Date Posted: July 23, 2026

Author/s: Agnes Christian P. Soriano, MD; Ma. Kathrina Mariñas, MD, FPOGS, FPSUOG; Claudette R. Cabingue, MD, FPOGS, FPSRM, FPSGE; Rey H. de los Reyes, MD, MHSA, PhD, FPOGS and Cherry Go-Palomar, MD, MAEd, FPOGS, FPSUOG (Research Adviser)

Endometrial carcinoma is the third most frequent gynecologic malignancy in the Philippines, with its peak incidence in perimenopausal and postmenopausal women. Nevertheless, 2.1% to 14.4% of occurrences of endometrial carcinoma are in women of reproductive age. Established risk factors include nulliparity, anovulation, obesity, diabetes mellitus, infertility, and PCOS. In the last 30 years, an increasing number of cases of endometrial cancer in young women worldwide have been reported. There are no local research studies in the Philippines regarding long-term oncologic and fertility outcomes, recurrence rates, and proper conservative management in such a limited group of patients. This case adds to the increasing evidence for fertility-sparing treatment in Gynecologic Oncology.

This case report discusses a 26-year-old nulligravid who presented with abnormal uterine bleeding. Diagnostic hysteroscopy, surgical, polypectomy revealed a well-differentiated endometrioid adenocarcinoma in a background of endometrial hyperplasia with atypia, leading to a diagnosis of Stage IA Endometrioid Endometrial Carcinoma. She was started on Megestrol Acetate and was kept under close surveillance with Hysteroscopy and Endometrial biopsies every three months. After six months of progesterone therapy, remission was confirmed with benign histologic findings. A Reproductive Medicine specialist has also been on board in her management, given her longstanding desire to conceive, to which she eventually achieved pregnancy after one cycle of Letrozole. She delivered a term, birth, living boy via Low Segment Cesarean Section without fetomaternal complications. On postpartum, she was maintained on Levonorgestrel Intrauterine System to help maintain remission and was advised to complete her desired childbearing before considering a definitive hysterectomy.

This case shows that conservative hormonal therapy with fertility treatment may be an option to achieve successful oncologic and reproductive outcomes in carefully selected cases. It advocates the significance of a personal approach to care, strict monitoring, and interdisciplinary coordination. Further research is needed to establish standardized protocols for managing young women with endometrial cancer in low-resource settings.

Keywords: Endometrial carcinoma, fertility preservation, young women, Megestrol Acetate, Letrozole, Levonorgestrel IUS, conservative management, Gynecologic Oncology