Endometrial hyperplasia is a non-cancerous condition where the cells of the endometrium proliferate excessively. It occurs when the endometrium is exposed to unopposed estrogen due to lack of progesterone. There are different classifications of hyperplasia from simple to complex and atypical. Atypical hyperplasia is a precancerous condition. Symptoms include abnormal bleeding. Treatment involves taking progesterone medications to shed the endometrial lining. For atypical hyperplasia, hormonal therapy or hysterectomy may be needed due to high cancer risk. Preventing excess estrogen exposure can reduce hyperplasia risk.

1. Endometrial HyperplasiaS.Laxiny,Medical Student,FHCS,EUSL.

2. Endometrial HyperplasiaEndometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium-Endometrial glands & surrounding tissue(Stroma).Endometrial hyperplasia is a non-cancerous condition.May involve part or all of the endometrium.

3. PathogenesisHyperplasia usually develops in the presence of continuous estrogen stimulation unopposed by progesterone.The female hormones—estrogen and progesterone—control the changes in the uterine lining. Estrogen builds up the uterine lining. Progesterone maintains and controls this growth. Estrogen without enough progesterone may cause the lining of the uterus to thicken.

4. Risks for developing Endometrial Hyperplasia Estrogen replacement therapy -Take estrogen without progesterone to replace the estrogen their body is no longer making and to relieve symptoms of menopausePolycystic ovary syndrome- women are anovulatory and have unopposed estrogen effect. Estrogen producing tumours(e.g. granulosa cell tumour).Irregular Menstrul Periods-Skipmenstrual periods or have no periods at all –continuous unopposed estrogen activity.Perimenopause periodOverweight Diabetes Mellitus

5. Classification of endometrial hyperplasiaSimple hyperplasia (cystic without atypia) Complex hyperplasia (adenomatous without atypia)Atypical simple hyperplasia (cystic with atypia)Atypical complex hyperplasia (adenomatous with atypia)

6. Simple Endometrial HyperlasiaSimple or Cystic HyperplasiaProliferation of glands and stroma.Glands vary in size, some are cystic.The epithelial cells are active with stratification and mitoses

7. Complex Endometrial Hyperlasiaa very complex gland patternabnormally shaped glands, in- and out-pouching.Glands are crowded with very little endometrial stroma,

8. AtypicalEndometrial Hyperplasia Increased gland densityNuclear atypia - hyperchromatic, enlarged epithelial cells with an increased nuclear to cytoplasmic ratio. Resembles well differentiated carcinoma.

9. Atypical Endometrial HyperplasiaOn high power view the nuclear atypia can be seen:Nuclei are of variable size, shape and chromatin distribution; prominent nucleoli.

10. Symptoms of Endometrial HyperplasiaVaginal dischargeAbdominal painBleeding between menstrual periodsHeavy or prolonged menstrual periods

11. Progressionof Endometrial HyperplasiaHyperplasia without atypia rarely progresses to endometrial cancer, Hyperplasia with atypia is a precancerous condition that may progress to overt malignancy.

12. InvestigationsVaginal ultrasound

13. Endometrial biopsy

14. Dilation and curettage (D&C)

15. HysteroscopyVaginal ultrasound

16. Focal Simple Hyperplasia

17. Atypical Hyperplasia

18. Treatment In most cases, endometrial hyperplasia can be treated with medication that is a form of the hormone progesterone. Taking progesterone will cause the lining to shed and prevent it from building up again. It often will cause vaginal bleeding. Treatment for endometrial hyperplasia without AtypiaIn hyperplasia without atypia, cyclical progestin therapy is the recommended choice in women not seeking contraception.10 mg medroxyprogesterone acetate for 10 to 14 days a month for 3 to 6 months.If they have a normal biopsy and are asymptomatic, discontinue therapy.If the hyperplasia is persistent, then continuous-dose progestin therapy is instituted with 20 mg/day for 3 to 6 monthsIn women desiring contraception, OCP can be used or an injectable depot preparation of medroxyprogesterone acetate ( Depo-Provera ) can be administered in the normal dose used for contraception - 150 mg every 12 weeks.

19. Commonly Used Progesterone- Only Agents Generic Name Common Trade Names Common DosageProgesterone Crinone;Progestasert; Prometrium 200 mg POMedroxyprogesteroneProvera 10-20 mg PO Acetate Depo-Provera 150 mg IMMegestrol acetate Megace 40-320 mg POLevonorgestrelMirena IUS 1 intrauterine every 5 years

20. Treatment for Atypical endometrial hyperplasiaIdeal management is hysterectomyIf hysterectomy is not a viable option for young patient & patient is a very poor surgical candidate), high-dose continuous progestin therapy can be used. Typically, 20 mg of medroxyprogesterone acetate daily. Another option is 40 to 160 mg megestrol acetate daily for 6 months. biopsies every 6 months because of the high risk of recurrence.

21. Protecting Against EndometrialHyperplasiaTake estrogen with progesterone after menopause, Women who don't have regular periods-Take oral contraceptives contain estrogen along with a form of progesterone. If you are overweight, losing weight may help.

22. Thank You