Gynaecologic Problems: Hyperplasia
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Description
Endometrial hyperplasia is a proliferation
(excessive growth) or thickening of the
which may involve part or all of the endometrium.
Hyperplasia usually develops in the presence of continuous oestrogen stimulation
unopposed by progesterone. During adolescence and in the years before
menopause women may have numerous cycles without ovulation ( anovulatory )
during which there is continuous unopposed oestrogen activity. Polycystic
ovary syndrome and consisting of oestrogen without progesterone may
also lead to endometrial hyperplasia.
The key determinant of a potential for malignancy is the presence of changes
known as atypia within the hyperplastic tissue.
There are a variety of types of hyperplasia, (simple, cystic, adenomatous)
which are all benign as long as they do not show atypia . Hyperplasia
without atypia rarely progresses to endometrial cancer while hyperplasia
with atypia is a precancerous condition that may progress to overt malignancy.
Diagnosis and Treatment
Diagnosis can only be made by the examination of a sample of tissue
removed from the thickened endometrium by a sampling procedure such as
,
, or .
Examination under the microscope of the endometrial tissue shows proliferation
of both the endometrial glands as well as the surrounding tissue ( stroma ).
The first step in the treatment of endometrial hyperplasia is a thorough
evaluation of the endometrium by means of a D&C; this is essential
in order to assess for the presence of atypia.
Hyperplasia without atypia often regresses
spontaneously, after D&C or progestin treatment. Progestin is given
continuously, either orally or long acting injections. A D&C is repeated
after 3-4 months of treatment to demonstrate resolution of the hyperplasia.
Failure of hyperplasia without atypia to resolve (even if no atypia is
found) in repeat D&C is a cause for concern. A second course of medical
therapy may then be tried consisting of high dose progestins. Following
this course of treatment another D&C is performed.
Hyperplasia with atypia is considered precancerous.
It is best treated surgically with hysterectomy (surgical removal of the
). Currently, endometrial
hyperplasia is the indication for 5% of all hysterectomies performed in
the U.S. However, if a patient desires future pregnancy, a trial of hormonal
treatment may be given.
The information in this page is presented in summarised form and has been taken
from the following source(s):
1. Alternatives to Hysterectomy:
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Introduction
