Endometrial Hyperplasia

Question 1

Regarding endometrial hyperplasia

How much higher is the incidence than endometrial Ca

Answer 1

3x

Question 2

Regarding endometrial hyperplasia

Is found in what % of astmptomatic obese women

Answer 2

10%

Question 3

Regarding endometrial hyperplasia

By how much is the incidence increased by in renal transplant patients

Answer 3

2x

Question 4

Regarding endometrial hyperplasia

What endometrial thickness cutoff is given for PCOS, under which hyperplasia is unlikely

Answer 4

7mm

Question 5

Regarding endometrial hyperplasia without atypia

What is the % risk of progression to cancer in >20yr

Answer 5

<5%

1%

Question 6

Regarding endometrial hyperplasia without atypia

What %regress spontaneously

What % regress with progestogens

Answer 6

75-81%

89-96% with progestogens

Question 7

Regarding endometrial hyperplasia

What other investigations should be considered

Answer 7

TVUSS to look for granulosa cell tumours

Inhibin and oestradiol levels if granulosa tumour suspected

Question 8

Regarding endometrial hyperplasia without atypia

What is first line treatment
How long should it be continued

Answer 8

Progestogens

Mirena
Oral medroxyprogeatogen or norethiaterone

Minimum 6 months

Question 9

Regarding endometrial hyperplasia without atypia

What surveillance is given the

Answer 9

Endometrial biopsy every 6 months

2 negative biopsies prior d/c

If hyperplasia persists for 12 months despite treatment
High risk of Ca, proceed to hysterectomy

Question 10

Regarding endometrial hyperplasia without atypia

When should hysterectomy be advised

Answer 10

• Decline surveillance
• Persistent bleeding
• Hyperplasia persists for 12 months despite treatment
• Progression to atypical hyperplasia
• Relapse after completing progestogen treatment

Question 11

Regarding endometrial atypical hyperplasia

What % of women proceeding to hysterectomy are found to have cancer in histological specimens

Answer 11

43%

Question 12

Regarding endometrial atypical hyperplasia

What is the cumulative cancer risk at 4yr
9yr
19yr

Answer 12

4yr 8%
9yr 12%
19yr 28%

Question 13

Regarding endometrial atypical hyperplasia

What is first line treatment in post menopausal women

Answer 13

TAH BSO

Question 14

Regarding endometrial atypical hyperplasia

What are treatment options in women wanting to preserve their fertility

Answer 14

Progestogens
1st line mirena
2nd line oral progestogens

Question 15

Regarding endometrial atypical hyperplasia

In women opting for conservative management what is the follow up

Answer 15

Endometrial biopsy every 3 months until 2 consecutive negative samples

Then every 6-12 months till hysterectomy

Question 16

Regarding endometrial atypical hyperplasia

What is the chance of disease regression

Answer 16

85.6%

Question 17

Regarding endometrial atypical hyperplasia

What is the risk of relapse

Answer 17

26%

Question 18

Regarding endometrial atypical hyperplasia

What is the live birth rate in those opting for conservative management

Answer 18

26%

Higher with assisted conception - refer early to fertility

Question 19

Regarding endometrial atypical hyperplasia

What is the risk of progression to cancer

Answer 19

2%

Question 20

Regarding endometrial atypical hyperplasia

What is the risk of metastatic disease and death

Answer 20

0.5%

Question 21

Regarding endometrial atypical hyperplasia

When can those opting for conservative management start trying to conceive

Answer 21

After minimum 1 normal biopsy

Question 22

If hyperplasia found in a polyp what % have concurrent background hyperplasia

Answer 22

52%