Endometrial hyperplasia medical therapy: Difference between revisions
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{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of endometrial hyperplasia'''</div>}} | {{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; | | | | | | | | |,|-|-|-|^|-|-|-|.| }} | ||
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | E01 | | | | | | E02 |E01=<div style="width: 9em; padding:0.2em;">'''Hyperplasia without atypia''' | |||
</div>|E02=<div style="width: 9em; padding:0.2em;">'''Hyperplasia with atypia'''</div>}} | |||
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{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | B01 | | | | | | B02 |B01=<div style="width: 9em; padding:0.2em;">'''Conservative''' | {{familytree |boxstyle=background: #DCDCDC; | | | | | | | | B01 | | | | | | B02 |B01=<div style="width: 9em; padding:0.2em;">'''Conservative''' | ||
</div>|B02=<div style="width: 9em; padding:0.2em;">''' | </div>|B02=<div style="width: 9em; padding:0.2em;">'''Desire for pregnancy?'''</div>}} | ||
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{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | | | | | {{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | Z01 | | | | | Z02 | Z01=<div style="width: 9em; padding:0.2em;">'''Yes'''</div> | Z02=<div style="width: 9em; padding:0.2em;">'''No'''</div>}} | ||
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{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | |!| | | | E01 | | | | | E02 |E01=<div style="width: 9em; padding:0.2em;">'''Conservative''' | |||
</div>|E02=<div style="width: 9em; padding:0.2em;">'''[[Hysterectomy|Total hysterectomy]]'''</div>}} | |||
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Revision as of 13:06, 22 March 2016
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Endometrial hyperplasia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Endometrial hyperplasia medical therapy On the Web |
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American Roentgen Ray Society Images of Endometrial hyperplasia medical therapy |
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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.[1]
Medical Therapy
- Patients with endometrial hyperplasias without atypia are treated conservatively, whereas patients with atypical hyperplasia or endometrioid intraepithelial neoplasia are treated surgically.[1]
Treatment of endometrial hyperplasia | |||||||||||||||||||||||||||||||||||||||||||||
Hyperplasia without atypia
| Hyperplasia with atypia | ||||||||||||||||||||||||||||||||||||||||||||
Conservative
| Desire for pregnancy? | ||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
Conservative
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Progestins (cyclic/continuous) | |||||||||||||||||||||||||||||||||||||||||||||
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
- ↑ 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.
- ↑ [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.