Endometrial hyperplasia (Complete)

Question 1

Define endometrial hyperplasia

Answer 1

Abnormal proliferation of endometrium in excess of normal proliferation which occurs during the menstrual cycle

Question 2

How does endometrial hyerplasia typically present?

Answer 2

Intermenstrual bleeding

Question 3

What are the main types of endometrial hyperplasia?

Answer 3

Endometrial hyperplasia without atypia

Endometrial hyperplasia with atypia

Based off histological analysis

Question 4

How are woman with endometrial hyperplasia without atypia managed?

Answer 4

Conservative:

Reasurrance: 5% develop endometrial cancer within 20 years and most cases self-resolve

Observation only with follow-up endometrial biopsies

Encourage modification of risk factors (e.g. weight loss, cessation of HRT)

Medical:

Progestogen (e.g. levonorgestrel-releasing intrauterine system [LNG-IUS])

• For women who fail to regress with observation alone
• For symptomatic women with abnormal bleeding

Question 5

When is progestogen considered in management of endometrial hyperplasia without atypica?

Answer 5

In woman who fail to regress following observation

Woman who are symptomatic with abnormal uterin bleeding

Question 6

What is the best way to adminster progestogen?

Answer 6

Levonorgestrel-releasing intrauterine system [LNG-IUS]

Associated with better regression rates and less side effects

Question 7

Patients should be on LNG-IUS for at least what duration?

Answer 7

For at least 6 months

Advised to keep for 5 years if not planning to conceive

Question 8

What is an alternative for levonorgestrel-releasing intrauterine system [LNG-IUS] if woman decline?

Answer 8

Continous progestogen (e.g. oral medroxyprogesterone or norethisterone)

Question 9

Name 2 examples of continous progesterone

Answer 9

Medroxyprogesterone

Norethisterone

Question 10

How are patients with endometrial hyperplasia with atypia managed?

Answer 10

Surgical:

First-line: Total hysterectomy +/- bilateral salpingo-oophorectomy

LNG-IUS

• In cases where woman wishes to maintain fertility

Question 11

How are patients with endometrial hyperplasia with atypia managed if they wish to maintain fertility?

Answer 11

LNG-IUS with regular monitoring (3-monthly) until fertility no-longer required and hysterectomy performed