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Endometrial Hyperplasia: Diagnosis and Management

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Preventive Oncology for the Gynecologist

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Abstract

Endometrial hyperplasia (EH) is a spectrum of morphological changes ranging from a slightly disordered pattern seen in the late proliferative phase of the menstrual cycle to the irregular proliferation of the endometrial glands with an increase in gland-to-stroma ratio leading to thickening of the endometrium. It encompasses histological subtle and spontaneously reversible proliferative lesions to emerging endometrial carcinoma. As endometrial hyperplasia is the only known direct precursor of endometrial carcinoma, sensitive and accurate diagnosis can reduce the likelihood of development of invasive endometrial carcinoma. Currently, two classifications are in use: the World Health Organization (WHO) 2014 classification and the endometrial intraepithelial neoplasia (EIN) classification. The optimal management of endometrial hyperplasia is the subject of significant debate. Regression of hyperplasia to normal endometrium represents the key to conservative treatment of endometrial hyperplasia. In younger women who desire fertility, medical treatment with progestin is appropriate with extremely close monitoring. In older women who do not wish to retain their uterus, hysterectomy is the treatment of choice. In this chapter, a brief overview of the development of a current understanding of EH will serve to understand their diagnosis and management.

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Abbreviations

AUB:

Abnormal uterine bleeding

BMI:

Body mass index

BSO:

Bilateral salpingo-oophorectomy

CT:

Computerized tomography

D&C:

Dilatation and curettage

DMPA:

Depot medroxyprogesterone acetate

EB:

Endometrial biopsy

EC:

Endometrial carcinoma

EGF:

Epithelial growth factor

EH:

Endometrial hyperplasia

EIN:

Endometrial intraepithelial neoplasia

ER:

Estrogen receptors

ERT:

Estrogen replacement therapy

ET:

Endometrial thickness

GnRH:

Gonadotropin-releasing hormone

H&E:

Hematoxylin and eosin

HRT:

Hormone replacement therapy

IGF-1:

Insulin-like growth factor-1

IL-1β:

Interleukin-1β

IUD:

Intrauterine device

LNG:

Levonorgestrel

MA:

Megestrol acetate

MPA:

Medroxyprogesterone acetate

MRI:

Magnetic resonance imaging

MSI:

Microsatellite instability

NETA:

Norethisterone acetate

OCs:

Oral contraceptives

PCNA:

Proliferating cell nuclear antigen

PCOS:

Polycystic ovarian syndrome

PMB:

Postmenopausal bleeding

PR:

Progesterone receptor

RCOG:

Royal College of Obstetricians and Gynaecologists

SERM:

Selective estrogen receptor modulator

SNPs:

Single nucleotide polymorphisms

TAH:

Total abdominal hysterectomy

TNF R1:

Tumor necrosis factor receptor 1

TNF-α:

Tumor necrosis factor-α

TVS:

Transvaginal sonography

USG:

Ultrasonography

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

    Bijal M. Patel

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  1. Bijal M. Patel
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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Babu Jagjivan Ram Memorial Hospital, New Delhi, India

    Sumita Mehta

  2. Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

    Anshuja Singla

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Patel, B.M. (2019). Endometrial Hyperplasia: Diagnosis and Management. In: Mehta, S., Singla, A. (eds) Preventive Oncology for the Gynecologist. Springer, Singapore. https://doi.org/10.1007/978-981-13-3438-2_3

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  • DOI: https://doi.org/10.1007/978-981-13-3438-2_3

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  • Online ISBN: 978-981-13-3438-2

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