until total regression is recommended. After childbearing we suggest TAH+BSO for prevention of endometrial, ovarian and breast cancer. [ABSTRACT FROM AUTHOR]