Endometrial Hyperplasia: Diagnosis and Management

  • Bijal M. Patel


Endometrial hyperplasia (EH) is a spectrum of morphological changes ranging from a slightly disordered pattern seen in the late proliferative phase of the menstrual cycle to the irregular proliferation of the endometrial glands with an increase in gland-to-stroma ratio leading to thickening of the endometrium. It encompasses histological subtle and spontaneously reversible proliferative lesions to emerging endometrial carcinoma. As endometrial hyperplasia is the only known direct precursor of endometrial carcinoma, sensitive and accurate diagnosis can reduce the likelihood of development of invasive endometrial carcinoma. Currently, two classifications are in use: the World Health Organization (WHO) 2014 classification and the endometrial intraepithelial neoplasia (EIN) classification. The optimal management of endometrial hyperplasia is the subject of significant debate. Regression of hyperplasia to normal endometrium represents the key to conservative treatment of endometrial hyperplasia. In younger women who desire fertility, medical treatment with progestin is appropriate with extremely close monitoring. In older women who do not wish to retain their uterus, hysterectomy is the treatment of choice. In this chapter, a brief overview of the development of a current understanding of EH will serve to understand their diagnosis and management.


Endometrial hyperplasia Endometrial intraepithelial neoplasia Endometrial carcinoma Hyperplasia without atypia Atypical hyperplasia Abnormal uterine bleeding Estrogen Progesterone Estrogen therapy Hormone therapy Hysterectomy 



Abnormal uterine bleeding


Body mass index


Bilateral salpingo-oophorectomy


Computerized tomography


Dilatation and curettage


Depot medroxyprogesterone acetate


Endometrial biopsy


Endometrial carcinoma


Epithelial growth factor


Endometrial hyperplasia


Endometrial intraepithelial neoplasia


Estrogen receptors


Estrogen replacement therapy


Endometrial thickness


Gonadotropin-releasing hormone


Hematoxylin and eosin


Hormone replacement therapy


Insulin-like growth factor-1




Intrauterine device




Megestrol acetate


Medroxyprogesterone acetate


Magnetic resonance imaging


Microsatellite instability


Norethisterone acetate


Oral contraceptives


Proliferating cell nuclear antigen


Polycystic ovarian syndrome


Postmenopausal bleeding


Progesterone receptor


Royal College of Obstetricians and Gynaecologists


Selective estrogen receptor modulator


Single nucleotide polymorphisms


Total abdominal hysterectomy


Tumor necrosis factor receptor 1


Tumor necrosis factor-α


Transvaginal sonography




World Health Organization


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Bijal M. Patel
    • 1
  1. 1.Department of Gynecologic OncologyGujarat Cancer and Research InstituteAhmedabadIndia

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