L1: Endometrial Hyperplasia

Question 1

Def of Endometrial Hyperplasia

Answer 1

• It is irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium.

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• Endometrial hyperplasia is the precursor of endometrial cancer which is the most common gynecological malignancy in the Western world

Question 2

Incidence of Endometrial Hyperplasia

Answer 2

• The incidence of endometrial hyperplasia is estimated to be at least three times higher than endometrial cancer.
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• It more common in nulls, peri-menopausal age and white races.

Question 3

Etiology of Endometrial Hyperplasia

Answer 3

• Prolonged unopposed estrogenic stimulation
• genetic and familial tendency

Question 4

RF for Endometrial Hyperplasia

Answer 4

Question 5

NE of Endometrial Hyperplasia

Answer 5

The uterus may be:
- normal sized
- atrophied “menopausal uterus”
- enlarged due to other associated pathology.

Question 6

ME of Endometrial Hyperplasia

Answer 6

Question 7

ME of Endometrial Hyperplasia

• Endometrial Hyperplasia without atypia

Answer 7

Question 8

ME of Endometrial Hyperplasia

• Atypical Endometrial Hyperplasia

Answer 8

Question 9

Dx of Endometrial Hyperplasia

Answer 9

Question 10

Dx of Endometrial Hyperplasia

• Symptoms

Answer 10

Question 11

Symptoms of Endometrial Hyperplasia

• History

Answer 11

History of etiology

(hyper estrogenic status)

Question 12

Symptoms of Endometrial Hyperplasia

• Asymptomatic

Answer 12

Asymptomatic and accidentally discovered on screening for endometrial carcinoma.

Question 13

Symptoms of Endometrial Hyperplasia

• Bleeding (AUB-M)

Answer 13

The most common presentation of endometrial hyperplasia is abnormal uterine bleeding, includes:

• heavy menstrual bleeding (HMB)
• inter-menstrual bleeding (IMB)
• irregular bleeding
• unscheduled bleeding on HRT
• postmenopausal bleeding

Question 14

Symptoms of Endometrial Hyperplasia

• Etiology

Answer 14

symptoms of the etiology

• e.g., picture of PCOS…etc.

Question 15

Symptoms of Endometrial Hyperplasia

• Uterus

Answer 15

The uterus may be normal, atrophied, or enlarged and may be ovarian swelling or tumors.

Question 16

Dx of Endometrial Hyperplasia

• INVx

Answer 16

Question 17

Dx of Endometrial Hyperplasia

• Imaging

Answer 17

TAS or TVS: there may be thickened endometrium.

Question 18

Dx of Endometrial Hyperplasia

• Histopathology

Answer 18

by endometrial curettage (show the types mentioned before).

Question 19

TTT of Endometrial Hyperplasia

Answer 19

Question 20

TTT of Endometrial Hyperplasia

• Depends on

Answer 20

Question 21

TTT of Endometrial Hyperplasia

• Reproductive Age

Answer 21

Question 22

TTT of Endometrial Hyperplasia

• Pre-or postmenopausal age

Answer 22

Question 23

• Follow up of treatment with endometrial sampling (office endometrial biopsy) not by ultrasound.

Answer 23

…

Question 24

• Hysterectomy when done for EH it is best vaginal or laparoscopic (minimally invasive technique).

Answer 24

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Question 25

- Bilateral salpingectomy should be done with hysterectomy for EH to reduce incidence of ovarian cancer ( when slapingo-oophorectomy is not done).

Answer 25

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Question 26

Algorithm for Management of **Endometrial Hyperplasia**

Answer 26