442 Obstetrics and Gynecology Board Review •••
❍ In the absence of cytologic atypia, what percentage of endometrial hyperplasia will progress to endometrial
carcinoma?
Approximately 1% to 3%.
❍ What percentage of complex atypical hyperplasia will progress to endometrial cancer?
29%.
❍ Why is endometrial hyperplasia more common at the extremes of reproductive life, near puberty, and the
perimenopause?
At both extremes anovulatory cycles are more common.
❍ In the postmenopausal woman, what is the main circulating estrogen and what is its source?
Estrone. It arises from the peripheral conversion of adrenal and ovarian androstenedione. In a slender woman this
amounts to 40 mg/day. In an obese woman it may exceed 200 mg/day.
❍ What are the most common presenting symptoms of endometrial hyperplasia in a woman of
reproductive age?
(1) Metrorrhagia.
(2) Menometrorrhagia.
❍ What is the most common presenting complaint in a postmenopausal woman with endometrial hyperplasia?
Postmenopausal vaginal bleeding.
❍ Can endometrial hyperplasia be accurately diagnosed by transvaginal ultrasonography?
No. Endometrial hyperplasia is a histologic diagnosis. An endometrial sample is necessary to exclude
adenocarcinoma. A thickened endometrial stripe in excess of 10 mm in a woman with abnormal uterine bleeding
may suggest endometrial hyperplasia but is not diagnostic.
❍ What type of ovarian neoplasm is most commonly associated with endometrial hyperplasia?
Granulosa cell tumor, as it secretes estradiol.
❍ In a postmenopausal woman, what sign on pelvic examination should suggest an elevated endogenous
estrogen level?
The absence of vaginal atrophy. The presence of a vagina with multiple rugal folds suggests an estrogen effect.
❍ What percentage of perimenopausal and postmenopausal women will have endometrial hyperplasia on an
endometrial biopsy performed for abnormal or postmenopausal bleeding?
8% to 9%. In women under the age of 40, only 1% to 2% will have endometrial hyperplasia diagnosed on
endometrial biopsy.
❍ What is the gland-stromal ratio in simple hyperplasia?
The gland stromal ratio in simple hyperplasia favors the glands. In a normal proliferative endometrium, the gland
stromal ratio favors the stroma.