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Endometrial
Hyperplasia
Zakaria Sanad,MD

Definition   Abnormal endometrial glandular proliferation Spectrum of morphologic and biologic alteration of end glands and stroma (exaggerated physiologic state to CIS) .

Etiology  Usually a result of chronic unopposed estrogen stimulation in absence of progesterone influence .

late menopause Chronic anovulation . PCOS Estrogen-producing ovarian tumors Menopausal use of ERT without proges Tamoxifen used for tt of cancer breast .Risk Factors         Obesity Age above 40 y Nulliparity Early menarche .

     DM . Hypertension Family history Alcohol intake High animal fat Chronic liver disease .

Decreased Risk    Combined pills Pregnancy Smoking .

Clinical Importance     May be associated w estrogen-producing ovarian tumors May result from exog unopposed E therapy May cause abnormal uterine bleedig May precede or occur simultaneously with endometrial cancer .

.......Complex (adenomatous w atypia) 29 % ....Classification (ISGP)     Based on architectural and cytologic features as well as long-term prognosis Simple (cystic without atypia) 1% Complex (adenomatous without atypia) 3 % Atypical : Simple (cystic w atypia) 8%...

no crowding .   Simple : dilated.cystic glands w round shapes increased G/S ratio . crowded glands w less stroma . no atypia Complex : budding and infolding . loss of polarity . increased N/C ratio . no atypia Atypical : large nuclei of variable size and shape . irreg clumped chromatin w parachromatin clearing . prominent nucleoli .

Novak .Diagnosis   Endometrial tissue sampling : Pipelle . Vabra D & C biopsy .

surgical risk . desire for future fertility . presence of atypia H without atypia : Some recommend D&C + Cyclic progestin ( MPA 10 mg / day for 14 days per cycle for 3-6 m) or Mirena or combined pills + re-biopsy H w atypia : Hystrectomy is recommended. continuous progestin ( Megestrol A 40 mg 2-4 times daily for 3-6 m )+maint if d F .Treatment    Depends on age .

Asherman Syndrome    Destruction of the endometrium and intra-uterine synechia resulting in 2ry amenorrhea 5-7 % of women w 2ry amenorrhea 1-2 % of infertile women .

TB.Risk Factors      Overzealous postpartum or post-abortive curettage …IU scarification (bleeding after delivery .B.placental remnants.septic abortion. metroplasty Endometritis.repeat D&C for retained POC) Uterine surgery :CS . myomectomy .severe pelvic infection Postpartum hypogonadism (Sheehan synd) UAE (endom damage from ischemia) .

dysmenorrhea Infertility after possible ut insult ( 40 % ) Repeated miscarriage .Presenting Complaints    Menstrual disorders ( 60 % ) : 2ry amenorrhea.hypomenorrhea.

Diagnosis     HSG Sonohysterograpgy (SIS) Diagnostic office hysteroscopy MRI .

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high dose estrogen for 2 m Repeat attempts are worthwile . broadsp antibiotic for 10 d .Treatment    Hysteroscopy with direct lysis of adhesions by cutting . cautery or laser Prevention of reformation of adhesions : a pediatric Foley catheter (3 ml.7 d).

Prognosis     Restoration of menses : more than 90% Successful pregnancy : 70-80% Live-birth : 30-70% Pregnancy complicated by preterm labor. p previa. p accreta. postpartum hem .

Uterine Polyps-Corporeal     Adenomatous (mucous) Fibroid Placental Malignant .

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Cervical      Adenomatous ( mucous ) Fibroid Malignant Bilharzial Tuberculous .Uterine Polyps .