Endometrial hyperplasia

Abstract

Endometrial hyperplasia (EH), a known precursor to endometrial adenocarcinoma, is a common gynecologic diagnosis among women, typically resulting from an increase in endogenous or exogenous unopposed estrogen. EH is a histologic diagnosis that is characterized by one of the two classification schemas: Either the widely used WHO94 criteria or the more standardized endometrial intraepithelial neoplasia (EIN) criteria. The risk of progression to cancer varies and depends on the severity of the lesion. Lesions with atypia have the highest risk ofprogression to cancer and the diagnosis of concurrent endometrial cancer. EH mainly effects perimeno- pausal or postmenopausal women. Significant risk factors for EH include obesity, chronic anovulation as seen in disorders such as PCOS, estrogen only hormone replacement, tamoxifen use, and Lynch syndrome. Clinical manifestations include abnormal uterine bleeding, postmenopausal bleeding, or atypical endometrial glands on pap smear, which require a diagnostic workup in peri-/ postmenopausal women. Transvaginal ultrasound (TVUS) is typically the first diagnostic study to be performed in a woman with abnormal uterine bleeding (AUB). Either office endometrial biopsy (EMB) or dilation and curettage (D&C) with or without hysteroscopy can be performed to diagnose EH. When EH is diagnosed, management includes surveillance, hormone therapy, or hysterectomy and choice of therapy depends on the type of EH, potential risk for endometrial cancer, and patient characteristics (i.e., desire to maintain fertility and surgical candidacy). There are no current recommendations for screening for endometrial hyperplasia in the general population.