A Novel GnRH Agonist-Based Regimen for Reducing Recurrence in Fertility-Preserved Atypical Polypoid Adenomyoma: A Retrospective Study

Background Atypical polypoid adenomyoma (APA) is an uncommon uterine lesion characterized by a potential for recurrence and malignant transformation. Fertility-sparing treatment represents a critical option for patients who wish to preserve reproductive capacity. Methods In this retrospective study, we analyzed 34 patients with APA (with or without concurrent endometrial lesions) who underwent hysteroscopic resection (HR) followed by either high-dose progestin or a GnRHa-based regimen (combined with letrozole) between January 2005 and January 2025. Clinicopathological characteristics, treatment outcomes, and reproductive results were evaluated. Results All patients diagnosed via HR, with a mean age of 31 years (range: 22–41). Among them, 31 had coexisting endometrial atypical hyperplasia (EAH) or endometrioid endometrial carcinoma (EEC). Eighteen patients (52.9%) were treated with high-dose progestin, and 16 (44.4%) received GnRHa plus letrozole. Complete response (CR) was achieved in all cases, with a median time to CR of 4.5 months (range: 3–15). The recurrence rate of endometrial lesions was 41.2%, with pathological progression observed in 14.7% of cases. Median disease-free survival was 37.5 months (range: 6–186), and 92.9% of recurrences occurred within five years. Factors associated with higher recurrence included age below 35 years, obesity, infertility, lesion location in the lower uterine segment and/or cervical canal. Although both the progestin and GnRHa groups showed similar CR rates and time to CR, the recurrence rate was relatively higher in the progestin group (52.6% vs. 26.7%). Uterine preservation was achieved in 31 patients (91.2%) during follow-up. Among 19 patients attempting conception, 11 pregnancies occurred in eight women, resulting in eight full-term live births. Conclusions Hormone therapy for APA demonstrates favorable initial response and reproductive outcomes. Given the high prevalence of coexisting endometrial hyperplastic lesions and a tendency for recurrence within 5 years, careful preoperative evaluation via HR and long-term follow-up are strongly recommended. GnRHa-based regimen may offer superior recurrence control compared to progestin therapy, although further studies are warranted to confirm these findings.