Cystic endometrial hyperplasia

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Macroscopic appearance of endometrial hyperplasia in a dog[1]

Cystic endometrial hyperplasia is a chronic inflammatory condition of the canine uterus characterized by endometritis and cystic hyperplasia and a leading cause of infertility in bitches.

Chronic cases are often associated with pyometra[2], and more rarely, uterine torsion[3], hematometra or hydrometra[4].

This condition is a chronic inflammatory state qhich frequently leads to endometrial degeneration, leading to bacterial overgrowth, usually by Escherichia coli, which migrate from the vagina and proliferate in the uterus at the end of estrus. Secondary pyometra is a common sequela[5]. The disease condition appears to be mediated by progesterone and potentially aggravated by estrogens[6].

Other cystic lesions of the uterus have been reported in dogs including serosal inclusion cysts, adenomyosis, endometrial polyposis, cystic remnants of mesonephric ducts, and cysts associated with endometrial hyperplasia.

Clinically affected dogs without pyometra sometimes present with persistent bloody vaginal discharge and hemorrhage is quite common within the uterus, with rare fatal outcomes[7].

Diagnosis is based on presenting clinical signs supported by radiographic or ultrasonogrpahic evidence of uterine wall thickening. Biopsy of uterine endometrium provides a definitive diagnosis.

Treatment is invariably effective with ovariohysterectomy, although use of aglepristone has been reportedly effective at minimising clinical signs[8].


  1. Penn Veterinary Medicine
  2. Schlafer DH & Gifford AT (2008) Cystic endometrial hyperplasia, pseudo-placentational endometrial hyperplasia, and other cystic conditions of the canine and feline uterus. Theriogenology 70(3):349-358
  3. Barrand KR (2009) Unilateral uterine torsion associated with haematometra and cystic endometrial hyperplasia in a bitch. Vet Rec 164(1):19-20
  4. Pretzer SD (2008) Clinical presentation of canine pyometra and mucometra: a review. Theriogenology 70(3):359-363
  5. Silva E et al (2010) Gene transcription of TLR2, TLR4, LPS ligands and prostaglandin synthesis enzymes are up-regulated in canine uteri with cystic endometrial hyperplasia-pyometra complex. J Reprod Immunol 84(1):66-74
  6. Verstegen J et al (2008) Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: advances in treatment and assessment of future reproductive success. Theriogenology 70(3):364-374
  7. Gumber S et al (2010) Uterine endometrial polyp with severe hemorrhage and cystic endometrial hyperplasia-pyometra complex in a dog. J Vet Diagn Invest 22(3):455-458
  8. Fieni F et al (2006) Clinical evaluation of the use of aglepristone, with or without cloprostenol, to treat cystic endometrial hyperplasia-pyometra complex in bitches. Theriogenology 66(6-7):1550-1556