Fertility preservation in women with endometrial carcinoma
- Joshua P Kesterson, MD
Joshua P Kesterson, MD
- Chief, Division of Gynecologic Oncology
- Associate professor
- Penn State Hershey Medical Center
- Hershey, Pennsylvania
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Head of Women's Cancers, Lifespan Cancer Institute
- Director of Medical Oncology, Rhode Island Hospital
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University
- Deputy Editors
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
Uterine cancer is the most common gynecologic malignancy in developed countries and is the second most common in developing countries (cervical cancer is more common). The incidence of endometrial carcinoma (EC) is increasing in developed countries due to increased obesity and longer life expectancy. (See "Endometrial carcinoma: Epidemiology and risk factors", section on 'Epidemiology'.)
The standard initial treatment of EC is hysterectomy, bilateral salpingo-oophorectomy, and assessment of retroperitoneal lymph nodes. This is an acceptable option for the majority of women with EC, most of whom are postmenopausal. However, younger women may desire fertility-sparing treatment options. For women who are candidates for fertility preservation, the most common approach is progestin therapy and deferral of surgical staging until after completion of childbearing. Use of this approach is limited to women with low-risk disease, and with fertility preservation the risk of recurrent or persistent disease is higher than with hysterectomy.
Fertility preservation in women with EC is reviewed here. Related topics are discussed in detail separately, including:
●Overview (see "Overview of endometrial carcinoma")
●Histopathology and pathogenesis (see "Endometrial carcinoma: Histopathology and pathogenesis")
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- INCIDENCE IN REPRODUCTIVE-AGE WOMEN
- RISKS OF FERTILITY PRESERVATION
- SELECTION OF CANDIDATES
- Selection criteria
- Pretreatment evaluation
- FERTILITY-SPARING THERAPY OPTIONS
- Progestin therapy
- - Oral agents
- Efficacy, agent, and dose
- Predictors of response
- Time interval to response
- Risk and timing of recurrence
- - Progestin intrauterine device
- - Clinical protocol
- Treatment regimen
- - Reproductive outcomes
- Hysteroscopic resection
- Other options
- SUMMARY AND RECOMMENDATIONS