When patients who undergo endometrial curettage due to thickening of the uterine wall (endometrium) and whose pathology results are simple endometrial hyperplasia are followed, less than 5%
will develop cancer in 20 years. The majority of cases without atypia (without malignant change)
regress spontaneously.
In women with low probability of regression in treatment with observation alone and in symptomatic women with abnormal uterine bleeding
Progesterone treatment is required.
Obesity is a risk factor. Even when normal weight is reduced, follow-up with endometrial biopsies is required. However, the chance of regression of the disease is higher when progesterone treatment is used.
Simple Endometrial Hyperplasia Treatment without Atypia
Intrauterine device (LNG-IUS) with oral or local intrauterine progesterone. With simple treatment
regression of endometrial hyperplasia can be achieved.
LNG-IUS is more effective and has fewer side effects compared to oral progesterone
. Women who do not accept LNG-IUS should be given uninterrupted progesterone treatment with Medroxyprogesterone 10-20 mg/day or
Norethisterone 10-15 mg/day. This
treatment should be used for at least six months. Since the effect of intermittent-cyclic progesterone treatment is lower
it is not used in such patients.
If the patient does not desire a child and does not complain about drug-related side effects, LNG-IUS
If possible, it should be kept for up to five years, so that both vaginal bleeding and the risk of recurrence of the disease will be reduced.
Endometrial biopsies are taken from the patient approximately every six months to check the histological status
is studied. If abnormal vaginal bleeding occurs before this period, it is considered that the disease has relapsed
and the necessary interventions should be made in a timely manner.
Patients with a BMI of more than 35 (obese) and receiving oral progesterone therapy are treated for relapse.
They constitute a high risk group and should be followed up with endometrial biopsies every six months.
If two consecutive endometrial biopsy results are negative, then annual follow-up
It is reversible.
Hysterectomy for endometrial hyperplasia is not recommended when there is no atypia,
because hysterectomy is a surgery with high morbidity. In the follow-ups If typical hyperplasia occurs,
endometrial hyperplasia recurs despite progesterone treatment, if there is no histological regression despite one year of treatment, if vaginal bleeding continues despite completion of medical treatment, the child If there is no desire, then hysterectomy (surgical removal of the uterus)
should be recommended. Postmenopausal
women requiring surgical treatment for endometrial hyperplasia without atypia should be advised bilateral salpingo opharynx along with total hysterectomy.
For postmenopausal women, the decision to remove the ovaries depends on the patient's condition
>Although it is a controversial issue, it may reduce the risk of ovarian malignancy in the future.
Bilateral oophorectomy is considered.
Endometrial ablation is not recommended for the treatment of endometrial hyperplasia, because
Complete or Permanent endometrial destruction cannot be achieved and the resulting intrauterine adhesion formation
may prevent endometrial histological follow-up in the future.
Article Writing Date: 11.07.2016
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