The incidence of endometrial cancer is the second highest among female genital tumors, about 25.7/100,000. most endometrial cancers are histological types of endometrioid adenocarcinoma, mostly with precancerous lesions. If left untreated, endometrial hyperplasia may develop into endometrial cancer. Endometrial hyperplasia is divided into four types based on histological manifestations: simple hyperplasia, complex hyperplasia, simple atypical hyperplasia, and complex atypical hyperplasia. Simple hyperplasia does not usually progress to endometrial cancer (1% risk), but the risk of developing endometrial cancer in complex atypical hyperplasia is about 25%. There are several known risk factors for endometrial hyperplasia and endometrial cancer risk: excess estrogen (either increased synthesis in obese women or intake of non-antagonistic estrogen can lead to altered glandular proliferation), diabetes mellitus, nulliparity and polycystic ovary syndrome. If the patient’s main symptom is irregular vaginal bleeding, endometrial pathology should be suspected. Ultrasonography can help rule out other lesions (polyps, fibroids) and assess the thickness and status of the endometrium. Endometrial tissue samples can further assist in the diagnosis. Clinicians can obtain tissue samples by diagnostic curettage, Pipelle biopsy or hysteroscopy. However, all of these methods may miss the diagnosis and result in false negative results. Once endometrial hyperplasia is diagnosed, surgery or pharmacologic treatment is required. If medication is considered, which drug treatment is more effective? Professor Hashim et al. from the Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt, summarized the studies on the efficacy of two pharmacological treatments, levonorgestrel intrauterine device (LNG-IUS) and oral progestin, for the treatment of endometrial hyperplasia without atypical hyperplasia and published the results in AmJObestetGynecol. The systematic review includes the results of seven randomized controlled trials. Studies included only patients without atypical hyperplasia, treated with LNG-IUS or oral progestin and followed for 3 to 24 months. The outcome analysis included 766 patients (329 patients treated with LNG-IUS and 437 patients treated with oral progestins). Oral progestins included medroxyprogesterone acetate, norethindrone acetate, and didrogestrel. Patients treated with LNG-IUS were found to have significantly better outcomes than those in the oral progestin group. The longer the follow-up period, the more pronounced the advantage of LNG-IUS; at 24 months, the OR was 7.46. The efficacy of LNG-IUS was significantly better than that of oral progestin, regardless of whether the hyperplasia was simple or complex. However, there was no significant difference in the frequency of irregular vaginal bleeding between the two groups. Patients requiring hysterectomy were significantly less likely to be in the LNG-IUS group than in the oral progestin group. Treatment of simple or complicated endometrial hyperplasia with LNG-IUS was significantly better than oral progestin The targeted treatment for endometrial cancer is hysterectomy. However, surgical treatment does not apply to all patients. Some patients still want to preserve their fertility, and others are not physically able to tolerate surgical treatment. In these cases, patients may be given long-term high-dose progestin therapy. Progestins have an anti-proliferative effect and may also reduce further glandular mutations. LNG-IUS has several advantages over oral preparations. One, compliance is better than with oral preparations. Second, side effect concerns are more favorable because LNG-IUS is administered locally rather than released systemically. Compared to oral preparations, a significant increase in local progestin concentration can achieve intrauterine treatment and therefore better therapeutic efficacy. In conclusion, the use of LNG-IUS for the treatment of simple or complicated endometrial hyperplasia is clearly superior to oral progestins. However, randomized trials included only patients without atypical hyperplasia. Most studies had a follow-up period of less than one year; the long-term follow-up effect still needs further study. Because there are no study data demonstrating the efficacy of LNG-IUS in patients with atypical hyperplasia, such cases still need to be treated with caution.