MANAGEMENT
Complex Atypical Hyperplasia
This case shows a rare presentation of complex atypical hyperplasia at an early age. The patient is a
22-year old and is desirous of pregnancy, thus medical management with continuous high-dose
progestin therapy is recommended.
DRUG NAME EFFICACY
Megestrol A progestogen used as
acetate an antineoplastic and
appetite stimulant. The
40 mg 3-4x mechanism of it's
daily antineoplastic effects is
not known but may be
due to inhibition of
estrogen synthesis,
modulation of other
steroid hormones and/or
a direct cytotoxic effect
on tumor cells.
Once the complex atypical hyperplasia is cleared, consideration should be given to periodic progestin
treatment or oral contraception until the patient chooses to attempt pregnancy.
Lynestrenol Lynestrenol is a
(Daphne) progestogen structurally
500mcg/tab, 1 related to norethisterone.
tablet OD It may be used alone or
as the progestogenic
component of some oral
contraceptives; Progestin
thickens the cervical
mucus, which then serves
as a barrier to the entry of
sperm in the uterus.
Alternative:
LNG-IUS Levonorgestrel, a
(Mirena) nortestosterone
derivative, is an active
isomer of norgestrel. It is
a potent inhibitor of
ovulation and has
androgenic activity ;
about 20 μg of
levonorgestrel (LNG) is
released into the
endometrial cavity each
SAFETY SUITABILITY
Adverse drug reactions: For women with complex
Acne, urticaria, fluid atypical hyperplasia who
retention, weight gain, desire preservation of
breast discomfort, childbearing function
premenstrual symptoms,
alopecia, hirsutism
Special precautions:
History of
thrombophlebitis, mild to
moderate hepatic
impairment, risk of fluid
retention, history of
depression, diabetes,
hypertension, renal or
cardiac dysfunction.
Adverse drug reactions: Progestins oppose the
GI distrubances, change mitotic action of estrogen,
in weight, fluid retention leading to a stable
decidualized
Special precautions: endometrium.
asthma, diabetes mellitus,
epilepsy, heart disease,
hypertension,
thromboembolic disorders,
past ectopic pregnancy,
functional ovarian cysts,
malabsorption syndromes,
migraine, renal
impairment, liver
dysfunction including
cholestatic jaundice
Adverse drug reactions: The LNG-IUS has a high
severe cramps or pelvic level of effectiveness for at
pain, pain during least 5 years. This IUD
intercourse, extreme also reduces menstrual
dizziness,lightheadedness blood loss and has been
, severe migraine used therapeutically to
headache, treat excessive uterine
bleeding.
 day.
Follow-up and Monitoring
 The patient should have a long-term follow-up and periodic sampling
o The first at 3 months and at least 6 months thereafter
 Pipelle Biopsy
o Prior to endometrial biopsy, pregnancy should be excluded
o Preprocedural NSAID can be given
o A speculum is placed and cervix is cleansed with an antibacterial solution
o A single-tooth tenaculum is needed to stabilize the cervix and permit passage of the
Pipelle through the cervical os and into the endometrial cavity.

Limitations to Endometrial Sampling

with a Pipelle Device:
 Inadequate
tissue
sample

(endometrial atrophy)
 Obstructions to catheter insertion (cervical stenosis, large submucous leiomyoma)
 Cancer-detection failure rate of 0.9 percent
 Greater percentage of false-negative results with focal pathology such as
endometrial polyps