Endometrial hyperplasia is usually suspected on clinical grounds. Diagnosis is confirmed by D+C and endometrial biopsy. Treatment is influenced by the age of the patient and the histologic type.
Cystic hyperplasia in a young woman may be treated with a cyclical progestogen - such as norethisterone for 10 days each month. If breakthrough bleeding becomes problematic, an oral contraceptive may be substituted. Hysterectomy may be indicated in an older woman.
Management of adenomatous hyperplasia must always bear in mind the likelihood of progression to malignancy. Cyclic progestogens or hysterectomy are the two alternatives. The latter is advised in older patients, those with significant cellular atypia, and those with other factors associated with increased risk of endometrial carcinoma e.g. obesity, nulliparity.
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