(32) Endometrial hyperplasia in an adolescent with secondary amenorrhoea

Background: Endometrial cancer is the most common gynaecological malignancy globally. The incidence is increasing, particularly in younger women with obesity but has the potential to be missed in adolescents as the presenting features, such as abnormal menstrual bleeding, are common.

This case describes an adolescent who was found to have endometrial hyperplasia and explores the risk factors and management of this condition.

Case: An 18-year-old female was referred to adolescent gynaecology with a 4 year history of chronic pelvic pain. A 9 month history of secondary amenorrhea with raised body mass index (BMI) (BMI 53kg/m2) was noted. Previous spinal MRI imaging showed suggestion of a thickened endometrial stripe [Fig1] so repeat pelvic imaging was arranged which reported endometrial thickening (19mm).

Hysteroscopy and endometrial biopsy confirmed endometrial hyperplasia without atypia, and a Mirena Intrauterine System (IUS) was placed in the endometrial cavity. Repeat hysteroscopy and endometrial biopsy 7 months later showed resolution of endometrial hyperplasia but subsequent hysteroscopy and endometrial biopsy at 12 months again found endometrial hyperplasia without atypia. [Fig2].
At 15 months repeat hysteroscopy showed a more typical appearing cavity with thin endometrim, endometrial biopsy with only yielded a scanty sample but with no atypia reported.

A repeat hysteroscopy and biopsy in another 6 months is planned and they are currently awaiting bariatric surgery.

Comments: This case report describes a rare case of confirmed endometrial hyperplasia without atypia in an adolescent.

Given its premalignant potential, endometrial hyperplasia is an important diagnosis to consider in adolescents, particularly in those presenting with risk factors such as raised BMI.

Ultrasound scan whilst not diagnostic for polycystic ovarian syndrome in adolescence still has an important role in considering differential diagnoses and for endometrial assessment.
Ultrasonographic endometrial assessment enables risk-stratifying for adolescents who would benefit from endometrial biopsy to identify endometrial hyperplasia.