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Gynaecologic Problems: Hyperplasia


Endometrial hyperplasia is a proliferation (excessive growth) or thickening of the endometrium 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 hormone replacement therapy 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 endometrial biopsy , D&C , or hysteroscopy . 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 uterus ). 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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