Premalignant Lesions of the Endometrium

•         Abnormal bleeding
•    The most significant and early sign of endometrial cancer
•    Occurs in about 80% of patients.
•    It could be in the form of premenstrual and postmenstrual bleeding besides intermenstrual spotting.
•   Excessive bleeding throughout the premenopausal years
•        Irregular vaginal discharge, particularly after menopause or intermittent spotting
•         Lower abdomen pain and cramps as a result of uterine contractions brought on by debris and blood sucked up behind a stenotic cervical os (hematometra).
•        Sepsis and the development of an abscess if the uterine contents are infected.

If you have any of these symptoms visit a Gynaecologist to be diagnosed and treated properly.

Endometrial hyperplasia develops as a result of constant estrogen stimulation that is unopposed by progesterone. This may be brought on by :

•       Endogenous estrogen due to prolonged anovulation linked to PCOS, or sources of exogenous estrogen.
•        Unopposed estrogen exposure in obesity because of the persistently elevated levels of estradiol
•      Ovarian tumors that secrete estradiol, like granulosa cell tumors

•        A pregnancy test to exclude pregnancy.
•        Assessment of the coagulation profile with total platelet counts, prothrombin time, and partial thromboplastin time to exclude coagulation and platelet disorders.
•       A complete blood count to assess anemia.
•       Imaging the endometrium
•       Hysteroscopy and direct biopsy sampling of the endometrium.
•       Fractional curettage
•       Pelvic and Endovaginal ultrasonography

Management options of premalignant endometrial lesions include :

•  Surgical Management :
•   Total hysterectomy is the current standard of care for premalignant lesions of the endometrium.
•   Abdominal hysterectomy
•   Vaginal hysterectomy
•   Minimally invasive procedures
•  Non-surgical Management :
•   Hormonal therapy
•   Aromatase inhibitors, gonadotropin-releasing hormone (GnRH) antagonists, and sulfatase inhibitors : To reduce estrogenic effects.
•   Progesterone derivatives such as medroxyprogesterone acetate (MPA) and megestrol acetate : To preserve fertility.
•   Selective estrogen receptor modulators (SERMS)