Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 2.5 of the Fer­ti­PRO­TEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.


Endo­metri­al hyper­plasia is a change in the lining of the uterus which, untreated, can lead to endo­metri­al cancer in approx­im­ately 1–3% of cases in the absence of atypia (i.e. changes in cell nuclei) and in 30% of cases with atypia.

Type I carcinoma is estrogen-dependent and has typical risk factors which often occur in con­nec­tion with an unful­filled wish to conceive. 3–14% of women with endo­metri­al cancer are under 40 years old. Endo­metri­al cancer with a low tumour stage and a good chance of recovery is typically found in these young women.

fertility pre­ser­va­tion problems due to treatment

In contrast to other cancers, there is no damage to the ovaries as a result of chemo­ther­apy. Either pro­ges­to­gens (corpus luteum hormone) are used, which do not lead to damage to the ovaries, or a hys­ter­ec­tomy is performed with removal of the ovaries and fallopian tubes.


The thera­peut­ic standard for endo­metri­al hyper­plasia is pro­ges­to­gen treatment and uterine cavity mon­it­or­ing using hys­ter­o­scopy and curettage for his­to­lo­gic­al exam­in­a­tion of the endo­met­ri­um. The desire to have children should be fulfilled quickly. Removal of the uterus should be con­sidered once family planning is completed.

endo­metri­al cancer

A hys­ter­ec­tomy together with removal of the ovaries and fallopian tubes are performed as standard for the treatment of endo­metri­al cancer. This treatment has a very good prognosis for carcinoma types I, FIGO 1a, G2. Removal of local lymph nodes is also indicated at higher stages.

Data on the pos­sib­il­ity and the risks of fertility pre­serving treatment in early endo­metri­al cancer is limited. Fertility pre­ser­va­tion with pre­ser­va­tion of the ovaries and the uterus may be con­sidered in indi­vidu­al cases in younger women with a diagnosis of well-dif­fer­en­ti­ated type I, FIGO 1a endo­metri­al cancer (minimal tumour spread). Accom­pa­ny­ing high-dose hormone therapy with pro­ges­to­gens is recom­men­ded for at least 6–9 months.

Because there is still a lack of data regarding a stand­ard­ized approach, decisions on fertility pre­ser­va­tion in endo­metri­al cancer should be made on an indi­vidu­al basis.

The following currently applies if pre­ser­va­tion of the uterus can be con­sidered (depending on the extent of the tumour):

  • Explan­a­tion of increased risk of relapse,
  • Risk of inad­equate staging because of abstain­ing from hysterectomy
  • Complete removal of the tumour (curettage!)
  • High-dose hormone therapy for at least 6–12 months
  • Follow-up every 3 months with hys­ter­o­scopy and biopsy
  • Shortest possible time until pregnancy occurs after cessation of hormone therapy
  • Complete cure in 50–84%, depending on the study.

practical approach if fertility pre­ser­va­tion is considered

The risk of sub­sequent ovarian cancer must be con­sidered when the ovaries are preserved. However, this risk is probably less than 1% with an early cancer. After family planning is completed, stage-adapted therapy should be performed, usually in the form of complete surgery.