Atypical Hyperplasia: Treatment and Concerns for Women

Atypical hyperplasia

Hello Doctor, my menstrual cycle has been irregular for a long time, and the flow is usually light or very minimal.
About seven years ago, I was diagnosed with polycystic ovary syndrome (PCOS) through a blood test, but I did not receive any aggressive treatment.
Recently, I experienced light bleeding from November 4 to November 7, followed by heavy bleeding from November 8 to November 22.
Due to the unusual heavy bleeding, I went to the hospital for examination.
They performed a blood test for hemostasis and conducted a pelvic exam, transvaginal ultrasound, and endometrial biopsy on the same day.
When I received the report a week later (on November 29), the doctor only mentioned atypical hyperplasia and prescribed progesterone (Norina) for 25 days, twice a day, without any further explanation.
Since I was unclear about my condition at that time, I only confirmed the medication schedule.
After researching related information, I found that some sources suggest that progesterone may not be effective for atypical hyperplasia and that a dilation and curettage (D&C) procedure may be necessary.
I would like to ask the doctor: (1) Is taking progesterone sufficient to manage atypical hyperplasia, or are there any additional precautions I should take? (2) During the treatment period, should I refrain from sexual intercourse, or is it sufficient to use protective measures? I have read that atypical hyperplasia has a higher likelihood of being classified as stage zero cancer, which is quite alarming.
Thank you for your response, Doctor.

Niming, 20~29 year old female. Ask Date: 2017/11/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The menstrual cycle has been irregular, with the flow usually being light or very light.
Approximately seven years ago, blood tests indicated the presence of polycystic ovary syndrome (PCOS), but no active treatment was pursued.
During the period from November 4 to November 7, there was light bleeding, followed by heavy bleeding from November 8 to November 22.
Due to the abnormal heavy bleeding, a visit to the hospital was made, where initial treatment with hemostatic agents was administered.
An internal examination, transvaginal ultrasound, and endometrial biopsy were performed on the same day.
When reviewing the results a week later (on November 29), the doctor only mentioned atypical hyperplasia and prescribed progesterone (Norina) for 25 days, twice a day, without further explanation.
Since there was uncertainty regarding the condition, only the medication schedule and status were confirmed.
After researching related information, it was found that atypical hyperplasia may not respond significantly to progesterone and might require a dilation and curettage (D&C) procedure.
I would like to ask the doctor: (1) Is taking progesterone sufficient to manage atypical hyperplasia, or are there additional precautions needed? (2) During the treatment period, should sexual intercourse be avoided, or is it sufficient to use protective measures? Answer: Please consult the doctor who reviewed the endometrial biopsy results.

Reply Date: 2017/11/29

More Info

A: Hello! Thank you for your questions regarding atypical hyperplasia and its treatment. Atypical hyperplasia is a condition characterized by the presence of abnormal cells in the lining of the uterus (endometrium). It is considered a precancerous condition, which means that while it is not cancer, it can increase the risk of developing endometrial cancer in the future.
1. Treatment with Progesterone: You mentioned that you have been prescribed Norina (a form of progesterone) for 25 days, twice a day. Progesterone is often used in the treatment of atypical hyperplasia, especially in women who wish to preserve their fertility. The goal of progesterone therapy is to counteract the effects of estrogen, which can stimulate the growth of the endometrial lining. While progesterone can be effective in some cases, it is important to note that its effectiveness can vary. Some studies suggest that while progesterone can help reduce the thickness of the endometrial lining and may lead to a regression of atypical hyperplasia, it may not be sufficient for all patients.
In cases where there is a significant risk of progression to cancer or if the atypical hyperplasia does not respond to progesterone therapy, a dilation and curettage (D&C) procedure may be recommended. This procedure involves scraping the uterine lining to remove abnormal tissue. It is essential to have regular follow-ups with your healthcare provider to monitor your response to treatment and to determine if further interventions are necessary.

2. Sexual Activity During Treatment: Regarding sexual activity during your treatment, it is generally advisable to consult with your healthcare provider. In many cases, engaging in sexual activity is permissible as long as you are comfortable and do not experience any unusual symptoms such as pain or excessive bleeding. However, if you are undergoing treatment for atypical hyperplasia, it may be wise to use protection to minimize any risk of infection or complications, especially if you are experiencing any bleeding or discomfort.

It is understandable to feel anxious about the diagnosis of atypical hyperplasia, especially with the associated risk of endometrial cancer. It is crucial to maintain open communication with your healthcare provider, who can provide personalized advice based on your specific situation. They can also discuss the potential need for further evaluation, such as repeat biopsies or imaging studies, to ensure that the condition is being effectively managed.

In summary, while progesterone therapy is a common treatment for atypical hyperplasia, its effectiveness can vary, and additional procedures may be necessary depending on your individual response. Regular follow-up appointments are essential to monitor your condition. As for sexual activity, consult your healthcare provider for personalized advice, but generally, it is permissible with precautions. Remember, you are not alone in this, and your healthcare team is there to support you through your treatment journey. Thank you for reaching out, and I wish you the best in your health journey!

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