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==Overview==
==Overview==
[[Progesterone]] therapy is the preferred drug for the treatment of [[benign]] hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956  }} </ref>
[[Progesterone]] therapy is the preferred drug for the treatment of [[benign]] hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956 }} </ref><ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473  }} </ref><ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473 }} </ref>


==Medical Therapy==
==Medical Therapy==
*Patients with endometrial hyperplasias without [[atypia]] are treated conservatively, whereas patients with atypical hyperplasia or endometrioid intraepithelial neoplasia are treated surgically.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956  }} </ref>
*Patients with endometrial hyperplasias without [[atypia]] are treated conservatively through normalization of the menstrual cycles, whereas patients with atypical hyperplasia or endometrioid intraepithelial neoplasia are treated surgically.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956 }} </ref><ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473  }} </ref><ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473 }} </ref>


{{familytree/start |summary=Treatment of endometrial hyperplasia}}
{{familytree/start |summary=Treatment of endometrial hyperplasia}}
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{{familytree |boxstyle=background: #DCDCDC; | | D01 | |D02 | | D03 | | D04 | |D01=<div style="width: 9em; padding:0.2em;">'''[[Weight loss]]''' </div> |D02=<div style="width: 9em; padding:0.2em;">'''[[Metformin]]''' </div> |D03=<div style="width: 9em; padding:0.2em;">'''[[Oral contraceptive pills]]''' </div> |D04=<div style="width: 9em; padding:0.2em;">'''[[Progestin]]s (cyclic/continuous)''' </div>}}
{{familytree |boxstyle=background: #DCDCDC; | | D01 | |D02 | | D03 | | D04 | |D01=<div style="width: 9em; padding:0.2em;">'''[[Weight loss]]''' </div> |D02=<div style="width: 9em; padding:0.2em;">'''[[Metformin]]''' </div> |D03=<div style="width: 9em; padding:0.2em;">'''[[Oral contraceptive pills]]''' </div> |D04=<div style="width: 9em; padding:0.2em;">'''[[Progestin]]s (cyclic/continuous)''' </div>}}
{{familytree/end}}
{{familytree/end}}
Treatment of endometrial hyperplasia is individualized, and may include [[hormonal therapy (oncology)|hormonal therapy]], such as cyclic or continuous [[progestin]] therapy, or [[hysterectomy]].<ref name="UTDOL-EH">[http://www.uptodateonline.com/utd/content/topic.do?topicKey=gen_gyne/13384&type=A&selectedTitle=1~22] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)</ref>
The implications for treatment are obvious: hyperplasias without atypia should generally be treated conservatively (normalization of the cycle through weight loss, metformin; oral contraceptives; cyclical gestagens; gestagen IUD). Preventive hysterectomy should only be considered in exceptional cases (e.g., extreme obesity without any prospect of weight loss) 1, 4. The surgery should be done as a total hysterectomy, i.e., it must include removal of the cervix 4.
Treatment of atypical hyperplasia/endometrioid intraepithelial neoplasia should generally consist of total (not supracervical) hysterectomy 1, 4. Conservative treatment with high-dose gestagens and close histological monitoring should only be considered in exceptional cases (when the patient wants to have children, satisfactory compliance) 1, 4, 6.
observation, hormonal treatment, or hysterectomy) <ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473  }} </ref>
EH (unopposed oestrogen effect, benign hyperplasia) is often treated symptomatically with short term progestins, follow up ultrasonography, and/or tissue resampling.<ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473  }} </ref>


==References==
==References==

Revision as of 03:24, 24 March 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]

Overview

Progesterone therapy is the preferred drug for the treatment of benign hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing.[1][2][2]

Medical Therapy

  • Patients with endometrial hyperplasias without atypia are treated conservatively through normalization of the menstrual cycles, whereas patients with atypical hyperplasia or endometrioid intraepithelial neoplasia are treated surgically.[1][2][2]
 
 
 
 
 
 
 
 
 
 
 
Treatment of endometrial hyperplasia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperplasia without atypia
 
 
 
 
 
Hyperplasia with atypia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative
 
 
 
 
 
Desire for pregnancy?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Progestins (cyclic/continuous)
 

References

  1. ↑ 1.0 1.1 Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO) (2015). "New WHO Classification of Endometrial Hyperplasias". Geburtshilfe Frauenheilkd. 75 (2): 135–136. doi:10.1055/s-0034-1396256. PMC 4361167. PMID 25797956.
  2. ↑ 2.0 2.1 2.2 2.3 Baak JP, Mutter GL (2005). "EIN and WHO94". J Clin Pathol. 58 (1): 1–6. doi:10.1136/jcp.2004.021071. PMC 1770545. PMID 15623473.


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