# Fertility-sparing hormonal treatment of early endometrial cancer

Source: https://onco.cc/technologies/fertility-sparing-endometrial/  
OnCo record `fertility-sparing-endometrial` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.

## Summary

Candidates: grade 1 endometrioid carcinoma confined to the endometrium on MRI, PR-positive, no myometrial invasion. Complete response ~70-80% at 12 months with oral megestrol/medroxyprogesterone or a levonorgestrel IUD (often combined with metformin or hysteroscopic resection); recurrence ~30%; live-birth rates ~30-40% with assisted reproduction. Hysterectomy after childbearing is recommended.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-07
- Principle: Progestin-induced differentiation and apoptosis of hormone-responsive endometrial cancer cells under close endometrial sampling surveillance.
- Strengths: Preserves fertility in a disease increasingly diagnosed in women under 45; Minimal toxicity
- Limitations: Recurrence risk ~30%; Requires strict imaging and biopsy follow-up; Not appropriate for grade 2-3, p53-abnormal, or invasive disease

## Sources

- Rodolakis et al., ESGO/ESHRE/ESGE guidelines for the fertility-sparing treatment of patients with endometrial carcinoma (International Journal of Gynecological Cancer 2023): https://doi.org/10.1136/ijgc-2022-004047

## Connected records

- cancers: [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Endometrial cancer with no specific molecular profile](https://onco.cc/cancers/endometrial-nsmp/)
- fronts: [Hormonal Therapy](https://onco.cc/fronts/hormonal/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [MRI](https://onco.cc/technologies/mri/)
- drugs: [Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD)](https://onco.cc/drugs/megestrol-progestins/)
- key papers: [ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma](https://onco.cc/key-papers/paper-rodolakis-int-j-gynecol-cancer/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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