Endometrial hyperplasia (EH) is a pre-cancerous, non-physiological, non-invasive proliferation of the endometrium that results in increased volume of endometrial tissue with alterations of glandular architecture (shape and size) and endometrial gland to stroma ratio of greater than 1:1.
Endometrial hyperplasia (EH) is one of the most frequent causes of abnormal uterine bleeding (AUB)
Menorrhagia (heavy/prolonged menstrual bleeding)
Metrorrhagia (bleeding between menstrual cycles)
Menometrorrhagia (menorrhagia + metrorrhagia)
Postmenopausal: Any bleeding
Amenorrhoea (missed menstrual cycles)
↑ risk of endometrial cancer:
Endometrial intraepithelial neoplasia: Premalignant lesion, characterised by increased volume of glandular crowding (greater than the stromal volume), the presence of cytological alterations, size of lesion larger than 1 mm, and exclusion of mimics or carcinoma.
Cyclic progestin therapy
Cyclic progestin therapy:
Medroxyprogesterone acetate (MDPA) or Megestrol (DRUG OF CHOICE)
MPA prevents overgrowth in the uterine lining in postmenopausal women receiving estrogen hormone and decreases the risk of EH progression.
Cyclic MPA has been shown to be a safer and more acceptable therapy than continuous MPA
Use: Absent/irregular menstrual periods, or AUB
Megestrol acetate (MA)
LNG-impregnated intrauterine device (LNG-IUD) is currently a very common treatment option for EH. This device releases a constant amount of LNG inside the uterus and effectively opposes the estrogenic effect
Norethisterone (or norethindrone)
Orally active steroidal progestin with antiandrogen and antiestrogen effects
Use: Oral contraceptive pills (OCP) and to treat premenstrual syndrome, irregular intense bleeding, irregular and painful periods, menopausal syndrome in combination with estrogen, or to postpone a period