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Endometrial hyperplasia w/o atypia
Is hysterectomy the only treatment for endometrial hyperplasia without abnormal cells? I tried prometrium but that resulted in very extreme blood loss (40 super plus tampons in 3 days) plus severe depression, mood swings and headache. Although I am 49 years old and no longer wish to bear children, I do not wish to undergo such a radical procedure.
J_Harrison_Hohner responded:
Dear HIPPYCHICK2U: As a bit of background for other readers, endometrial hypertrophy means an overgrowth of the lining of the uterus. Another term for this is endometrial hyperplasia. Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes proliferation and a thickening of the lining or hypertrophy), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for endometrial hyperplasia and endometrial cancer. The most common reasons for a woman to not be ovulating (no lawn mower activity so thicker lawn) are being heavy set or being perimenopausal. The good news is that you do not have complex hyperplasia or atypical cells ("simple hyperplasia"). The treatment for simple hyperplasia which does not contain abnormal cells is progesterone pills or shots. This shrinks down the too thick lining. The synthetic progesterone containing IUD (Mirena) has also been used. The advantage is that there are less systemic effects as blood levels during the first year of use are about as high as a woman using the progestin only mini-pill. Endometrial ablation (destruction of the uterine lining by laser, cautery, hot water balloon, etc) can be used to decrease heavy bleeding. Here is a good overview of possible treatments from the National Library of Medicine site: 1: J Gynecol Obstet Biol Reprod (Paris). 2006 Oct;35(6):542-50.[Endometrial hyperplasia: A review>[Article in French> Brun JL, Descat E, Boubli B, Dallay D. Service de Gynécologie Obstétrique, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux. Endometrial hyperplasias can be divided into two categories based on the presence or absence of cytological atypia and further classified as simple or complex according to the extent of architectural abnormalities. They are usually diagnosed because of irregular bleeding in perimenopause. Hysteroscopy with a biopsy gives a more accurate diagnosis than transvaginal ultrasonography, sonohysterography, or blind curettage. Endometrial hyperplasias with no cytological atypia, regarded as a response to unopposed endogenous estrogenic stimulation, are normally treated with progestins. The intra-uterine route (levonorgestrel intra-uterine system) is more effective and better tolerated than the oral route. Either conservative surgery (endometrial resection, thermal ablation) or radical surgery (hysterectomy) in the case of other genital diseases is performed on women who did not respond to medical treatment. Endometrial hyperplasias with cytological atypia, considered as intra-epithelial neoplasias, are traditionally treated by hysterectomy. The absence of management protocols in the literature offers various treatment options and indications. Gonadotropin-releasing hormone agonists, danazol, or aromatase inhibitor are effective, but have adverse effects and are expensive. Endometrial ablation can be performed as a first line therapy in women suffering from bleeding related to hyperplasia without cytological atypia. Medical treatment may be offered to young women suffered from hyperplasias with cytological atypia and desiring pregnancy. Yours, Jane

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