Endometrial hyperplasia medical therapy: Difference between revisions

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{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of endometrial hyperplasia'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of endometrial hyperplasia'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |,|-|-|-|^|-|-|-|.| }}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |,|-|-|-|^|-|-|-|.| }}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | E01 | | | | | | E02 |E01=<div style="width: 9em; padding:0.2em;">'''Hyperplasia without atypia'''
</div>|E02=<div style="width: 9em; padding:0.2em;">'''Hyperplasia with atypia'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | | | | |!| }}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | B01 | | | | | | B02 |B01=<div style="width: 9em; padding:0.2em;">'''Conservative'''  
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | B01 | | | | | | B02 |B01=<div style="width: 9em; padding:0.2em;">'''Conservative'''  
</div>|B02=<div style="width: 9em; padding:0.2em;">'''Surgery'''</div>}}
</div>|B02=<div style="width: 9em; padding:0.2em;">'''Desire for pregnancy?'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | | | | |!| | |}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | |,|-|-|^|-|-|-|.| |}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | | | | C01 | | |C01=<div style="width: 9em; padding:0.2em;">'''[[Hysterectomy]]''' </div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | Z01 | | | | | Z02 | Z01=<div style="width: 9em; padding:0.2em;">'''Yes'''</div> | Z02=<div style="width: 9em; padding:0.2em;">'''No'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | |!| | | | | | |!| }}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | E01 | | | | | E02 |E01=<div style="width: 9em; padding:0.2em;">'''Conservative'''
</div>|E02=<div style="width: 9em; padding:0.2em;">'''[[Hysterectomy|Total hysterectomy]]'''</div>}}
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | | | | | | | |}}
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Revision as of 13:06, 22 March 2016

Endometrial hyperplasia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [3]

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]

Medical Therapy

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


Treatment of endometrial hyperplasia is individualized, and may include hormonal therapy, such as cyclic or continuous progestin therapy, or hysterectomy.[2]


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) [3]

EH (unopposed oestrogen effect, benign hyperplasia) is often treated symptomatically with short term progestins, follow up ultrasonography, and/or tissue resampling.[3]

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. [1] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)
  3. 3.0 3.1 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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