How would you proceed with a 64-year-old woman who has complex endometrial hyperplasia and secretory changes? The patient is not receiving hormone replacement therapy, and her follicle-stimulating hormone and luteinizing hormone levels are appropriately elevated. Does she require dilatation and curettage? — Roy A. Hart, DO, Moline, Ill.

If the diagnosis of endometrial hyperplasia in a postmenopausal woman is made after endometrial biopsy, it is advisable to perform curettage to observe the histologic findings from a greater area of the endometrial cavity than is accessible with a biopsy instrument.

Endometrial cancer may be present in only one area of the endometrial cavity. If the biopsy or curettage reveals complex endometrial hyperplasia with atypia, it is best to perform a hysterectomy, since many of these lesions will progress to carcinoma. — Daniel R. Mishell Jr, MD (157-7)

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