Endometrial hyperplasia medical therapy: Difference between revisions

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Revision as of 19:15, 15 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(medscape)

Medical Therapy

  • Patients with endometrial hyperplasias without atypia are treated conservatively, whereas patients with atypical hyperplasia/endometrioid intraepithelial neoplasia are treated surgically.[1]
 
 
 
 
 
 
 
 
 
Treatment of endometrial hyperplasia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative
 
 
 
 
 
Surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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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. 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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