Endometrial hyperplasia is defined as irregular proliferation of the endometrial glands with an increase
in the gland to stroma ratio when compared with proliferative endometrium.
Endometrial cancer is the most common gynaecological malignancy in the Western world and
endometrial hyperplasia is its precursor.2 In the UK, 8617 new cases of endometrial cancer were
registered in 2012. The incidence of endometrial hyperplasia is estimated to be at least three times
higher than endometrial cancer and if left untreated it can progress to cancer.
The most common presentation of endometrial hyperplasia is abnormal uterine bleeding. This
includes heavy menstrual bleeding, intermenstrual bleeding, irregular bleeding, unscheduled bleeding
on hormone replacement therapy (HRT) and postmenopausal bleeding.
Identification and assessment of evidence
risk factors for endometrial hyperplasia
How should endometrial hyperplasia be classified?
The revised 2014 World Health Organization (WHO) classification is recommended. This separates
endometrial hyperplasia into two groups based upon the presence of cytological atypia: i.e. (i)
hyperplasia without atypia and (ii) atypical hyperplasia
What diagnostic and surveillance methods are available for endometrial hyperplasia?
How should endometrial hyperplasia without atypia be managed?
What should the first-line medical treatment of hyperplasia without atypia be?
How should atypical hyperplasia be managed?
atypical hyperplasia who wish to preserve their fertility
How should endometrial hyperplasia be managed in women wishing to conceive?
HRT and endometrial hyperplasia