Endometrial hyperplasia is proliferation of endometrial glands of the inner lining of the uterus i.e. endometrium. It can progress to endometrial carcinoma.It is basically of two types; Simple and Complex Hyperplasia.

• Simple hyperplasia (1%)
• Complex hyperplasia (3%)
• Simple atypical hyperplasia (8%)
• Complex atypical hyperplasia (29%)

When endometrial hyperplasia left untreated it progresses to endometrial cancer (% - rate of progression).

What Causes Endometrial Hyperplasia

• Continuous estrogen stimulation that is unopposed by progesterone. This can be due to endogenous estrogen or exogenous estrogenic sources.
• Endogenous estrogen may be caused by chronic anovulation associated with polycystic ovary syndrome (PCOS) or perimenopause.
• Obesity also contributes to unopposed estrogen exposure due to chronic high levels of estradiol. E
• Estrogen-secreting ovarian tumors such as granulosa cell tumors.
• Nulliparity, early menarche, and late menopause

Symptoms

• Abnormal uterine bleeding - menorrhagia, metrorrhagia, or postmenopausal bleeding.
• Abnormal vaginal discharge or Pap smear results showing glandular abnormalities.

Diagnosis

• Diagnosis of endometrial hyperplasia is usually made by sampling the endometrial cavity with an endometrial biopsy in the office or dilation and curettage (D&C) in the operating room.
• Ultrasound, CT scan, MRI

Treatment of Endometrial Hyperplasia

Progesterone can effectively treat endometrial hyperplasia to control bleeding and prevent progression to cancer. They can serve as prevention of recurrence in those with continued risk factors. Hyperplasia without atypia responds well to progesterone. Multiple regimens of progesterone therapy have been found effective in reversing endometrial hyperplasia, including the following:

• Medroxyprogesterone acetate, 10-20 mg qid, or cyclic 12-14 days per month up-to 6 months
• Mirena, 1-5 years

If hyperplasia with atypia, definitive treatment is hysterectomy due to the high rate of endometrial cancer.

Endometrial cancer

Endometrial cancer starts in the endometrium, the inner lining of the uterus. It is the most frequently occurring female genital cancer in developed countries whereas in developing countries it is third most common. Endometrial adenocarcinoma occurs during the reproductive and menopausal years. The median age of persons with this malignancy is early in the seventh decade of life, although most patients are aged 50-59 years.

Symptoms of Endometrial Carcinoma

• Postmenopausal bleeding.
• Heavy, frequent menstrual periods
• Intermenstrual bleeding

Investigations and Diagnosis

• Ultrasonography
• Endometrial biopsy
• Hysteroscopically directed biopsy
• Dilatation and curettage

Treatment of Endometrial Carcinoma

Treatment of endometrial cancer is dependent on the stage of the disease and the patient’s surgical fitness. In general, surgery is recommended. Chemotherapeutic medications such as cisplatin can be used in the management of endometrial carcinoma.

Prev Next