Updated: 10/12/2018

Endometrial Hyperplasia

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Snapshot
  • A 60-year-old G0 female was found on outpatient endometrial biopsy to have abnormal proliferation of stromal and glandular endometrial elements. 
Overview

Introduction
  • An estrogen-dependent hyperplasia affecting mainly postmenopausal women
    • incidence peaks between ages 50 and 60
  • Risk factors include
    • increased estrogen exposure
      • unopposed postmenopausal estrogen replacement
      • obesity
      • nulliparity
      • late menopause (after age 52)
      • polycystic ovarian syndrome
      • estrogen-producing tumors
      • anovulation
    • cancer syndromes
      • hereditary nonpolyposis colon cancer
  • 3 classes of hyperplasia severity
    • simple
      • ↑ number of glands with no crowding
    • complex
      • ↑ number of branching glands with crowding
    • atypical
      • ↑ number of atypical glands with crowding
      • highest risk of progression to endometrial cancer
Presentation
  • Symptoms
    • abnormal uterine bleeding
    • post-menopausal bleeding
Evaluation
  • Tissue biopsy
    • gold standard
Treatment
  • Pharmacologic
    • progesterone
      • indications
        • simple or complex hyperplasia
      • used to reverse hyperplastic process
  • Surgical
    • hysterectomy
      • indications
        • atypical hyperplasia
      • because of high chance of invasion
 

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