Endometrial Hyperplasia

All are true of endometrial hyperplasia except

A. Disordered proliferation of endometrial stroma
B. Results from the unopposed estrogen stimulation
C. Abnormal gland-to-stroma ratio
D. Atypical features in the cells and nuclei

The risk factors associated with endometrial hyperplasia are all except

A. Multiparity
B. Genetic
C. Diabetes Mellitus
D. Lynch syndrome

Conditions of estrogen excess causing endometrial hyperplasia are all except –

A. Anovulatory cycle
B. Estrogen secreting ovarian tumors
C. Tamoxifen
D. Oral contraceptive use

Not true about endometrium –

A. Cells of the glands do not show mitoses in secretory phase of normal menstrual cycle
B. In endometrial hyperplasia without atypia, the glandular to stromal ratio is less than 50 %
C. In endometrial hyperplasia with atypia cribriform and maze-like pattern with back to back glands are seen
D. The glands may show mitoses in endometrial hyperplasia without atypia

The progression rate to cancer in complex hyperplasia with atypia is –

A. 30%
B. 1%
C. 8%
D. 50%

 D score for endometrial intraepithelial lesion (EIN) is

A. More than 1

B. Less than zero

C. One to zero

D. More than 5

Which of the following requires an endometrial biopsy –

A. Asymptomatic postmenopausal women with an endometrial thickness more than 4 mm
B. PCOS with endometrial thickness less than 7mm
C. Postmenopausal Women with the endometrial thickness is less than 3 or 4 mm
D. Irregular endometrium in post menopausal women

In short

Management of benign endometrial hyperplasia/ hyperplasia without atypia: LNG-IUS is preferred because it has lower side effects, a higher rate of disease resolution, and bleeding per vagina, Women who refuse LNG-IUS can be started on continuous oral progestogens

Indications for hysterectomy in benign endometrial hyperplasia/ hyperplasia without atypia

  • Atypical hyperplasia develops during the treatment period
  • No resolution of the disease after 12 months of treatment
  • Relapse of endometrial hyperplasia
  • Non-resolution of bleeding
  • A non-compliant patient who declines surveillance and follow-up

Uterine morcellation, endometrial ablation, and supracervical hysterectomy are not recommended for the management of endometrial hyperplasia as they may lead to residual disease and formation of intrauterine synechiae which may make future follow up and diagnosis difficult.
Endometrial intraepithelial neoplasia/ hyperplasia with atypia: A total hysterectomy has been recommended. A laparoscopic procedure is preferred. Lymphadenectomy and frozen section analysis of the uterine lining not done routinely.

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