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Endometrial hyperplasia (Pathophysiology (Development
Excess unapposed…
Endometrial hyperplasia
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Pathophysiology
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Histology
Simple or complex hyperplasia
Glandular: stromal ratio (high in complex, no stroma in Ca)
Appearance of cells (high nuc:cyto ratio etc.)
Classification
Endometrial hyperplasia (simple or complex)
Atypical endometrial hyperplasia (high risk endometrial Ca)
Clinical
presentation
Abnormal bleeding
(IMB, PMB)
Diagnosis
Examination
Abdominal: cachexia, masses (unlikely)
Pelvic: masses (if local spread), bleeding
Speculum: blood in vagina, visible mass
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
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Imaging
USS: measure endometrial thickness
Hysteroscopy: visualise internal uterus,
take biopsy if needed (histology grading)
CT abdo/pelvis: if oestrogen-sec tumour suspected
History
POH
Gravity/parity, delivery,
gestation, complications
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PGH
Known conditions, menses, bleeding,
contraception/HRT, STIs, smears
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PC/HPC
Abnormal bleeding, pain, weight loss
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SH
Occupation, social support,
smoking, alcohol
Management
Conservative
Information, advice, support
Exclude treatable causes (oestrogen only HRT,
oestrogen-secreting tumour)
Long-term surveillance with repeat biopsies 3-6mth
Medical
Progestrogens
Indication: endometrial hyperplasia;
atypical hyperplasia and fertility needed
E.g. PO progestrogens, Mirena coil
SEs: weight gain, mood disturbance, acne
Surgical
Hysterectomy
Indication: atypical hyperplasia and family complete
MOA: total abdo hysterectomy plus BSO
Complications
Endometrial cancer
1% simple, 3.5% complex,
50% atypical