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Endometrial hyperplasia

Updated: Apr 30, 2018

It is the abnormal growth of the endometrial glands, and It is one of the precursor that may lead to endometrial cancer.

  • Risk factors that is associated with increase in the endometrial hyperplasia:- excessive Estrogen production without progestin as happens in these cases: 1- increase body mass index. 2- anovulation as in cases of polycystic ovary syndrome or as in premenopausal periods. 3- Ovarian tumors producing Estrogen. 4- The use of Estrogen containing drugs or tamoxifen for a long period.

  • Types: 1- endometrial hyperplasia without atypia. 2- endometrial hyperplasia with atypia.

  • How is it diagnosed? 1- Vaginal ultrasound: It is not diagnostic but It may show increase in the endometrial thickness (after menopause >4mm/ before menopause >7mm) are considered abnormal. 2- Endometrial histopathology examination either using pipelle biopsy or by curettage. 3- Hysteroscopy directed biopsy especially if there is endometrial polyp.

  • What are the symptoms you may feel? 1- Irregular vaginal bleeding. 2- Postmenopausal bleeding.

  • How is it treated?

1- In cases of endometrial hyperplasia without atypia. - Risk of progression to endometrial cancer < 5% over 20 yrs. - There are two types of therapy: 1- Observation and stopping the primary cause: May be beneficial in 74-81% of the cases.

2- Progesterone therapy: It is more effective in returning the tissue to the normal in 89%-96% of the cases.

Continuous progesterone or LNG IUCD is given for 6 months then repeat dilatation and curettage till two negative results at 6 months interval, if symptoms improve and there is no risk factors discharge patient but if there is risk factor continue annual biopsy .

  • When It is better to do hysterectomy: 1-If the female ends her family and doesn't want any future pregnancy. 2- In cases of progression of the disease. 3 -In cases of persistent disease despite therapy. 4- If it recurs after completion of therapy. 5- If bleeding continue despite treatment. 6- If the patient is uncooperative regarding compliance to treatment and follow up protocol. It is better to remove the ovaries and tubes in postmenopausal female.

It is contraindicated to do endometrial ablation because it may cause adhesion that may hinder taking future biopsies

2- In cases of endometrial hyperplasia with atypia: the best choice is to do hysterectomy+/- bilateral salpingeoopherectomy especially in postmenopausal females because:

1- The risk of progression to endometrial cancer is up to 30% 2- There is 43% concurrent endometrial cancer at time of hysterectomy.

Also endometrial ablation is contraindicated.

If the female desire to retain her future fertility or if the patient is unfit for surgery

- they should be counseled regarding concurrent malignant chances and the possibility of progression of these cells to malignant cells with the risk of metastasis and death. - If they insist to avoid hysterectomy they need to do these tests: 1- Tumors marker. 2- Ultrasound scan. 3- MRI pelvis. - Then the doctor will give them progesterone and sampling of the endometrium will be done every 3 months till we reach two negative results then follow up will be every 6-12 months.

-If no improvement in the hyperplastic cells or recurrence of the disease it is better to go for hysterectomy. - It is better to encourage pregnancy as soon as possible even if It necessitates doing IVF.

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