Endometrial Hyperplasia.

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Abnormal uterine bleeding, particularly postmenopausal bleeding, is a key indicator of endometrial pathology, with 10-20% of cases being hyperplasia or cancer.
• Atypical hyperplasia, or endometrial intraepithelial neoplasia (EIN), significantly increases the risk of concurrent or future endometrial cancer.

Purpose of the Study:

• To provide a comprehensive review of endometrial hyperplasia, covering etiology, risk factors, classification, malignant potential, prevention, and treatment.
• To outline current surgical and nonsurgical management strategies for endometrial hyperplasia and EIN.

Main Methods:

• Literature review and synthesis of current clinical expert knowledge on endometrial hyperplasia.
• Discussion of diagnostic criteria, risk stratification, and therapeutic options.

Main Results:

• Key risk factors for EIN include genetic predispositions (e.g., Lynch syndrome), obesity, chronic anovulation, and polycystic ovarian syndrome.
• Protective factors against EIN include oral contraceptive use and progesterone-containing intrauterine devices.
• Hysterectomy is the definitive treatment for EIN, but nonsurgical options are increasingly considered due to patient factors like obesity, fertility desires, and comorbidities.

Conclusions:

• Prompt evaluation of abnormal uterine bleeding is crucial for diagnosing endometrial hyperplasia and cancer.
• EIN necessitates treatment due to its high risk of malignant progression.
• Treatment decisions for EIN should be individualized, considering hysterectomy alongside fertility-sparing and medical management options.