24. Fractional Curretage
• Indication: >40 yrs
• The whole uterine cavity can be visualized
• Very small lesions such as polyps can be identified & biopsied or
removed
• Method: 3 samples:
endocervical, lower segment, upper segment
25.
26.
27.
28.
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31.
32.
33.
34.
35. ENDOMETRIAL HYPERPLASIA
• Definition:
it is irregular proliferation of the endometrial glands with an increase in
the gland to stroma ratio when compared with proliferative endometrium
• Endometrial hyperplasia is the precursor of endometrial cancer which is
the most common gynecological malignancy in the Western world.
• The incidence of endometrial hyperplasia is estimated to be at least
three times higher than endometrial cancer
36. Epidemiology
The most common presentation of endometrial hyperplasia is abnormal
uterine bleeding; includes
- heavy menstrual bleeding
-inter-menstrual bleeding
- irregular bleeding
-unscheduled bleeding on HRT
- Postmenopausal menopause
37. Risk Factors
-increased body mass index (BMI) ; with excessive peripheral conversion of
androgens in adipose tissue to estrogen;
-anovulation associated with the perimenopause or polycystic ovary
syndrome (PCOS);
-estrogen-secreting ovarian tumors, e.g. granulosa cell tumors (with up to
40% prevalence of endometrial hyperplasia)
-drug induced endometrial stimulation e.g. the use of systemic ERT or long-
term tamoxifen
38. Clinical presentation
• The most common clinical presentation of patients with endometrial
hyperplasia is abnormal uterine bleeding, whether in the form of
menorrhagia, metrorrhagia, or post menopausal bleeding
• vaginal discharge
39.
40. Diagnosis
• Histological examination by outpatient endometrial sampling
• Diagnostic hysteroscopy should be considered if biopsy fails or is
nondiagnostic, or if endometrial hyperplasia is diagnosed in a polyp or
other isolated focal lesion.
• Trans-vaginal ultrasound may have a role in the diagnosis of endometrial
hyperplasia in pre- and postmenopausal women.
• Dilation and curettage D&C
