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Dr Ayesha Khaleel, F1
Date of submission
Explicit definition of patient group to which it applies (e.g. Adult women with histological diagnosis of
inclusion and exclusion criteria, diagnosis) endometrial hyperplasia
Version 1
Date: 8.4.17
Target audience General gynaecologists (all grades) at NUH
This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The
interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If
in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date.
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Algorhythm for the management of endometrial hyperplasia without atypia
Inform
Tell the patient that the risk of endometrial hyperplasia without atypia progressing to
endometrial cancer is less than 5% over 20 years and that many cases will
spontaneously regress.
Advise that treatment with progestogens has a higher disease regression and we
recommend progestogen treatment. Discuss ways to reduce their risk factors such
as losing weight and stopping any oestrogenic treatments.
Treatment
Follow up
Progestogen treatments should be given for at least 6 months then rebiopsy in clinic
(Pipelle) to ensure histological reversal.
Two consecutive negative biopsies at least 6 months apart should be obtained prior
to discharge.
Women who have a LNG-IUS (such as MIRENA) and are satisfied with it, can be
advised to continue with this treatment for 4 years.
If EH has not regressed after 6 months of treatment, women should be offered a
further 6 months treatment with oral progestogens or LNG-IUS then rebiopsy 6
months later. If EH persists after the second course of treatment, surgical
management may be offered if preservation of the uterus is not desired. If
preservation of the uterus is desired then refer to the Gynaecology Oncology team
for further assessment and counselling.
Surgical management
Hysterectomy is indicated in women who do not wish or need to preserve their fertility when:
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Algorhythm for the management of endometrial hyperplasia with atypia
Is fertility or preservation of
uterus required?
NO YES
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Aims and purpose
To guide general gynaecologists on the management of adult women with a
histological diagnosis of endometrial hyperplasia.
Background
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Classification
References