Endometrial polyps, hyperplasia and carcinoma

Indication of Endometrial biopsy:

1. older than 45 years with AUB.

2. Postmenopausal bleeding

3. abnormal uterine bleeding in patients with BMI ≥30

Normal endometrial measurement:

• premenopausal: <16mm

• Postmenopausal with NO bleeding: <8mm

• Postmenopausal with bleeding: <5mm

Postmenopausal bleeding is considered…… until proven otherwise.

endometrial cancer

postmenopausal patients with uterine bleeding, the frequency of having endometrial “ Polyp “ is ….

37%

postmenopausal patients with uterine bleeding, the frequency of having endometrial “ atrophy “ is ….

30%

postmenopausal patients with uterine bleeding, the frequency of having endometrial “ proliferation “ is ….

14%

postmenopausal patients with uterine bleeding, the frequency of having endometrial “ carcinoma “ is ….

6.6%

postmenopausal patients with uterine bleeding, the frequency of having endometrial “ fibroids “ is ….

6%

postmenopausal patients with uterine bleeding, DDx could be?

All pathologies mentioned before in addition to endometrial hyperplasia (least common).

Endometrial hyperplasia and carcinoma Risk factors:

Anything increases estrogen

HND, TB, PAU هند تبي باو

• HRT

• Nulliparity

• Diabetes

• Tamoxifen

• BMI >= 30

• PCOS

• Age (old)

• Unopposed estrogen stimulation (Highest leading cause)

Diminishes the Risk

• Progestin

• COC

• Menopause before 49

• multi parity

• smoking

Mangment of Endometrial hyperplasia with atypia

• Preferred: Hysterectomy (who complete family)

• Alternative: Progestin therapy (desire fertility or unfit for hysterectomy)

Mangment of endometrial cancer:

• first do Staging “Surgically” Laparoscopic hysterectomy with bilateral salpingo-oophorectomy with pelvic-aortic LN dissection and sentinel LN biopsy.

• Alternative route: Vaginal hysterectomy with or without BSO.

Cervical Polyps Management:

Excision in the clinic only if:

symptomatic (bleeding, discharge)

large (≥3 cm)

appear atypical

Endometrial Polyp Management:

• expectant: if asymptomatic

• Hysteroscopic polypectomy, only if:

  1. Patients with risk factors for cancer

  2. large or multiple polyps

  3. infertility or

  4. abnormal uterine bleeding (AUB)