Endometrial Hyperplasia
INTRODUCTION:
- Endometrial hyperplasia is overgrowth of uterine lining (endometrium) that may progress to or coexist with endometrial (uterine) cancer.
- Long-term unopposed estrogen production causes overgrowth of the uterine lining and results in endometrial hyperplasia.
- Atypical endometrial hyperplasia undergoes malignant transformation in 25%
RISK FACTORS:
- Obesity
- Polycystic Ovarian Syndrome
- Estrogen therapy without progesterone
- Estrogen-secreting ovarian tumors
- Tamoxifen
TYPES:
- Simple without atypia: One percent risk of uterine cancer.
- Complex without atypia: Three percent risk of uterine cancer.
- Simple with atypia: Eight percent risk of uterine cancer.
- Complex with atypia:
- The most significant type of endometrial hyperplasia.
- 29% progress to uterine cancer and 17 to 59% of cases have coexistent uterine cancer.
SYMPTOMS:
- Endometrial hyperplasia typically causes abnormal uterine bleeding and most commonly occurs in post-menopausal women.
DIAGNOSIS:
- Biopsy without hysteroscopy:blind biopsy. A thin plastic tube is inserted into the uterus, and a small sample of the lining is obtained.
- Biopsy with hysteroscopy :thin camera being guided into the uterine cavity and a small biopsy obtained
- Hysteroscopy, D&C is performed in the operating room under anesthesia
TREATMENT:
- Hysterectomy (removal of the uterus) is recommended for patients who are post-menopausal or patients who have completed childbearing.
Hyperplasia without atypia
- Progesterone therapy
- Depo Provera (injection)
- IUD (Intrauterine device)
Hyperplasia with atypia
- D&C should be performed to confirm the absence of cancer
- High-dose oral progesterone therapy
- Persistent hyperplasia after treatment for nine months is considered treatment failure and hysterectomy should be considered.
Exam Question
- Endometrial hyperplasia is seen in PCOD cervix
- Treatment of choice in a postmenopausal lady with atypical endometrial hyperplasia is Hysterectomy
- Atypical endometrial hyperplasia undergoes malignant transformation in 25%
- Endometrial hyperplasia is indication for using endogenous progesterone
- Estrogen causes endometrial hyperplasia
- The risk of endometrial carcinoma is highest with Complex hyperplasia with atypia
- Tamoxifen causes Endometrial hyperplasia
Don’t Forget to Solve all the previous Year Question asked on Endometrial Hyperplasia
