Endometrial hyperplasia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Endometrial hyperplasia}} | {{Endometrial hyperplasia}} | ||
{{CMG}} | {{CMG}}{{AE}} {{STM}} | ||
==Overview== | ==Overview== | ||
Progesterone therapy is the preferred drug for the treatment of benign hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing(medscape) | |||
==Medical Therapy== | ==Medical Therapy== | ||
*Patients with endometrial hyperplasias without atypia are treated conservatively, whereas patients with atypical hyperplasia/endometrioid intraepithelial neoplasia are treated surgically.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956 }} </ref> | |||
{{familytree/start |summary=Treatment of endometrial hyperplasia}} | |||
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of endometrial hyperplasia'''</div>}} | |||
{{familytree |boxstyle=background: #DCDCDC; | | | | | | |,|-|-|-|^|-|-|-|.| }} | |||
{{familytree |boxstyle=background: #DCDCDC; | | | | | | B01 | | | | | | B02 |B01=<div style="width: 9em; padding:0.2em;">'''Conservative''' | |||
</div>|B02=<div style="width: 9em; padding:0.2em;">'''Surgery'''</div>}} | |||
{{familytree |boxstyle=background: #DCDCDC; | | | | |,|-|^|-|.| | | |,|-|^|-|.|}} | |||
{{familytree |boxstyle=background: #DCDCDC; | | | | C01 | | C02 | | C03 | | C04 | | C05 |C01=<div style="width: 9em; padding:0.2em;">'''Hypertonic saline''' | |||
</div>|C02=<div style="width: 9em; padding:0.2em;">'''Sodium tetradecyl sulfate'''</div>|C03=<div style="width: 9em; padding:0.2em;">'''Carbon dioxide''' | |||
</div>|C04=<div style="width: 9em; padding:0.2em;">'''Argon''' | |||
</div>|}} | |||
{{familytree/end}} | |||
Treatment of endometrial hyperplasia is individualized, and may include [[hormonal therapy (oncology)|hormonal therapy]], such as cyclic or continuous [[progestin]] therapy, or [[hysterectomy]].<ref name="UTDOL-EH">[http://www.uptodateonline.com/utd/content/topic.do?topicKey=gen_gyne/13384&type=A&selectedTitle=1~22] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)</ref> | Treatment of endometrial hyperplasia is individualized, and may include [[hormonal therapy (oncology)|hormonal therapy]], such as cyclic or continuous [[progestin]] therapy, or [[hysterectomy]].<ref name="UTDOL-EH">[http://www.uptodateonline.com/utd/content/topic.do?topicKey=gen_gyne/13384&type=A&selectedTitle=1~22] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)</ref> | ||
The implications for treatment are obvious: hyperplasias without atypia should generally be treated conservatively (normalization of the cycle through weight loss, metformin; oral contraceptives; cyclical gestagens; gestagen IUD). Preventive hysterectomy should only be considered in exceptional cases (e.g., extreme obesity without any prospect of weight loss) 1, 4. The surgery should be done as a total hysterectomy, i.e., it must include removal of the cervix 4. | |||
Treatment of atypical hyperplasia/endometrioid intraepithelial neoplasia should generally consist of total (not supracervical) hysterectomy 1, 4. Conservative treatment with high-dose gestagens and close histological monitoring should only be considered in exceptional cases (when the patient wants to have children, satisfactory compliance) 1, 4, 6. | |||
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EH (unopposed oestrogen effect, benign hyperplasia) is often treated symptomatically with short term progestins, follow up ultrasonography, and/or tissue resampling.<ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473 }} </ref> | EH (unopposed oestrogen effect, benign hyperplasia) is often treated symptomatically with short term progestins, follow up ultrasonography, and/or tissue resampling.<ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473 }} </ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 18:59, 15 March 2016
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Endometrial hyperplasia Microchapters |
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Endometrial hyperplasia medical therapy On the Web |
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Risk calculators and risk factors for Endometrial hyperplasia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [3]
Overview
Progesterone therapy is the preferred drug for the treatment of benign hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing(medscape)
Medical Therapy
- Patients with endometrial hyperplasias without atypia are treated conservatively, whereas patients with atypical hyperplasia/endometrioid intraepithelial neoplasia are treated surgically.[1]
Treatment of endometrial hyperplasia | |||||||||||||||||||||||||||||||||||||||||||||
Conservative
| Surgery | ||||||||||||||||||||||||||||||||||||||||||||
Hypertonic saline
| Sodium tetradecyl sulfate | Carbon dioxide
| Argon
| {{{ C05 }}} | |||||||||||||||||||||||||||||||||||||||||
Treatment of endometrial hyperplasia is individualized, and may include hormonal therapy, such as cyclic or continuous progestin therapy, or hysterectomy.[2]
The implications for treatment are obvious: hyperplasias without atypia should generally be treated conservatively (normalization of the cycle through weight loss, metformin; oral contraceptives; cyclical gestagens; gestagen IUD). Preventive hysterectomy should only be considered in exceptional cases (e.g., extreme obesity without any prospect of weight loss) 1, 4. The surgery should be done as a total hysterectomy, i.e., it must include removal of the cervix 4.
Treatment of atypical hyperplasia/endometrioid intraepithelial neoplasia should generally consist of total (not supracervical) hysterectomy 1, 4. Conservative treatment with high-dose gestagens and close histological monitoring should only be considered in exceptional cases (when the patient wants to have children, satisfactory compliance) 1, 4, 6.
observation, hormonal treatment, or hysterectomy) [3]
EH (unopposed oestrogen effect, benign hyperplasia) is often treated symptomatically with short term progestins, follow up ultrasonography, and/or tissue resampling.[3]
References
- ↑ Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO) (2015). "New WHO Classification of Endometrial Hyperplasias". Geburtshilfe Frauenheilkd. 75 (2): 135–136. doi:10.1055/s-0034-1396256. PMC 4361167. PMID 25797956.
- ↑ [1] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)
- ↑ 3.0 3.1 Baak JP, Mutter GL (2005). "EIN and WHO94". J Clin Pathol. 58 (1): 1–6. doi:10.1136/jcp.2004.021071. PMC 1770545. PMID 15623473.