Approach to endometrial hyperplasia

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium, the inner lining of the uterus, that is more than normal.

The most common symptom is abnormal vaginal bleeding.

Patients who are overweight, have large intervals or have risk factors such as chronic anovulation (PCOS) are at risk.

From whom should we biopsy the uterus?

In any bleeding in the postmenopausal period

In all abnormal uterine bleeding over the age of 45,

Recurring under 45 years of age, unresponsive to medical treatment,

In women with risk factors such as obesity or chronic anovulation (PCOS)

In women with atypical glangular cells in cervical smear results

In pre- and post-menopausal women with abnormal bleeding, the risk of disease is increased if the endometrial thickness is 12 mm and above.

In patients with endometrial hyperplasia without atypia, the first choice is drug therapy.

Progesterone Treatment:

They are potent anti-estrogens, have anti-mitotic and growth-restricting effects on the endometrium. In anovulatory women, cyclic treatment with an oral progestin (12-14 days per month) can initiate regular menstrual cycles.

Medroxyprogesterone acetate 10-20 mg twice daily

Megestrol acetate 20-40 mg, twice a day,

Norethindrone 5 mg can be used twice daily.

Treatment should be continued for 3 weeks in a period of approximately 3 months.

Depot MPA (150 mg every 3 months, IM) in patients who have difficulty using regular medication

It is a useful option in the treatment of endometrial hyperplasia without atypia.

LNG-IUS (Mirena®) 52 mg mixed with polymethyl silicone controlling hormone release rate

It has a reservoir containing levonorgestrel. It has come to the fore in the treatment of endometrial hyperplasia without atypia. Both the absence of systemic side effects of the drug and its release where it needs to be treated, direct thinning of the endometrium is an effective treatment option.

In all patients given medical treatment, biopsy from the uterus should be performed again after 3-6 months, and it should be investigated whether the disease continues. If there is a treatment-resistant condition, surgery should be considered.

Surgery is the first choice in patients with atypia as a result of endometrial hyperplasia.

Those with atypia are treated with uterine removal surgery due to the increased frequency of concurrent uterine cancer.

With an exception, if our patient does not have children, biopsy from the uterus should be performed again after 3 months in patients who are given medical treatment, and it should be investigated whether the disease continues. If the result is normal, it should be ensured to have a child with assisted reproductive treatments. If drug therapy fails, another surgery option should be considered.

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