Endometrial hyperplasia

Question 1

What is endometrial hyperplasia (aetiology, RF)

Answer 1

excess endometrial growth which occurs after menopause -can progress to cancer
(can be with atypia (cells abnormal) or without)

RF - OESTROGEN
inceasing age
Oestogen- early menarge, late menopause, nullparous, tamoxifen, HRT, COCP)
high insulin levels
Obesity/smoke
Fhx (ovarian), bowel (HNPCC, Lynch), uterine

Question 2

Sx and Ix of endometrial Hyperplasia

Answer 2

Sx - PV bleeding -usually PMB (post menopausal)

Ix -
TVUSS-( if PMB, if not match USS with ovulatory
<4mm -unlikely
4> - need 2nd ix

2nd- goldstandard- hysterescopy + biopsy -
complex hyperplasia with atypia is premalignant

Question 3

Mx of Endometrial hyperplasia

Answer 3

after the hysterescopy and biopsy-
EH without atypia - 
manage RF (smoke, obese), endometrial surveillance every 6m
1st line - prostergens -
LNG IUS- for 5 years
or oral progestorens

2nd line =hysterscomy

EH with atypia -
fertility non sparing - total hysterectomy
Sparing - LNG IUS or oral progestrogens, and surveillance every 3m