Pathogenesis presentationdiagnosis endometrial hyperplasia and endometrial carcinoma clinical scenario 1 case scenario 2. However, there are no studies evaluating ct use for following up of women with endometrial hyperplasia when treated conservatively. Pathogenesis presentationdiagnosis endometrial hyperplasia and endometrial carcinoma clinical scenario 1 case scenario 2 clinical scenario 3 clinical. Controversies in the management of endometrial cancer. Future studies will need to determine the optimal nonsurgical management of atypical endometrial hyperplasia or endometrial intraepithelial neoplasia, standardizing agent, dose, schedule. Treatment with progestin therapy may provide a safe alternative to hysterectomy. Endometrial hyperplasia, management of greentop guideline. Treatment of simple and complex endometrial nonatypical hyperplasia with natural progesterone. However, welldesigned randomized trials for an optimal endometrial hyperplasia management are lacking, and guidelines for followup are also unclear. Lecturer of gynecology and obstetrics management of endometrial hyperplasia 2.
Therapeutic options for management of endometrial hyperplasia vishal chandra,1,2, jong joo kim,3, doris mangiaracina benbrook,1 anila dwivedi,2 rajani rai3 1department of obstetrics and gynecology, university of oklahoma health sciences center, oklahoma city, ok, usa 2division of endocrinology, csircentral drug research institute, lucknow, india. Hkcog guidelines number 16 september 2015 3 for hysterectomy. Low to mediumrisk endometrial hyperplasia can be treated with nonsurgical options. Problems in the differential diagnosis of endometrial. Larger studies are needed before surgical alternatives to hysterectomy can be routinely recommended for hyperplasia.
Therapeutic options for management of endometrial hyperplasia. Endometrial hyperplasia wide spectrum of patients associated with prolonged, unopposed exppgosure to estrogen therapy depends on type patient setting. In general, estrogen causes stimulation or growth of the lining, while progesterone the antiestrogen hormone causes the uterine lining to shed, resulting in a menstrual period. Management of endometrial hyperplasia linkedin slideshare. In cases of protracted hormonal decline, incomplete to complete atrophy will result figure 1. If vaginal bleeding resumes, another endometrial biopsy should be performed 28, 29. Depoprovera versus norethisterone acetate in management of endometrial hyperplasia without atypia. If hysterectomy is performed for atypical endometrial hyperplasia or endometrial intraepithelial neoplasia, then intraoperative. Review therapeutic options for management of endometrial. Although endometrial hyperplasia occurs mostly in postmenopausal women, it can occur at much younger ages when estrogen is unopposed, as seen in polycystic ovarian syndrome and obesity some cases of endometrial hyperplasia, especially atypical, can progress to endometrial cancer, so it is important to study the two together. There is insufficient evidence evaluating computerised tomography ct, diffusionweighted magnetic resonance imaging mri or biomarkers as aids in the management of endometrial hyperplasia and their use is not routinely recommended. Pdf therapeutic options for management of endometrial.
This paper outlines development of our current classification of endometrial hyperplasias in some detail to provide an understanding of the complexity of the problem of determining the malignant potential of the hyperplasias, which is the central issue. An update on the management of endometrial hyperplasia. Treatment of endometrial hyperplasia can be medical or surgical and is dependent on cause, malignant potential, fertility requirements and medical co morbidities. Updates in the management of complex atypical hyperplasia endometrial intraepithelial neoplasia 12420 2 definition proliferation of endometrial glands. Surgical treatment, including complete hysterectomy, removal of remaining adnexal structures, and an appropriate surgical staging, represents the milestone of curative. This can be taken in several forms, including pill, shot, vaginal cream, or intrauterine device. Reference rcogbsge guideline on management of endometrial hyperplasia rcog 2016 feb pdf synthesized recommendation grading system for dynamed content the dynamed team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decisionmaking see 7step evidence. This condition is benign, but may lead to cancer at times.
Endometrial hyperplasia endometrial hyperplasia covers a range of pathological changes in the uterine glands and stroma. Request pdf diagnosis and management of endometrial hyperplasia endometrial hyperplasia eh, with or without atypia, is a common gynecologic diagnosis. Endometrial hyperplasia refers to the thickening of the endometrium. Obesity and having metabolic syndrome may increase the risk of endometrial cancer. Endometrial hyperplasia symptoms,causes,diagnosis and. Endometrial hyperplasia obstetrics, gynaecology and. Diagnosis and management of endometrial hyperplasia journal of. The classification, diagnosis and optimal management of endometrial hyperplasia are still the subject of vigorous debate. Introduction and background epidemiology endometrial hyperplasia is defined as irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium. Atypical types of endometrial hyperplasia, especially complex, increase your risk of getting cancer.
After the menopause, endometrial thickening may be indicative of proliferation, cystic atrophy, simple hyperplasia, complex hyperplasia, atypical hyperplasia, or endometrial cancer. Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy andor radiation therapy. During the reproductive years, the risk of eh is increased by conditions associated with intermittent or absent ovulation, in particular, polycystic ovary syndrome. It may return to normal without any treatment in some cases.
Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices. Endometrial hyperplasia eh, with or without atypia, is a common gynecologic diagnosis and a known precursor of endometrial carcinoma, the most common gynecologic malignancy. Conservative management is recommended for endometrial hyperplasia without cytological atypia grade b recommendation. Endometrial hyperplasia is defined as irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium. Pathology of the endometriumpathology of the endometrium.
The most common presentation of endometrial hyperplasia is abnormal uterine bleeding. Although endometrial hyperplasia usually is not cancerous, it is a risk factor for the development of cancer of the uterus. Endometrial cancer ec remains the most common malignancy of the female genital tract. Introduction the endometrium lining of the uterus may develop endometrial hyperplasia eh, which includes nonneoplastic entities disordered proliferative endometrium, benign hyperplasia, simple and complex hyperplasias without atypia characterized by a proliferation of endometrial glands of irregular size and shape, and precancerous neoplasms endometrial. Aug 22, 2017 endometrial hyperplasia is a thickening of the inner lining of the womb uterus. The most common presenting symptom of endometrial hyperplasia is abnormal. In some women it may progress to a cancer of the lining of the womb. When your endometrium thickens, it can lead to unusual bleeding.
This is the layer of cells that line the inside of your uterus. It may have many causes, but the most important association is with endometrial malignancy. Endometrial hyperplasia obstetrics and gynecology wiley. Request pdf diagnosis and management of endometrial hyperplasia endometrial hyperplasia eh, with or without atypia, is a common gynecologic diagnosis and a known precursor of endometrial. This paper outlines development of our current classification of endometrial hyperplasias in some detail to provide an understanding of the complexity of the problem of determining the malignant potential of the hyperplasias, which is the central issue in determining. Endometrial hyperplasia eh is defined histologically as abnormal overgrowth of endometrial glands. Prevention and treatment of endometrial hyperplasia. Endometrial hyperplasia abnormal proliferation of endometrial glandular epithelium and often stroma that lacks stromal invasionthat lacks stromal invasion. Olawaiyeg,mollybrewerh,daveborutai, jeanine villellaj,k, tom herzogl,fadiabushahinm, for the society of gynecologic oncology clinical. Endometrial hyperplasia is of clinical significance because it is often a precursor lesion to adenocarcinoma of the endometrium.
Although uncommon, both atypical hyperplasia and endometrial cancer may originate from endometrial polyps. Treatment options for endometrial hyperplasia depend on what type you have. Nonatypical hyperplasiabenign endometrial hyperplasia eh without atypia is nonneoplastic and may exhibit increasing degrees of endometrial gland crowding. The who94 schema classifies histology based on glandular complexity. Review article therapeutic options for management of. Varying shapessizes and presence of cytologic atypia results from chronic estrogen stimulation 4. Currently, the incidence of eh is indistinctly reported to be around 200,000. The initial result of hyperestrogenism is the development of endometrial hyperplasia, which is reversible in most cases by appropriate hormonal therapy. Jun 02, 2011 endometrial hyperplasia is a condition that occurs due to the excessive growth of the lining and cells of the endometrium, i. Results from chronic estrogen stimulation unopposed by progesterone. On the other hand, tvus scan was able to correctly identify absence of malignant changes in the endometrium. Hkcog guidelines number 16 september 2015 hkcog guidelines. Request pdf management of endometrial hyperplasia endometrial hyperplasia is a commonly seen clinical entity.
The endometrium is the lining of the uterus, a hollow, muscular organ in a womans pelvis. Endometrial hyperplasia symptoms, causes, and treatments. Diagnosis and management of endometrial hyperplasia. Up to now, the correct clinical evaluation of endometrial hyperplasias was made more difficult by the different classification systems still in use. See classification and diagnosis of endometrial hyperplasia. Management is guided by the severity of histologic features, menopausal status, and fertility and contraception plans. Menstruating women with endometrial hyperplasia have a risk of developing anemia low red blood cell count. The value of mri in management of endometrial hyperplasia. Although endometrial hyperplasia occurs mostly in postmenopausal women, it can occur at much younger ages when estrogen is unopposed, as seen in polycystic ovarian syndrome and obesity. Biopsy refers to the removal of a sample of tissue to examine it under the microscope. Endometrial hyperplasia is an overgrowth of the endometrium, the lining of the uterus, that may progress to or coexist with endometrial cancer.
Joint rcog, bsge and bgcs guidance for the management of. In 1985, kurman et al 3 clarified the classification system for endometrial hyperplasia, proposing 2 broad categories. Besides endometrial hyperplasia, prominent risk factors for carcinoma are unopposed estrogen therapy, obesity, diabetes, early menarche, and late menopause. The results of previous case series indicate that malignancy occurs within 0% to 12. Diagnosis and management of endometrial hyperplasia request pdf. It is most often diagnosed in postmenopausal women, but women at any age with unopposed estrogen from any source are at an increased risk for developing endometrial hyperplasia.
Clinical factors to consider in choosing a management approach include the following. Endometrial pathology in the postmenopausal woman an evidence based approach to management mohamed otify msc mrcog,a, joanna fuller mrcog,a jackie ross frcog,b hizbullah shaikh,c jemma johns md mrcog d aclinical research fellow, suite 8, golden jubilee wing, kings college hospital, denmark hill, london se5 9rs, uk bconsultant gynaecologist. Jun 19, 2018 standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy andor radiation therapy. Risk factors for endometrial carcinoma include chronic ovulatory dysfunction, obesity, early menarche, late menopause, increasing age, tamoxifen therapy, and lynch syndrome. Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus. Symptoms of endometrial hyperplasia vaginal discharge abdominal pain bleeding between menstrual periods heavy or prolonged menstrual periods 11. Endometrial pathology in the postmenopausal woman a an. Hysterectomy should not be considered as a firstline treatment. When is surgical management appropriate for women with endometrial hyperplasia without atypia. Pathophysiology and management of endometrial hyperplasia. Endometrial cancer is currently the commonest pelvic malignancy affecting american women, most of whom share the same pathophysiologic basis, that is, unopposed estrogenic stimulation. Some cases of endometrial hyperplasia, especially atypical, can progress to endometrial cancer, so it is important to study the two together. A great majority of patients present with abnormal uterine bleeding. Endometrial cancer is the most common gynaecological malignancy in the western world and endometrial hyperplasia is its precursor.
Dec 01, 2015 endometrial hyperplasia eh is a precancerous, nonphysiological, noninvasive proliferation of the endometrium that results in increased volume of endometrial tissue with alterations of glandular architecture shape and size and endometrial gland to stroma ratio of greater than 1. Part i sgo clinical practice endometrial cancer working group, william m. This includes heavy menstrual bleeding, intermenstrual bleeding, irregular bleeding, unscheduled bleeding on hormone replacement therapy hrt and postmenopausal bleeding. In others, hormone treatment or an operation may be needed. Prognostic factors for improved longterm os were the absence of residual disease. The diagnosis of endometrial hyperplasia is by biopsy or curettage of the uterine endometrium. Conservative management of endometrial hyperplasia. Management of endometrial hyperplasia in postmenopausal women eh. Complications of untreated or poorly controlled endometrial hyperplasia can be serious. Endometrial hyperplasia eh is a precancerous, nonphysiological, noninvasive proliferation of the endometrium that results in increased volume of endometrial tissue with alterations of glandular architecture shape and size and endometrial gland to stroma ratio of greater than 1. Progressionof endometrial hyperplasia hyperplasia without atypia rarely progresses to endometrial cancer, hyperplasia with atypia is a precancerous condition that may progress to overt malignancy. Hyperplasia can be simple or complex, with or without atypia.
Glandtostroma ratio 50 percent and crowded appearance. Minassian and mira 16 reported use of thermal balloon ablation of the endometrium in a patient with complex endometrial hyperplasia with atypia the patient initially presented with a complaint of menorrhagia and had a. Endometrial hyperplasia micrograph showing simple endometrial hyperplasia, where the glandtostroma ratio is preserved but the glands have an irregular shape andor are dilated. The classification, diagnosis and management of endometrial. Pdf endometrial hyperplasia eh is comprised of a spectrum of changes in the endometrium ranging from a slightly disordered pattern that. It is commonly di agnosed in women with uterine bleeding. May 10, 2015 management of endometrial hyperplasia 1. Nonatypical hyperplasia benign endometrial hyperplasia eh without atypia is nonneoplastic and may exhibit increasing degrees of endometrial gland crowding. The differential diagnosis of endometrial hyperplasia and welldifferentiated endometrioid adenocarcinoma is complicated not only by the resemblance of these lesions to each other, but also by.
There are currently two systems of endometrial precancer nomenclature in common usage. At this magnification, complex endometrial hyperplasia with backtoback glandular crowding is evident. Overview of endometrial hyperplasia, risk factors, classification and treatment options. Taking tamoxifen for breast cancer or taking estrogen alone without progesterone can increase the risk of endometrial cancer. Furthermore,if the endometrial thickness is 5 mm yet symptoms persist,then we agree that additional assessment with hysteroscopy andor transvaginal ultrasound should be undertaken. The median age at diagnosis is the sixth decade, with abnormal uterine bleeding at the presentation in 90% of the patients. Women who experience irregular menstrual cycles are more prone to this disease, as they do. Endometrial hyperplasia symptoms, causes, treatments.
Jan 04, 2019 although endometrial hyperplasia usually is not cancerous, it is a risk factor for the development of cancer of the uterus. Survival is gener ally defined by the stage of the disease and histology, with most patients at stage i and ii. Endometrial hyperplasia eh is a precancerous, nonphysiological, noninvasive proliferation of the endometrium that results in increased volume of endometrial tissue with alterations of glandular architecture endometrial glands to shape and size and. Endometrial hyperplasia is a precursor to the most common gynecologic cancer diagnosed in women. The presence of atypia is the most worrisome feature as approximately 20% of those with atypical hyperplasia will have a concomitant endometrial carcinoma and a. Olawaiye g,mollybrewer h,daveboruta i, jeanine villella j,k.
1280 1449 191 517 703 170 771 776 1248 1237 699 1368 1316 1293 1359 969 892 542 272 138 316 155 1033 463 582 891 1495 1381