Name
ENDOMETRIAL HYPERPLASIA
DESCRIPTION
DETAIL
CLASSIFICATION OF HYPERPLASIA : 1. SIMPLE HYPERPLSIA 2. COMPLEX HYPERPLASIA WITH CROWDED IRREGULAR GLANDS 3. SIMPLE HYPERPLASIA WITH ATYPIA 4. COMPLEX HYPERPLASIA WITH ATYPIA RISK FACTORS : - OBESITY - NULLIPARITY - EARLY MENARCHE - LATE MENOPAUSE* ENDOMETRIAL BIOPSY
TYPENOTES
REPEAT BIOPSY IS RECOMMENDED AFTER 3 MTHS TO CHECK FOR MEDICAL RESPONSE & CONTINUED SURVEILLENCE AFTER REGRESSION OF LESION IS RECOMMENDED EVERY 6 - 12 MTHS IF RISK FACTORS PERSIST.MEDICAL TREATMENT : Once tissue diagnosis of endometrial hyperplasia is made, treatment depends on patient symptoms such as degree of bleeding, presence of cytologic atypia, patient's surgical risks, and wish for future childbearing. Progestins can effectively treat endometrial hyperplasia and they can serve as prevention of recurrence in those with continued risk factors. Hyperplasia without atypia responds well to progestins. More than 98% of women with hyperplasia treated with cyclic progestins saw regression of the disease in 3-6 months (Gambrell, 1995). The PEPI trial showed a 94% normalization of complex or atypical hyperplasia in 45 women treated with progestins (PEPI, 1996). Multiple regiments of progestin therapy have been found effective in reversing hyperplasia. Medroxyprogesterone acetate (Provera), 10-20 mg qd, or cyclic 12-14 days per month Micronized vaginal progesterone (Prometrium), 100-200 mg qd or cyclic 12-14 days per month Levonorgestrel-containing IUD (Mirena), 1-5 years Megestrol acetate (Megace), 40-200 mg per day, usually reserved for women with atypical hyperplasia If hyperplasia with atypia is found on dilation and curettage (D&C) or endometrial biopsy, definitive treatment with hysterectomy is recommended due to the high rate of concurrent endometrial cancer. However, if the patient has not completed child bearing or is not a surgical candidate, then concurrent cancer must first be ruled out by D&C with hysteroscopy prior to medical management. Because D&C and Pipelle biopsy only sample 50-60% of the endometrial lining, focal lesions containing adenocarcinoma may be missed. Biopsy is recommended after 3 months to check for response, and continued surveillance after regression of lesion is recommended every 6-12 months if risk factors persist.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
PAP"S SMEAR, ULTRA SOUND WHOLE ABDOMEN - FEMALE, COMPLETE BLOOD COUNT, BIOPSY