Effects of a fertility-sparing re-treatment for recurrent atypical endometrial hyperplasia and endometrial cancer: a systematic literature review

Sep 24, 2026

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Objective: examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) after initial fertility-sparing therapy. Methods: conduct a systematic literature review and meta-analysis comparing progestin re-treatment with conventional hysterectomy, with survival, disease recurrence as primary outcomes and pregnancy as secondary outcome. Results: 32 studies (365 patients) showed 81.1% complete remission; recurrence risk increased versus hysterectomy (OR=6.78). Pregnancy occurred in 14.0%. Conclusion: repeat progestin therapy may be an effective option while preserving fertility.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

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Abstract

Objective

Methods

Results

Conclusion

Conflict of Interest

Author Contributions

J Gynecol Oncol. 2023 Jul;34(4):e49 [https://doi.org/10.3802/jgo.2023.34.e49](https://doi.org/10.3802/jgo.2023.34.e49)[ ](https://doi.org/10.3802/jgo.2023.34.e49)pISSN 2005-0380·eISSN 2005-0399 Original Article Received: Aug 10, 2022 Revised: Jan 2, 2023 Accepted: Jan 18, 2023 Published online: Mar 6, 2023 Correspondence to Isao Murakami Department of Obstetrics and Gynecology, Toho University Ohashi Medical Center, 2-22-36 Oohashi, Meguro-ku, Tokyo 153-8515, Japan. Email: [isao.murakami@med.toho-u.ac.jp](isao.murakami@med.toho-u.ac.jp) †Isao Murakami and Hiroko Machida contributed equally to this work. © 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Isao Murakami [https://orcid.org/0000-0002-7189-3315](https://orcid.org/0000-0002-7189-3315)[ ](https://orcid.org/0000-0002-7189-3315)Hiroko Machida [https://orcid.org/0000-0003-2252-3577](https://orcid.org/0000-0003-2252-3577)[ ](https://orcid.org/0000-0003-2252-3577)Tohru Morisada [https://orcid.org/0000-0002-4223-1291](https://orcid.org/0000-0002-4223-1291)[ ](https://orcid.org/0000-0002-4223-1291)Yasuhisa Terao [https://orcid.org/0000-0002-9126-3361](https://orcid.org/0000-0002-9126-3361)[ ](https://orcid.org/0000-0002-9126-3361)Tsutomu Tabata [https://orcid.org/0000-0003-0243-8180](https://orcid.org/0000-0003-0243-8180)[ ](https://orcid.org/0000-0003-0243-8180)Mikio Mikami [https://orcid.org/0000-0002-7496-3518](https://orcid.org/0000-0002-7496-3518) Effects of a fertility-sparing re-treatment for recurrent atypical endometrial hyperplasia and endometrial cancer: a systematic literature review Isao Murakami ,1,† Hiroko Machida ,2,† Tohru Morisada ,3 Yasuhisa Terao ,4 Tsutomu Tabata ,5 Mikio Mikami ,2 Yasuyuki Hirashima ,6 Yoichi Kobayashi ,3 Tsukasa Baba ,7 Satoru Nagase 8 1Department of Obstetrics and Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan 2Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan 3Department of Obstetrics and Gynecology, Kyorin University Faculty of Medicine, Tokyo, Japan 4Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan 5Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo, Japan 6Division of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan 7Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan 8Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan ABSTRACT Objective: To examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) following initial fertility-sparing treatment. Methods: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Endometrial Cancer Committee. Multiple search engines, including PubMed/MEDLINE and the Cochrane Database, were searched in December 2021 using the keywords “Endometrial neoplasms,”“Endometrial hyperplasia,”“Endometrial intraepithelial neoplasia,” “Fertility preservation,”“Progestins,”AND “Recurrence.” Cases describing progestin re-treatment for recurrent EIN, AH and EC were compared with cases that underwent conventional hysterectomy. The primary outcomes were survival and disease recurrence, and the secondary outcome was pregnancy. Results: After screening 238 studies, 32 with results for recurrent treatment wer

FAQs

What question does the systematic review address?

It evaluates how effective progestin re-treatment is for recurrent EIN, atypical endometrial hyperplasia, and endometrial cancer after initial fertility-sparing treatment.

How was the evidence collected and compared?

A comprehensive systematic review and meta-analysis compared cases receiving progestin re-treatment for recurrent disease with cases undergoing conventional hysterectomy.

What were the key outcomes regarding remission, recurrence, and pregnancy?

Complete remission was achieved in 81.1% of cases, disease recurrence risk was higher with progestin re-treatment than with hysterectomy (OR=6.78), and pregnancy occurred in 14.0% of women after recurrence.

Sep 24, 2026

Uploaded by Jake