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Endometrial Hyperplasia: Diagnosis and Management

  • Bijal M. Patel
Chapter

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.

Keywords

Endometrial hyperplasia Endometrial intraepithelial neoplasia Endometrial carcinoma Hyperplasia without atypia Atypical hyperplasia Abnormal uterine bleeding Estrogen Progesterone Estrogen therapy Hormone therapy Hysterectomy 

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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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Bijal M. Patel
    • 1
  1. 1.Department of Gynecologic OncologyGujarat Cancer and Research InstituteAhmedabadIndia

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