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Endometrial hyperplasia

Endometrial hyperplasia is often clinically relevant because it causes bleeding disorders. Some types of endometrial hyperplasia are also precancerous lesions of an endometrial cancer. In the diagnostics bleeding disorders and a sonographically thickened endometrium are signs of an endometrial hyperplasia. In perimenopausal bleeding disorders and sonographically higher endometrium thickness a sonographically supported progestagen test can be carried out for the differential diagnostics of endometrial hyperplasia and other endometrial lesions (polyps, carcinoma). So many patients can be spared an invasive procedure. In all other situations a hysteroscopy and curettage is the diagnostic method of choice. The pathologist must then make an exact histological classification of endometrium hyperplasia (simple, simple atypical, complex or atypical complex hyperplasia). This classification is the basis for all further treatment decisions. However, it must be considered that in histological findings of atypical hyperplasia in specimen of curettage in up to 40 % of the cases an endometrial cancer can be found even later. This must be considered by the therapeutic management. Progestagen plays an important role in the conservative treatment of endometrial hyperplasia. Additionally to the systemic oral progestagen application (cyclic or continuous) the use of local progestagen treatment by a LNG-IUS also provides good results. A conservative treatment by drugs is possible in all hyperplasias without atypias. In cases of hyperplasias with atypias in patients who desire a pregnancy a conservative therapy should be used only carefully and in combination with strict clinical and sonographical controls. Endometrial resection is an operative organretaining method in patients with simple hyperplasias. In all cases of atypical hyperplasia the total hysterectomy is the first-line therapy because a possible early endometrial cancer has to be considered. The total hysterectomy should be carried out in these clinical situations without morcellement. By an early diagnostic and treatment of endometrial hyperplasia the clinical symptoms of bleeding disorders can be treated successfully. Endometrial cancer can be prevented by the adequate medical and surgical treatment of endometrial hyperplasia. The treatment of endometrial hyperplasia is dependent on the classifications, the menopausal status and clinical symptoms of patients and requires a differentiated implementation in the clinical practice.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(2): 150–167

Endometrial hyperplasia, endometrial cancer, progestagens, hysteroscopy, progestagen test

Thomas Römer
Gynäkologisch-geburtshilfliche Abteilung,
Evangelisches Krankenhaus Köln-Weyertal, Köln
Reviewer: Dolores Foth, Köln
und Gunther Göretzlehner, Rostock

Römer T. Endometriumhyperplasie Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(2): 150–167 publiziert 31.07.11 ©akademos Wissenschaftsverlag 2011 ISSN 1614-8533