444 Obstetrics and Gynecology Board Review •••
❍ What are the common side effects of depo-medroxyprogesterone therapy for endometrial hyperplasia?
Spotting, breast soreness, weight gain, fluid retention, nervousness, irritability, and bloating.
❍ What are common side effects of GnRH analog therapy for endometrial hyperplasia?
Menopausal symptoms: hot flashes, vaginal dryness, changes in the serum lipid profile, effects on the coronary
arteries, and bone loss.
❍ What is the recommended follow-up for a woman with a histologic diagnosis of simple or complex
hyperplasia without cytologic atypia?
In addition to medical therapy, follow-up endometrial sampling is recommended in 6 months.
❍ What is the failure rate of medical therapy for simple and complex hyperplasia?
Approximately 20%.
❍ What is the recommended follow-up for a woman with a histologic diagnosis of atypical hyperplasia treated
conservatively?
In addition to medical treatment, repeat endometrial sampling in 3 months; however, more recent evidence
suggests that intervals up to 6 months may be necessary to establish hormonal conversion.
❍ What is the most common gynecological malignancy in the United States?
Endometrial cancer, of which 80% are the endometrioid adenocarcinoma type. Endometrial cancer accounts for
6% of all cancers in women.
❍ In 2012, approximately how many new cases and deaths from endometrial cancer occurred?
Endometrial cancer is the most common invasive gynecologic cancer in US women, with an estimated 47,130 new
cases expected to occur in 2012. This disease primarily affects postmenopausal women at an average age of 60 years at
diagnosis. In the United States, it is estimated that approximately 8010 women will die of endometrial cancer in 2012.
Incidence rates of endometrial cancer have been increasing by an average of 1.1% per year from 2004 to 2008. Death
rates from cancer of the uterine corpus have been increasing by an average of 0.3% per year from 1998 to 2007.
❍ What is the estimated prevalence of endometrial cancer in asymptomatic postmenopausal women?
Approximately 24.1 per 100,000 for women in the United States.
❍ What is the 5-year survival rate for women with a diagnosis of endometrial carcinoma confined to the
uterus at the time of surgical staging?
80%.
❍ What is the effect of cigarette smoking on the endometrium?
Cigarette smoking significantly reduces the incidence of endometrial cancer. Endometrial atrophy, even in women
on estrogen replacement therapy, is common in smokers, particularly if they are thin.
❍ Describe the screening test for endometrial cancer.
There is no screening test for endometrial cancer; however, the American Cancer Society recommends annual
endometrial biopsy starting at age 35 for all women at risk of hereditary nonpolyposis colorectal cancer (HNPCC).