Gyn endometrial hyperplasia

Question 1

How do you diagnoise endometrial hyperplasi

Answer 1

TVUSS and biopsy - with diagnostic hysterscopy sampling
pipelle can be used but always meh

seperate between hyperplasia with or without atypia

Question 2

How do you manage endometrial hyperplasia without atypia

Answer 2

<5% risk of malignancy in 20y
change reversible facotrs (fat, HRT)
IUS is best first line 
if not - continous oral progestrogens
surveillance every 5years

always option of hysterctomy if needed

Question 3

How do you manage endometrial hyperplasia with atypia

Answer 3

Not preserving fertility - total hysterectomy (and remove tubes and ovaries if post menopausal)

Preserving fertility follows the lign of no atypia
1st line IUS
2nd - oral progesterones
routine surveillance 3m, but if 2 negative samples can go to 6-12m