From the Guidelines
Focal endometrial hyperplasia should be treated with continuous progestin-based therapy, such as megestrol acetate, medroxyprogesterone, or an intrauterine device containing levonorgestrel, to reduce the risk of progression to endometrial cancer, as recommended by the NCCN guidelines 1. The treatment of focal endometrial hyperplasia depends on the severity of the condition, the patient's age, and their desire for future fertility.
- For young patients with endometrial hyperplasia who desire fertility preservation, continuous progestin-based therapy may be considered, with close monitoring with endometrial sampling every 3 to 6 months 1.
- The use of progestin-based therapy should be carefully considered in the context of other patient-specific factors, including contraindications such as breast cancer, stroke, myocardial infarction, pulmonary embolism, deep vein thrombosis, and smoking 1.
- For women who have completed childbearing or have atypical hyperplasia, hysterectomy may be considered as definitive treatment, with TH/BSO with surgical staging recommended after childbearing is complete, if therapy is not effective, or if progression occurs 1. The NCCN guidelines recommend consultation with a fertility expert and genetic evaluation of tumor and evaluation for inherited cancer risk when considering fertility-sparing therapy 1.
- Patients should also receive counseling that fertility-sparing therapy is not the standard of care for the treatment of endometrial carcinoma, and that the ultimate recurrence rate is high, even with successful treatment 1. Regular follow-up with endometrial sampling is essential to monitor response to treatment, typically every 3-6 months, to reduce the risk of progression to endometrial cancer 1.
From the Research
Definition and Risk Factors
- Focal endometrial hyperplasia is a condition where there is an abnormal growth of the endometrium, the lining of the uterus, in a specific area 2.
- The risk factors for endometrial hyperplasia include unopposed estrogen exposure, polycystic ovary syndrome, obesity, and genetic predispositions such as Lynch syndrome 3, 4, 5.
- Abnormal uterine bleeding is a common symptom of endometrial hyperplasia and can be a sign of underlying cancer 3, 4, 5.
Diagnosis and Classification
- Endometrial hyperplasia can be diagnosed through endometrial biopsy and classified into different types based on the presence of atypia and the complexity of the hyperplasia 2, 6.
- The World Health Organization (WHO) classification system is commonly used to classify endometrial hyperplasia into simple, complex, simple atypical, and complex atypical hyperplasia 6.
- The diagnosis of atypical endometrial hyperplasia carries a high risk of concomitant endometrial cancer or eventual progression to cancer in the absence of treatment 4, 5.
Treatment and Management
- The treatment of endometrial hyperplasia depends on the type and severity of the condition, as well as the patient's desire for fertility preservation 2, 4, 5.
- Hormonal therapy, particularly progestins, is a common treatment for endometrial hyperplasia, especially for women who wish to preserve fertility 2, 4, 5.
- Hysterectomy is often recommended for women with atypical endometrial hyperplasia or those who are at high risk of progression to cancer 4, 5.
- Regular monitoring with biopsies is essential for women undergoing conservative treatment for endometrial hyperplasia 5.
Progression Risk
- The risk of progression from endometrial hyperplasia to endometrial cancer varies depending on the type of hyperplasia and other factors such as genetic mutations and obesity 5, 6.
- Women with atypical endometrial hyperplasia have a higher risk of progression to cancer, with estimates ranging from 20 to 50% 5.
- Emerging data suggest that the long-term risk of progression to cancer among women with simple or complex hyperplasia is less than 5%, but the risk among women with atypical hyperplasia is approximately 30% 6.