Fertility Preservation Using Endomyometrial Resection for Atypical Hyperplasia and Low Grade, Stage 1A, Endometrial Cancer
This study protocol evaluates the use of hysteroscopic endomyometrial resection in women diagnosed with atypical endometrial hyperplasia or grade I endometrial cancer who have not responded to anti-hormone therapy. Patients in this study wish to preserve fertility.
• Age less than 40 years
• Pathologist confirmed biopsy evidence of one of the following:
‣ Grade I endometrial endometrioid adrenocarcinoma (EC) with less than 1/3 of the endometrial surface involved.
⁃ Atypical endometrial hyperplasia (AH)
• MRI demonstrating less than 1/3 myometrial invasion if the patient has EC
• Absence of significant surgical co-morbidities e.g. pulmonary hypertension, significant cardiac valvular disease, or contraindication to surgery.
• Desire to preserve fertility
• Reasonable chance to conceive based on consultation with an infertility specialist
• Adequate dose and duration of progesterone therapy prior to enrolment:
• Adequate dose:
‣ Medroxyprogesterone acetate (Provera; 200mg/day)
⁃ Megestrol acetate (Megace; 160mg/day)
• Adequate duration: 6 months
• Failure of progestin therapy defined as:
‣ Unsuccessful eradication of hyperplasia or cancer in the uterus
⁃ Intolerance to the side effects
• Signed informed consent