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Report showed complex endometrial hyperplasia without atypia. Suggest treatment?

Mar 2016
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Answered by

Practicing since : 2011
Answered : 4047 Questions
Earlier in the month I did an endometrial biopsy with the results that I had a proliferative endometrial. Going forward, 2 weeks later I had a laparoscopy, hysteroscopy, d &c and and endometrial ablation scheduled. All four procedures were done on September 19, 2013. I received the pathology report on my d & c this past Monday; September 23, 2013 stating that I have complex endometrial hyperplasia without atypia. I'm worried that my ablation was a mistake because I have an extensive family history of cancer; my mother had breast and pancreatic cancer, died at the age of 62, my aunt died of colon cancer at the age of 60 and my other aunt died of ovarian cancer at the age of 58; they are my mother's sisters. I guess I'm thinking that with having the ablation done there is no way of keeping an eye on the endometrial hyperplasia. I've researched and found that maybe a vaginal hysterectomy would be an option; only removing my uterus, but I'm not a doctor. I must say though that I'm very worried.
Posted Tue, 15 Oct 2013 in Vaginal and Uterus Health
Answered by Dr. S Patra 3 hours later
Brief Answer:
Follow the guideline.

Detailed Answer:

Thanks for writing to us on Healthcare Magic. Followings are my comments regarding your query:

First thing, positive family history of cancer among first degree blood relations has always greater risk for development of endometrial carcinoma in future from current uterine pathology.

If untreated, about 10% patients will progress to endometrial cancer in presence of Complex Endometrial Hyperplasia without Atypia

TREATMENT: Progesterone therapy can be started initially with above uterine pathology to regress endometrial hyperplasia to some extent.

However, best and definite treatment option is total abdominal hysterectomy with removal of both sided ovaries and fallopian tubes (TAH + BSO) in women who have completed her family. It is the gold standard choice in your age (45 years). This will eliminate certain risks of endometrial cancer in future.

Kindly, consult with your gynecologist to proceed the necessary investigations to complete the operation at scheduled time. In the mean time, you would take progesterone as mentioned above and iron supplements to correct anemia.

After that, you can opt for HRT) for few years to eliminate post menopausal symptoms.

Hope, above information is quite helpful to you. Let me know, if you need any clarification.

Wish your good health and take care yourself.

Dr Soumen

For future query, you can directly approach me through
Above answer was peer-reviewed by
Follow-up: Report showed complex endometrial hyperplasia without atypia. Suggest treatment? 2 hours later
If my gynecologist disagree with doing a hysterectomy; how do my endometrial hyperplasia get monitored for endometrial carcenoma? And yes, I have completed my family and forgot to mention that I had a tubal ligation done over 10 years ago.
Answered by Dr. S Patra 51 minutes later
Brief Answer:
Definite treatment is hysterectomy.

Detailed Answer:

Thanks for follow up query.

1) Your first treatment option is progesterone supplement to regress endometrial hyperplasia to some extent as it is without atypia at present.

With above presentation, I prefer to treat my patients by medroxyprogesterone acetate (MPA) initially. You can consult with your gynecologist regarding this.

However, definite treatment is hysterectomy (TAH + BSO) to eliminate future risk of endometrial carcinoma. It is mandatory in your case and you have family completed.

2) Endometrial hyperplasis is needed to monitor closely at periodic interval till you have undergone the operation.

Best method of monitoring is Trans vaginal ultrasound scan with endometrial biopsy through D & C. Pap smear test is required on yearly basis.

Hope, I have answered your query. If you do not have any other query, you can close the discussion.

All the best. Good luck.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Report showed complex endometrial hyperplasia without atypia. Suggest treatment? 11 minutes later
Will the trans vaginal ultrasound and/or endometrial biopsy through D & C still be viable even after the endometrial ablation was done on 9/19/2013?
Answered by Dr. S Patra 18 minutes later
Brief Answer:
Details are below.

Detailed Answer:

Thanks for your additional queries.

Endometrial ablation is a technique which is used to destroy uterine lining tissue when patient does not want hysterectomy or typical indication is not obtained. It is an alternative and temporary procedure to hysterectomy.

It is quite effective (about 80%) in treating endomerial hyperplasia or abnormal uterine bleeding. However, it may recur and more than 20% patients require hysterectomy additionally.

Endometrial tissue is not viable soon after undergoing ablation as it is already destroyed. However, it should be monitored at 6 months interval through above tests to check any type of hyperplasia (recurrence) or growth to exclude relative risk.

Hope, I have cleared your all doubts. Be well & stay healthy.

Dr Soumen
Above answer was peer-reviewed by
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