Conservative management of young women with endometrial carcinoma or complex atypical hyperplasia: report of three cases and literature review

Although endometrial cancer is primarily a postmenopausal disease, 25% of patients are in premenopausal age with 3-5% being 40 years old or younger. The younger groups of women with endometrial carcinoma are frequently nulligravid with a history of infertility and strong desire to preserve fertility, which may pose a therapeutic dilemma for both patients and physicians. We report on three young women with atypical complex hyperplasia or early-stage endometrial cancer that were treated with conservative hormonal therapy. Hormonal therapy has been proposed for young women with endometrial cancer (grade 1) who wish to preserve their fertility. However, detailed evaluation including physical examination, history taking, performing D&C, examining the specimen by a skilled pathologist, using imaging techniques, especially contrast enhanced MRI and for some patients explorative laparoscopy with sampling of peritoneal and lymph nodes, and evaluation of adnexa is necessary. Also for patients in Stage I/grade 1, advisory sessions on the benefits and side-effects of high-dose progesterone with evaluation of the endometrium every three months until total regression is recommended.