Endometrial hyperplasia medical therapy: Difference between revisions

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==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.<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>
[[Progesterone]] therapy is the preferred drug for the treatment of [[benign]] hyperplasia. The management of endometrial hyperplasia depends upon the desire for future childbearing.<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><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><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>


==Medical Therapy==
==Medical Therapy==
*Patients with endometrial hyperplasias without [[atypia]] are treated conservatively, whereas patients with atypical hyperplasia or 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>
*Patients with endometrial hyperplasias without [[atypia]] are treated conservatively through normalization of the menstrual cycles, whereas patients with atypical hyperplasia or 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><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><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>


{{familytree/start |summary=Treatment of endometrial hyperplasia}}
{{familytree/start |summary=Treatment of endometrial hyperplasia}}
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{{familytree |boxstyle=background: #DCDCDC; | | D01 | |D02 | | D03 | | D04 | |D01=<div style="width: 9em; padding:0.2em;">'''[[Weight loss]]''' </div> |D02=<div style="width: 9em; padding:0.2em;">'''[[Metformin]]''' </div> |D03=<div style="width: 9em; padding:0.2em;">'''[[Oral contraceptive pills]]''' </div> |D04=<div style="width: 9em; padding:0.2em;">'''[[Progestin]]s (cyclic/continuous)''' </div>}}
{{familytree |boxstyle=background: #DCDCDC; | | D01 | |D02 | | D03 | | D04 | |D01=<div style="width: 9em; padding:0.2em;">'''[[Weight loss]]''' </div> |D02=<div style="width: 9em; padding:0.2em;">'''[[Metformin]]''' </div> |D03=<div style="width: 9em; padding:0.2em;">'''[[Oral contraceptive pills]]''' </div> |D04=<div style="width: 9em; padding:0.2em;">'''[[Progestin]]s (cyclic/continuous)''' </div>}}
{{familytree/end}}
{{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>
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) <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==

Revision as of 03:24, 24 March 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]

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.[1][2][2]

Medical Therapy

  • Patients with endometrial hyperplasias without atypia are treated conservatively through normalization of the menstrual cycles, whereas patients with atypical hyperplasia or endometrioid intraepithelial neoplasia are treated surgically.[1][2][2]
 
 
 
 
 
 
 
 
 
 
 
Treatment of endometrial hyperplasia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperplasia without atypia
 
 
 
 
 
Hyperplasia with atypia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative
 
 
 
 
 
Desire for pregnancy?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Progestins (cyclic/continuous)
 

References

  1. 1.0 1.1 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.
  2. 2.0 2.1 2.2 2.3 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.


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