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ENDOMETRIAL HYPERPLASIA AND POLYCYSTIC OVARIAN SYNDROME
Endometrial hyperplasia – thick lining of endometrium on ultrasound
Endometrial hyperplasia may be a precursor to endometrial carcinoma. Cystic glandular hyperplasia may progress to cancer in 0.4% of cases. Adenomatous hyperplasia may progress in up to 15% of cases over a period of 10 years.
Some clinicians suggest that women with PCOS who have amenorrhea (no menstrual cycles over a period of twelve months) or oligomenorrhea (menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year) should be considered for withdrawal bleeding to help prevent endometrial hyperplasia.
In other words, patients with PCOS who have irregular periods do not have the monthly loss of tissue that patients with normal menstrual cycles do have. Therefore, the lining of the uterus (endometrium) continues to get thicker and thicker, because the tissue is not being shed and because there is constant exposure to estrogen, due to the lack of ovulation. These patients therefore are at higher risk to have hyperplasia. Some also recommend that PCOS women should have a period at least every 3 months.
Dr. Brandeis recommends that patients with PCOS patients should have an ultrasound to measure endometrial thickness every 6-12 months. If the lining is over 10 mm, this patient may be encouraged to have an artificially-induced cycle of bleeding. This can be accomplished most effectively with a low-dose birth control pill. After the cycle of bleeding, Dr. Brandeis may recommend a repeat vaginal ultrasound and possibly an endometrial biopsy, especially if the endometrium did not become thinner after the cycle of bleeding. Other options include a progesterone-secreting intra-uterine system such as Mirena.
Progesterone-secreting intra-uterine system such as Mirena.