Endometrial Hyperplasia

00:01 Here we have endometrial hyperplasia.

00:04 From now on, the two conditions that you want to group together include endometrial hyperplasia and endometrial carcinoma.

00:12 The reason for that is because when it comes to prognosis and what your next step of management would be, you’d find this to be quite interesting and unfortunate.

00:21 Endometrial hyperplasia and carcinoma, both extremely responsive to estrogen.

00:26 So therefore, related to abnormally high, prolonged level of estrogen stimulation.

00:33 So what might you be thinking about? You might be thinking about a lady who had early menarche, late menopause.

00:38 Whew.

00:39 tons of exposure to estrogen.

00:42 What else? Maybe she ends up developing polycystic ovarian syndrome and polycystic ovarian syndrome is quite a bit of estrogen that the female is producing.

00:52 Also, she maybe perhaps is a candidate for hormone replacement therapy.

00:59 A hormone that in fact that you’re replacing is estrogen.

01:01 Unfortunately, there’s every possibility that she might then develop endometrial hyperplasia/endometrial cancer.

01:11 Detected by abnormal bleeding especially post menopausal.

01:16 So what are you going to find? You’d do a pelvic exam and, when you do so, if you take a look at the cervical os, from the cervical os, you’d notice that there’s bleeding.

01:24 That should clue you that perhaps your patient is suffering from endometrial hyperplasia and carcinoma.

01:30 It is a risk factor for endometrial cancer and it’s absolutely based on a very important topic, cellular atypia.

01:40 So what does that mean to you? If you find endometrial hyperplasia, and upon biopsy, you find that the cell here is showing normal nucleus.

01:52 In other words, it’s not showing atypia.

01:54 It doesn’t look “ugly.” First line treatment for patients with endometrial hyperplasia without atypia is progestin therapy.

02:03 Medical or surgical treatment is now considered superior for most cases excluding those with a very low risk of progression to endometrial carcinoma, such as a premenopausal patient.

02:15 However, if there’s nuclear atypia, whoa, it changes everything.

02:20 With endometrial hyperplasia, if upon histologic examination, you’d find nuclear atypia.

02:26 Next step of management? Hysterectomy, okay? Completely different.

02:33 In some select patients that have endometrial hyperplasia with atypia, but are still wanting to become pregnant, progestin therapy and very close follow-up are an acceptable option.

02:43 Once again, if you don’t find nuclear atypia, maybe follow up, maybe progesterone.

02:48 If you find nuclear atypia, because of the risk of cancer, do not joke around.

02:54 Do not take chances.