No atypia

a. Endometrial hyperplasia without atypia is evaluated initially by hysteroscopy and dilatation and curettage. If the diagnosis remains unchanged and an ovarian estrogen source is excluded, then treatment with continuous medroxyprogesterone acetate (MPA, Provera) 10 mg daily for three months can be initiated. A follow-up endometrial biopsy should be performed immediately after cessation of drug therapy.

2. With atypia. Endometrial hyperplasia with atypia is a premalignant condition, preferably treated with hysterectomy. Alternatively, continuous oral megestrol at doses of 40 mg two to four times per day can be administered after coexistent endometrial cancer is excluded. An endometrial biopsy should be performed after three months of therapy.

References: See page 184.

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