Skip to main content
SpringerLink
Log in

Endometrial Hyperplasia

  • Living reference work entry
  • First Online:
Handbook of Gynecology

  • 805 Accesses

Abstract

Endometrial hyperplasia (EH), a known precursor to endometrial adenocarcinoma, is a common gynecologic diagnosis among women, typically resulting from an increase in endogenous or exogenous unopposed estrogen. EH is a histologic diagnosis that is characterized by one of the two classification schemas: either the widely used WHO94 criteria or the more standardized endometrial intraepithelial neoplasia (EIN) criteria. The risk of progression to cancer varies and depends on the severity of the lesion. Lesions with atypia have the highest risk of progression to cancer and the diagnosis of concurrent endometrial cancer. EH mainly effects perimenopausal or postmenopausal women. Significant risk factors for EH include obesity, chronic anovulation as seen in disorders such as PCOS, estrogen only hormone replacement, tamoxifen use, and Lynch syndrome. Clinical manifestations include abnormal uterine bleeding, postmenopausal bleeding, or atypical endometrial glands on pap smear, which require a diagnostic workup in peri-/postmenopausal women. Transvaginal ultrasound (TVUS) is typically the first diagnostic study to be performed in a woman with abnormal uterine bleeding (AUB). Either office endometrial biopsy (EMB) or dilation and curettage (D&C) with or without hysteroscopy can be performed to diagnose EH. When EH is diagnosed, management includes surveillance, hormone therapy, or hysterectomy and choice of therapy depends on the type of EH, potential risk for endometrial cancer, and patient characteristics (i.e., desire to maintain fertility and surgical candidacy). There are no current recommendations for screening for endometrial hyperplasia in the general population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;8:CD003677.

    PubMed  Google Scholar 

  • Abu Hashim H, Ghayaty E, El Rakhawy M. Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: a systematic review and metaanalysis of randomized trials. Am J Obstet Gynecol. 2015;213(4):469–78.

    Article  CAS  PubMed  Google Scholar 

  • ACOG. ACOG Committee Opinion No. 388 388 November 2007: supracervical hysterectomy. Obstet Gynecol. 2007;110(5):1215–7.

    Article  Google Scholar 

  • ACOG. Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338–67.

    Article  Google Scholar 

  • ACOG. Tamoxifen and uterine cancer. Committee Opinion No. 601. Obstet Gynecol. 2014;123(6):1394–7.

    Article  Google Scholar 

  • ACOG. Practice Bulletin No. 149: endometrial cancer. Obstet Gynecol. 2015;125(4):1006–26.

    Article  Google Scholar 

  • Affinito P, Di Carlo C, Di Mauro P, Napolitano V, Nappi C. Endometrial hyperplasia: efficacy of a new treatment with a vaginal cream containing natural micronized progesterone. Maturitas. 1994;20(2–3):191–8.

    Article  CAS  PubMed  Google Scholar 

  • Armstrong AJ, Hurd WW, Elguero S, Barker NM, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol. 2012;19(5):562–71.

    Article  PubMed  Google Scholar 

  • Ash SJ, Farrell SA, Flowerdew G. Endometrial biopsy in DUB. J Reprod Med. 1996;41(12):892–6.

    CAS  PubMed  Google Scholar 

  • Baak JP, Orbo A, van Diest PJ, Jiwa M, de Bruin P, Broeckaert M, et al. Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias. Am J Surg Pathol. 2001;25(7):930–5.

    Article  CAS  PubMed  Google Scholar 

  • Baak JP, Mutter GL, Robboy S, van Diest PJ, Uyterlinde AM, Orbo A, et al. The molecular genetics and morphometry-based endometrial intraepithelial neoplasia classification system predicts disease progression in endometrial hyperplasia more accurately than the 1994 World Health Organization classification system. Cancer. 2005;103(11):2304–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Balbi G, Napolitano A, Seguino E, Scaravilli G, Gioia F, Di Martino L, et al. The role of hypertension, body mass index, and serum leptin levels in patients with endometrial hyperplasia during premenopausal period. Clin Exp Obstet Gynecol. 2012;39(3):321–5.

    CAS  PubMed  Google Scholar 

  • Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence. J Obstet Gynaecol Res. 2014;40(2):301–11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cheung AP. Ultrasound and menstrual history in predicting endometrial hyperplasia in polycystic ovary syndrome. Obstet Gynecol. 2001;98(2):325–31.

    CAS  PubMed  Google Scholar 

  • Committee on Gynecologic Practice, Society of Gynecologic Oncology. Committee Opinion No. 631: endometrial intraepithelial neoplasia. Obstet Gynecol. 2015;125(5):1272–8.

    Article  Google Scholar 

  • Committee on Practice Bulletins- Gynecology, Society of Gynecologic Oncology. ACOG Practice Bulletin No. 147: lynch syndrome. Obstet Gynecol. 2014;124(5):1042–54.

    Article  Google Scholar 

  • Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000;89(8):1765–72.

    Article  CAS  PubMed  Google Scholar 

  • Elsandabesee D, Greenwood P. The performance of pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol. 2005;25(1):32–4.

    Article  CAS  PubMed  Google Scholar 

  • Epplein M, Reed SD, Voigt LF, Newton KM, Holt VL, Weiss NS. Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history. Am J Epidemiol. 2008;168(6):563–70; discussion 71–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin N Am. 2007;34(4):717–37, ix.

    Article  Google Scholar 

  • Farquhar CM, Lethaby A, Sowter M, Verry J, Baranyai J. An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am J Obstet Gynecol. 1999;181(3):525–9.

    Article  CAS  PubMed  Google Scholar 

  • Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97(22):1652–62.

    Article  CAS  PubMed  Google Scholar 

  • Gallos ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(6):547.e1–10.

    Article  CAS  Google Scholar 

  • Garuti G, Cellani F, Centinaio G, Sita G, Nalli G, Luerti M. Histopathologic behavior of endometrial hyperplasia during tamoxifen therapy for breast cancer. Gynecol Oncol. 2006;101(2):269–73.

    Article  CAS  PubMed  Google Scholar 

  • Gol K, Saracoglu F, Ekici A, Sahin I. Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. Gynecol Endocrinol. 2001;15(1):63–7.

    Article  CAS  PubMed  Google Scholar 

  • Guven M, Dikmen Y, Terek MC, Ozsaran AA, Itil IM, Erhan Y. Metabolic effects associated with high-dose continuous megestrol acetate administration in the treatment of endometrial pathology. Arch Gynecol Obstet. 2001;265(4):183–6.

    Article  CAS  PubMed  Google Scholar 

  • Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod. 2012;27(5):1327–31.

    Article  PubMed  Google Scholar 

  • Hecht JL, Ince TA, Baak JP, Baker HE, Ogden MW, Mutter GL. Prediction of endometrial carcinoma by subjective endometrial intraepithelial neoplasia diagnosis. Mod Pathol. 2005;18(3):324–30.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: a study of 219 cases. J Midlife Health. 2013;4(4):216–20.

    PubMed  PubMed Central  Google Scholar 

  • Judd HL, Mebane-Sims I, Legault C, Wasilauskas C, Merino SJM, Barrett-Connor E, et al. Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. JAMA. 1996;275(5):370–5.

    Article  CAS  Google Scholar 

  • Kim JJ, Chapman-Davis E. Role of progesterone in endometrial cancer. Semin Reprod Med. 2010;28(1):81–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer. 1985;56(2):403–12.

    Article  CAS  PubMed  Google Scholar 

  • Lacey Jr JV, Sherman ME, Rush BB, Ronnett BM, Ioffe OB, Duggan MA, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol. 2010;28(5):788–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lacey Jr JV, Chia VM, Rush BB, Carreon DJ, Richesson DA, Ioffe OB, et al. Incidence rates of endometrial hyperplasia, endometrial cancer and hysterectomy from 1980 to 2003 within a large prepaid health plan. Int J Cancer. 2012;131(8):1921–9.

    Article  CAS  PubMed  Google Scholar 

  • Lethaby A, Farquhar C, Sarkis A, Roberts H, Jepson R, Barlow D. Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev. 2000;2:CD000402.

    PubMed  Google Scholar 

  • March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544–51.

    Article  PubMed  Google Scholar 

  • Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol. 2000;182(6):1506–19.

    Article  CAS  PubMed  Google Scholar 

  • Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Matsuo K, Ramzan AA, Gualtieri MR, Mhawech-Fauceglia P, Machida H, Moeini A, et al. Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia. Gynecol Oncol. 2015;139(2):261–7.

    Article  PubMed  Google Scholar 

  • Mentrikoski MJ, Shah AA, Hanley KZ, Atkins KA. Assessing endometrial hyperplasia and carcinoma treated with progestin therapy. Am J Clin Pathol. 2012;138(4):524–34.

    Article  PubMed  Google Scholar 

  • Morotti M, Menada MV, Moioli M, Sala P, Maffeo I, Abete L, et al. Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol. 2012;125(3):536–40.

    Article  PubMed  Google Scholar 

  • Mutter GL. Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The Endometrial Collaborative Group. Gynecol Oncol. 2000;76(3):287–90.

    Article  CAS  PubMed  Google Scholar 

  • Nebgen DR, Lu KH, Rimes S, Keeler E, Broaddus R, Munsell MF, et al. Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome. Gynecol Oncol. 2014;135(1):85–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Polena V, Mergui JL, Zerat L, Sananes S. The role of Pipelle Mark II sampling in endometrial disease diagnosis. Eur J Obstet Gynecol Reprod Biol. 2007;134(2):233–7.

    Article  PubMed  Google Scholar 

  • Reed SD, Voigt LF, Newton KM, Garcia RH, Allison HK, Epplein M, et al. Progestin therapy of complex endometrial hyperplasia with and without atypia. Obstet Gynecol. 2009;113(3):655–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Runowicz CD, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Ford LG, et al. Gynecologic conditions in participants in the NSABP breast cancer prevention study of tamoxifen and raloxifene (STAR). Am J Obstet Gynecol. 2011;205(6):535.e1–5.

    Article  CAS  Google Scholar 

  • Schmeler KM, Lynch HT, Chen LM, Munsell MF, Soliman PT, Clark MB, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med. 2006;354(3):261–9.

    Article  CAS  PubMed  Google Scholar 

  • Suh-Burgmann E, Hung YY, Armstrong MA. Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage. Obstet Gynecol. 2009;114(3):523–9.

    Article  PubMed  Google Scholar 

  • Tingthanatikul Y, Choktanasiri W, Rochanawutanon M, Weerakeit S. Prevalence and clinical predictors of endometrial hyperplasiain anovulatory women presenting with amenorrhea. Gynecol Endocrinol. 2006;22(2):101–5.

    Article  PubMed  Google Scholar 

  • Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, et al. Management of endometrial precancers. Obstet Gynecol. 2012;120(5):1160–75.

    PubMed  PubMed Central  Google Scholar 

  • Zaino RJ, Kauderer J, Trimble CL, Silverberg SG, Curtin JP, Lim PC, et al. Reproducibility of the diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106(4):804–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA

    Kristina Williams

  2. Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA

    Emily Ko

Authors
  1. Kristina Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristina Williams .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology and Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Donna Shoupe

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

Williams, K., Ko, E. (2016). Endometrial Hyperplasia. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_3-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17002-2_3-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-17002-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation