Safety And Efficacy of The Levonorgestrel-Releasing Intrauterine System in Treatment of Endometrial Hyperplasia: Review Article

Background: Endometrial hyperplasia (EH) is a proliferative disorder of the endometrial lining, primarily resulting from prolonged unopposed estrogen exposure. It is a recognized precursor to endometrial carcinoma, particularly among perimenopausal women. The levonorgestrel-releasing intrauterine system (LNG-IUS) has proven to be an efficient, localized hormonal management for endometrial hyperplasia, particularly for non-atypical types. Objective: This review article aimed to throw the light on the safety and efficacy of the levonorgestrel-releasing intrauterine system in treatment of endometrial hyperplasia. Methods: We used Google Scholar, Science Direct, PubMed, and other internet databases for Endometrial hyperplasia, Non-atypical hyperplasia, Levonorgestrel-releasing intrauterine system, Hormonal therapy. Additionally, the writers combed through relevant literature for references, however they only included researches covering the years from 2002 to 2024. Due of lack of translation-related sources, documents in languages other than English were excluded. Also, works in progress, unpublished publications, abstracts from conferences, and dissertations that did not form part of broader scientific investigations were excluded. Conclusion: LNG-IUS releases a consistent dose of levonorgestrel directly into the uterus, leading to endometrial thinning, glandular atrophy, and restoration of normal endometrial histology. Studies have demonstrated high regression rates, with up to 93% histological resolution within 12 months of insertion. Compared to oral progestins, LNG-IUS offers enhanced efficacy, fewer systemic side effects, improved compliance, and additional contraceptive benefits. In perimenopausal women, LNG-IUS serves as a non-surgical, fertility-sparing treatment, with a favorable safety profile. Although, some concerns have been raised regarding its association with breast cancer, current evidence remains inconclusive and requires further investigation. Its role in atypical hyperplasia is still being explored. However, it may be considered in selected cases where hysterectomy is contraindicated or maintenance of fertility is wanted. Given its high therapeutic efficacy, ease of use, & case acceptability, levonorgestrel-releasing intrauterine system is suggested as a 1st-line management for non-atypical endometrial hyperplasia & holds promise as a conservative option in broader clinical contexts.