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Endometrial Hyperplasia

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Handbook of Gynecology

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Abstract

Endometrial hyperplasia (EH), a known precursor to endometrial adenocarcinoma, is a common gynecologic diagnosis among women, typically resulting from an increase in endogenous or exogenous unopposed estrogen. EH is a histologic diagnosis that is characterized by one of two classification schemas: either the widely used World Health Organization 2014 criteria or the more standardized endometrial intraepithelial neoplasia (EIN) criteria. The risk of progression to cancer varies and depends on the severity of the lesion. Lesions with atypia have the highest risk of progression to cancer and the diagnosis of concurrent endometrial cancer. EH mainly affects perimenopausal or postmenopausal women. Significant risk factors for EH include obesity, chronic anovulation as seen in disorders such as polycystic ovarian syndrome, estrogen-only hormone replacement, tamoxifen use, and Lynch syndrome. Clinical manifestations include abnormal uterine bleeding, postmenopausal bleeding, or atypical endometrial glands on Pap smear, which require a diagnostic workup in peri-/postmenopausal women. Transvaginal ultrasound (TVUS) is typically the first diagnostic study to be performed in a woman with abnormal uterine bleeding. Either office endometrial biopsy or dilation and curettage with or without hysteroscopy can be performed to diagnose EH. When EH is diagnosed, management includes surveillance, hormonal therapy, or hysterectomy, and choice of therapy depends on the type of EH, potential risk for endometrial cancer, and patient characteristics (i.e., desire to maintain fertility and surgical candidacy). There are no current recommendations for screening for endometrial hyperplasia in the general population.

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Abbreviations

AEH:

Atypical endometrial hyperplasia

AUB:

Abnormal uterine bleeding

BMI:

Body mass index

BSO:

Bilateral salpingo-oophorectomy

D&C:

Dilation and curettage

EH:

Endometrial hyperplasia

EIN:

Endometrial intraepithelial neoplasia

EMB:

Endometrial biopsy

EMS:

Endometrial stripe

PCOS:

Polycystic ovarian syndrome

TVUS:

Transvaginal ultrasound

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Authors and Affiliations

  1. Division of Gynecologic Oncology, New York University Langone Health, New York, NY, USA

    Catherine Hermann

  2. Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA

    Kristina Williams

  3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA

    Emily M. Ko

Authors
  1. Catherine Hermann
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  2. Kristina Williams
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  3. Emily M. Ko
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Corresponding author

Correspondence to Emily M. Ko .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

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Hermann, C., Williams, K., Ko, E.M. (2023). Endometrial Hyperplasia. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-14881-1_3

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  • DOI: https://doi.org/10.1007/978-3-031-14881-1_3

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