Version May 2024
| Drug* | Treatment dose (typically used for 3 to 6 months at which point endometrial sampling is repeated) | Provides contraception | Patient selection |
| Preferred: | |||
| Levonorgestrel 52 mg IUD (LNG 52; Mirena, Liletta)¶,Δ | Releases 20 mcg/day initially | Yes | The LNG 52 is the preferred progestin therapy for pre- and postmenopausal patients with EH (any type) |
| Alternatives for patients who decline, or cannot tolerate, the LNG 52: | |||
| Megestrol acetate | 40 to 160 mg orally daily◊,§ | No | Can be used for pre- and postmenopausal patients with EH (any type) |
| Medroxyprogesterone acetate (MPA) | 10 to 20 mg orally daily§ | No | Can be used for pre- and postmenopausal patients with EH (any type) |
| Norethindrone acetate (NETA, also known as norethisterone acetate; Aygestin) | 5 to 15 mg orally daily | No | Can be used for pre- and postmenopausal patients with EH (any type) who decline, or cannot tolerate, stronger oral progestins |
| Micronized progesterone (oral) | 200 to 300 mg orally daily | No | Use only for patients with all of the following:
|
| Norethindrone (progestin-only contraceptive pill; eg, Camila, Ortho Micronor) | 0.35 mg orally twice or three times daily | Yes¥ | Use only for patients with all of the following:
|
| Combined estrogen-progestin contraceptive (COC) | Variable; refer to product labeling | Yes | Use only for patients with all of the following:
|
| Depo medroxyprogesterone acetate (DMPA) | 150 mg intramuscularly every three months | Yes | Use only for patients with all of the following:
|
IUD: intrauterine device; LNG: levonorgestrel; EH: endometrial hyperplasia; FDA: United States Food and Drug Administration.
* The medications listed are not approved by the FDA for treatment of endometrial hyperplasia. Megestrol acetate and depot medroxyprogesterone acetate are FDA-approved at higher doses for treatment of endometrial cancer.
¶ LNG 52 is approved for six years of use as a contraceptive; however, as the dose rate decreases to approximately 10 mcg per day at 5 years, we remove and replace the IUD at five years when treating EH.
Δ Lower dose LNG-releasing IUDs are also available (ie, LNG 19.5, LNG 13.5); however, these have not been studied in patients with EH and, in our practice, we do not use them for treatment of EH.
◊ May cause weight gain (acts as an appetite stimulant), particularly at higher doses. Dose selection is based on shared decision-making and tolerance of side effects. One contributor's practice is to use 40 mg twice daily for patients with EH without atypia and 80 mg twice daily for patients with EH with atypia.
§ Higher doses have been reported.
¥ Progestin-only pills have lower contraceptive efficacy than IUDs or combined estrogen-progestin contraceptives; they must be taken at the same time each day to maximize contraceptive efficacy.
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