The revised 2014 WHO classification of endometrial hyperplasia is recommended, distinguishing between hyperplasia without atypia and atypical hyperplasia. Diagnosis is typically via endometrial biopsy. For hyperplasia without atypia, initial treatment involves counseling and observation, with progestogen therapy or a levonorgestrel intrauterine device recommended if regression does not occur. For atypical hyperplasia or failure of medical treatment, total hysterectomy is usually recommended. Special considerations apply to fertility-preserving treatment and management in breast cancer patients on tamoxifen.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
Management of ovarian masses e Clinical situations & recommendations Apollo Hospitals
Adenexal mass is a common clinical presentation. This clinical situation is a problem that affects women of all ages. The biggest challenge is that one should not miss out on a diagnosis of malignant ovarian tumor. An ovarian mass or cyst that raises the suspicion of malignancy is a common dilemma in a gynecological practice. In the United States, a woman has a 5-10% lifetime risk of undergoing surgery for a suspected ovarian neoplasm and an estimated 13e21% chance of this turning into a diagnosis of ovarian cancer. Most of the adnexal masses are benign but the first responsibility of the treating gynecologist is to exclude malignancy. Management decisions often are influenced by the age and family history and presentation of the patient.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. Definition:
it is irregular proliferation of the
endometrial glands with an increase
in the gland to stroma ratio when
compared with proliferative
endometrium.
osama warda 3
4. O Endometrial hyperplasia is the precursor of
endometrial cancer which is the most common
gynecological malignancy in the Western world.
O The incidence of endometrial hyperplasia is
estimated to be at least three times higher than
endometrial cancer.
osama warda 4
5. O 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 bleeding
osama warda 5
6. 1- Endometrial hyperplasia develops when
estrogen, unopposed by progesterone, stimulates
endometrial cell growth by binding to estrogen
receptors in the nuclei of endometrial cells.
2- other elements such as immunosuppression
and infection may also be involved.
osama warda 6
7. 1- increased body mass index (BMI) ; with excessive
peripheral conversion of androgens in adipose tissue to
estrogen;
2- anovulation associated with the perimenopause or
polycystic ovary syndrome (PCOS);
3- estrogen-secreting ovarian tumors, e.g. granulosa cell
tumors (with up to 40% prevalence of endometrial
hyperplasia);
4- drug-induced endometrial stimulation, e.g. the
use of systemic ERT or long-term tamoxifen
osama warda 7
8. þ
Endometrial hyperplasia is often
associated with multiple identifiable risk
factors and assessment should aim to
identify and monitor these factors.
osama warda 8
9. Classification
- WHO 1994 :
(i) simple hyperplasia,
(ii) complex hyperplasia,
(iii) Simple hyperplasia with atypia and
(iv) complex hyperplasia with atypia.
The association of cytological atypia with an increased
risk of endometrial cancer has been known since 1985.
osama warda 9
10. Classification
Endometrial intraepithelial neoplasia (EIN)
classification (2003): NOT popular
The EIN diagnostic schema comprises 3
Categories :
1-benign (endometrial hyperplasia),
2- premalignant (a diagnosis of EIN based upon
five subjective histological criteria) and
3- malignant (endometrial cancer)
osama warda 10
11. Classification
The 2014 revised WHO classification:
- Simply separates endometrial hyperplasia into 2
groups based upon the presence or absence of
cytological atypia, (i) hyperplasia without atypia and
(ii) atypical hyperplasia;
- The complexity of architecture is no longer part of the
Classification.
osama warda 11
12. [D]
The revised 2014 WHO classification
of endometrial hyperplasia is
recommended.
osama warda 12
13. Diagnosis
O Histological examination via outpatient endometrial
sampling [B]
O Diagnostic hysteroscopy should be considered if
biopsy failed or non diagnostic, or endometrial
hyperplasia has been diagnosed within a polyp or
other discrete focal lesion. þ
O Trans-vaginal ultrasound may have a role in diagnosing
endometrial hyperplasia in pre- and postmenopausal
women. þ
osama warda 13
14. Diagnosis
There is insufficient evidence
evaluating (CT), (MRI) or biomarkers
as aids in the management of
endometrial hyperplasia and their use
is not routinely recommended. [B]
osama warda 14
16. E
H
without
a
t
y
p
ia
Initial
counseling
- Women should be informed that the risk of EH without
atypia progressing to endometrial cancer is less than
5% over 20 years and that the majority of cases of
endometrial hyperplasia without atypia will regress
spontaneously during follow-up. [B]
-Reversible risk factors such as obesity and the use of
HRT should be identified and addressed if possible. þ
osama warda 16
17. E
H
without
a
t
y
p
ia
initial
counseling
Observation alone with follow-up endometrial biopsies to
ensure disease regression can be considered,
especially when identifiable risk factors can be reversed.
However, women should be informed that
treatment with progestogens has a higher disease
regression rate compared with observation alone.
[C]
osama warda 17
18. E
H
without
a
t
y
p
ia
Medical
treatment;
is indicated in women who fail to
regress following observation alone
and in symptomatic women with
abnormal uterine bleeding þ
osama warda 18
19. EH
without
atypia
Medical
treatment;
- Progestogens ; Both continuous oral
and local intrauterine (levonorgestrel-
releasing intrauterine system [LNG-IUS])
are effective in achieving regression
of endometrial hyperplasia without
atypia [A]
- osama warda 19
20. EH
without
atypia
Medical
treatment;
- The LNG-IUS should be the first-line
medical treatment because compared
with oral progestogens it has a higher
disease regression rate with a more
favorable bleeding profile and it is
associated with fewer side effects. [A]
osama warda 20
21. EH
without
atypia
Medical
Treatment
Continuous progestogens should
be used (medroxy-progesterone
10–20 mg/day or norethisterone
10–15 mg/day) for women who
decline the LNG-IUS. [B]
osama warda 21
22. EH
without
atypia
Medical
Treatment
Cyclical progestogens should not
be used because they are less
effective in inducing regression of
EH without atypia compared with
continuous oral progestogens or
the LNG-IUS [A]
osama warda 22
23. EH
without
atypia
Duration
of
treatment
and
follow
up
O Treatment with oral progestogens or
the LNG-IUS should be for a
minimum of 6 months in order to
induce histological regression of
endometrial hyperplasia without
atypia. [B]
osama warda 23
24. EH
without
atypia
Duration
of
treatment
and
follow
up
If adverse effects are tolerable and
fertility is not desired, women should
be encouraged to retain the LNG-IUS
for up to 5 years as this reduces the
risk of relapse, especially if it
alleviates abnormal uterine bleeding
symptoms. þ
osama warda 24
25. EH
without
atypia
Duration
of
treatment
and
follow
up
O Outpatient endometrial biopsy is
recommended after a diagnosis of
hyperplasia without atypia. [C]
O Endometrial surveillance should be arranged
at a minimum of 6-monthly intervals. At least
two consecutive 6-monthly negative biopsies
should be obtained prior to discharge. [D]
osama warda 25
26. EH
without
atypia
Duration
of
treatment
and
follow
up
In women at higher risk of relapse, such as
women with a BMI of ≥ 35 or those treated
with oral progestogens, 6-monthly endometrial
biopsies are recommended. Once two
consecutive negative endometrial biopsies
have been obtained then long-term follow-up
should be considered with annual endometrial
biopsies [D]
osama warda 26
27. EH
without
atypia
Surgical
management
O Hysterectomy should not be considered as a first-line treatment
for hyperplasia without atypia as most cases respond to
progestogens [C]
O Hysterectomy is indicated in women not wanting to preserve
their fertility when: [C]
(1) progression to atypical hyperplasia occurs during follow-up,
(2) no histological regression of hyperplasia in 12 ms. treatment,
(3) there is relapse of endometrial hyperplasia after treatment
(4) persistence of bleeding symptoms,
(5) the woman not compliant to progestogen or follow-up .
osama warda 27
28. EH
without
atypia
Surgical
management
O Postmenopausal women ; should be offered a bilateral
salpingo-oophorectomy together with total
hysterectomy. þ
O For pre-menopausal women, the decision to remove the
ovaries should be individualised; however, bilateral
salpingectomy should be considered as this may
reduce the risk of a future ovarian malignancy. [D]
osama warda 28
29. EH
without
atypia
Surgical
management
O Endometrial ablation is not recommended for the
treatment of endometrial hyperplasia because:
- complete endometrial destruction not ensured
- resulting adhesion perclude future endometrial
surveillance [D]
osama warda 29
30. EH
with
Atypia
Surgical
management
A laparoscopic approach to total
hysterectomy is preferable to an
abdominal approach as it is
associated with a shorter hospital
stay, less postoperative pain and
quicker recovery. [B]
osama warda 30
31. EH
with
Atypia
Surgical
management
O No benefit from intraoperative frozen section analysis
of the endometrium or routine lymphadectomy. [C]
O Post-menopausal women with atypical hyperplasia
should be offered bilateral salpingo-oophorectomy
together with the total hysterectomy. þ
osama warda 31
32. EH
with
Atypia
Surgical
management
O For premenopausal women, the decision to remove
the ovaries should be individualized; however,
bilateral salpingectomy should be considered as this
may reduce the risk of a future ovarian malignancy. [D]
O Endometrial ablation is not recommended because of
the same reasons mentioned before. [C]
osama warda 32
33. EH
with
Atypia
women
wishing
fertility
or
unsuitable
for
surgery
MANAGEMENT
O Should be counseled about the risks of underlying
malignancy & subsequent progression to endometrial
cancer. þ
O Pretreatment investigations should aim to rule out
invasive endometrial cancer or co-existing ovarian
cancer. þ
osama warda 33
34. Special
cases
O Women wishing fertility or unsuitable for
surgery.
O EH & fertility management
O EH & HRT
O EH- in women on adjuvant treatment for
breast cancer
osama warda 34
35. EH
with
Atypia
Women
wishing
fertility
or
unsuitable
for
surgery
MANAGGEMENT
O First-line treatment with the LNG-IUS should be
recommended, with oral progestogens as a second-
best alternative . [B]
O Once fertility is no longer required, hysterectomy should
be offered in view of the high risk of relapse. [B]
osama warda 35
36.
EH
with
Atypia
Women
Not
undergoing
hysterectomy
FOLLOW
UP
O Routine endometrial biopsies every 3 month until 2
consecutive negative endometrial biopsies obtained [D]
O For asymptomatic women with 2 negative endometrial
biopsies --- Long term follow up with 6-12 months
biopsy until hysterectomy is performed þ
osama warda 36
37. EH
and
fertility
management
O Disease regression should be achieved on at least one
endometrial sample before women attempt to conceive. þ
O Assisted reproduction may be considered as the live birth rate is
higher and it may prevent relapse compared with women who
attempt natural conception. [C]
O Regression of endometrial hyperplasia should be achieved before
ARTas this is associated with higher implantation and clinical
pregnancy rates. [B]
osama warda 37
38. EH
and
HRT
O Systemic estrogen-only HRT should not be used in women
with a uterus. [A]
O All women taking HRT should be encouraged to report any
unscheduled vaginal bleeding promptly. !
O women on sequential HRT preparation and
wishing to continue HRT are advised to shift to
LNG-IUS or a continuous combined HRT
preparation [B]
osama warda 38
39. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
O Women taking tamoxifen should be informed about the
increased risks of developing endometrial hyperplasia and
cancer. They should be encouraged to report any abnormal
vaginal bleeding or discharge promptly. [D]
O Women taking aromatase inhibitors (such as anastrozole,
exemestane and letrozole) should be informed that these
medications are not known to increase the risk of endometrial
hyperplasia and cancer. þ
osama warda 39
40. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
There is evidence that the LNG-IUS prevents
polyp formation and that it reduces the
incidence of endometrial hyperplasia in women
on tamoxifen. The effect of the LNG-IUS on
breast cancer recurrence risk remains uncertain
so its routine use cannot be recommended.
[A]
osama warda 40
41. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
O Endometrial hyperplasia confined to an
endometrial polyp, complete removal of uterine
polyp (s) is recommended & endometrial biopsy
should be obtained to sample the background
endometrium [D]
O Subsequent management according to the
histological classification of EH þ
osama warda 41