What is the condition of the endometrium?

From the Guidelines

The most effective approach to managing endometrial cancer is to prioritize surgical staging, as it allows for accurate assessment of the disease extent and guides adjuvant therapy decisions, thereby improving patient outcomes in terms of morbidity, mortality, and quality of life. When evaluating patients with endometrial cancer, it is essential to consider the histological subtype, grade, and depth of myometrial invasion to determine the risk of recurrence and guide treatment decisions 1. The European Society for Medical Oncology modified risk stratification system is a useful tool for categorizing patients into low, intermediate, or high-risk groups based on factors such as FIGO stage, tumor grade, histological subtype, and lymphovascular space invasion 1. Sentinel lymph node mapping is a viable alternative to comprehensive lymphadenectomy, offering a sensitivity of 97.2% and a negative predictive value of 99.6% in detecting node-positive disease 1. In terms of diagnosis, office endometrial biopsy is a reliable method for diagnosing endometrial cancer, with a false-negative rate of approximately 10%, and should be followed by a fractional dilation and curettage under anesthesia if the result is negative in a symptomatic patient 1. For patients with suspected endometriosis, expanded protocol transvaginal ultrasound (TVUS) and MRI are useful imaging modalities for detecting and characterizing deep endometriosis, with TVUS offering a higher sensitivity than routine pelvic US 1. Key considerations in the management of endometrial cancer and endometriosis include:

• Accurate diagnosis and staging
• Risk stratification to guide treatment decisions
• Surgical staging and sentinel lymph node mapping
• Adjuvant therapy for high-risk patients
• Imaging modalities such as TVUS and MRI for detecting deep endometriosis. Overall, a comprehensive approach to managing endometrial cancer and endometriosis is crucial for improving patient outcomes and reducing morbidity, mortality, and quality of life.

From the FDA Drug Label

ACTIONS Medroxyprogesterone acetate, administered parenterally in the recommended doses to women with adequate endogenous estrogen, transforms proliferative endometrium into secretory endometrium. The medroxyprogesterone acetate transforms proliferative endometrium into secretory endometrium in women with adequate endogenous estrogen 2.

• The effect of medroxyprogesterone acetate on the endometrium is to transform it from a proliferative to a secretory state.
• This transformation occurs when medroxyprogesterone acetate is administered in the recommended doses to women with adequate endogenous estrogen.

From the Research

Endometrium Overview

• The endometrium is a layer of tissue that lines the uterus, and its health is crucial for reproductive functions 3.
• Endometrial hyperplasia (EH) is a common gynecologic diagnosis and a known precursor of endometrial carcinoma, the most common gynecologic malignancy 3, 4.

Risk Factors for Endometrial Hyperplasia

• Conditions associated with intermittent or absent ovulation, such as polycystic ovary syndrome, increase the risk of EH during reproductive years 3.
• After menopause, EH is more common in women with conditions that increase levels of circulating estrogen, such as obesity or estrogen replacement therapy 3.
• Genetic predispositions, such as Lynch syndrome, also increase the risk of EH 4.

Diagnosis of Endometrial Hyperplasia

• Endometrial biopsy is a safe and efficient method to evaluate the endometrium for EH and endometrial cancer 5, 6.
• Hysteroscopic endometrial biopsy under direct visualisation is associated with a significantly higher rate of sample adequacy and is comparable to blind endometrial sampling for the diagnosis of endometrial cancer and precancer 6.
• Immunohistochemical biomarkers and genomic analysis may also be used to diagnose EH and predict the risk of progression to endometrial cancer 7.

Treatment Options for Endometrial Hyperplasia

• The definitive and curative treatment for EH is hysterectomy, but nonsurgical treatment modalities, such as hormone therapy, may be considered for women who desire fertility-sparing treatments or have medical comorbidities 3, 4.
• The use of oral contraceptive pills or progesterone-containing intrauterine devices may decrease the risk of EH 4.