Rcog Hyperplasia

Question 1

What is prognosis hyperplasia without atypia?

Answer 1

< 5% in 20 years cancer most will regress

Question 2

How do you manage hyperplasia no atypia?

Answer 2

Lifestyle (weight)
HRT

If asymptomatic can observe with biopsy to monitor for regression especially if RF addressed-but quicker resolution progestogens

If symptoms-treat LNG IUS first line oral P 2nd.

Question 3

What dose oral P?

Answer 3

10-20 mg medroxyprogesterone
10-15 mg NET

Question 4

How often endometrial surveillance without atypia?

Answer 4

6/12 need two negative prior to d/c

If persisting high risk consider annual f/u

Question 5

When is hysterectomy indicated without atypia?

Answer 5

Progression
failure to resolve 12 mths
Relapse
Bleeding still
Refusal re surveillance/rx

Question 6

What is management with atypia?

Answer 6

Hysterectomy (risk progression or underlying malignancy)

If fertility desired or high risk for op-mdt plan re P and surveillance and aim rule out malignancy of ovary/endometrium if possible.

Question 7

If cannot do hysterectomy atypia how often monitor?

Answer 7

3/12 until 2 Neg. If evidence regression 6-12/12 till hysterectomy

Question 8

If want to conceive hyperplasia (generally) what to advise?

Answer 8

At least one negative biopsy first

Question 9

Hrt and hyperplasia (generally)

Answer 9

Switch sequential to conti/mirena

If on conti already reconsider hrt. Switch to mirena

Question 10

Does tamoxifen or aromatase inhibitor cause increased risk hyperplasia?

Answer 10

Tamoxifen

Question 11

Does tamoxifen or aromatase inhibitor cause increased risk hyperplasia?

Answer 11

Tamoxifen