Endometrial Hyperplasia

Question 1

What is this describing?
An increase in the number of endometrial glands relative to the endometrial stroma (closely packed glands). Causes endometrial thickening.

Answer 1

Endometrial hyperplasia

Question 2

What is this a presentation of?

Abnormal vaginal bleeding (IMB, PMB, polymenorrhoea), endometrial thickening seen on TV USS or hysteroscopy.

Answer 2

Endometrial hyperplasia

Question 3

What causes endometrial hyperplasia and what can it lead to?

Answer 3

1. High levels of unopposed oestrogen

2. Precursor to carcinoma

Question 4

How does PCOS increase the risk of endometrial hyperplasia?

Answer 4

Increase in LH:FSH and hyperinsulinaemia = androgen excess = anovulation = no corpus luteum = no progesterone

Question 5

How do obesity, type 2 diabetes, and hypertension increase the risk of endometrial hyperplasia?

Answer 5

Peripheral aromatisation of androgens to oestrogen

Question 6

How does tamoxifen therapy increase the risk of endometrial hyperplasia?

Answer 6

Antagonises breast in treatment of breast cancer, agonist of the endometrium.

Question 7

How do anovulatory cycles in the perimenopause increase the risk of endometrial hyperplasia?

Answer 7

No corpus luteum = no progesterone

Question 8

What factors increase the risk of endometrial hyperplasia?

Answer 8

1. PCOS
2. Obesity, T2DM, HTN
3. Tamoxifen therapy
4. Anovulatory cycles
5. Unopposed oestrogen HRT
6. Genetic
7. Nulliparity

Question 9

How is endometrial cancer investigated?

Answer 9

TV USS

Question 10

What is the difference in risk of progression and treatment between non-atypical and atypical endometrial hyperplasia?

Answer 10

1. Non-atypical - low risk of progression, exogenous progesterone therapy (Mirena IUS)
2. Atypical - Up 50% risk of progression, hysterectomy recommended

Question 11

What is dysplasia in the endometrium called?

Answer 11

Atypical hyperplasia - premalignant