Use of contraceptive methods among women with endometrial hyperplasia: a systematic review

Background: The objective of this systematic review is to evaluate the evidence for the safety of contraceptive use among women with endometrial hyperplasia. Study Design: We searched the PubMed database for peer-reviewed articles published in any language from database inception through February 2009 concerning the safety of using any contraceptive method among women diagnosed with endometrial hyperplasia. We excluded case reports but included all other study designs. The quality of each individual piece of evidence was assessed using the United States Preventive Services Task Force grading system. Results: We identified nine articles that met the criteria for review. Each study examined levonorgestrel intrauterine devices (LNG-IUDs); no studies were identified that examined other contraceptive methods. Overall, these studies suggest that LNG-IUD use is not associated with adverse health events among women diagnosed with endometrial hyperplasia. Disease regression with LNG-IUD use was observed in all women in seven studies, in 90% of women in one study, and in 67% of women in one study. Limitations of the studies include small sample sizes and lack of a comparison group or nonrandomized assignment to LNG-IUD. Conclusions: There is fair quality evidence indicating that use of the LNG-IUD is safe for women with endometrial hyperplasia and may have therapeutic benefits. Published by Elsevier Inc.