Classification and diagnosis of endometrial hyperplasia
- Susan D Reed, MD, MPH
Susan D Reed, MD, MPH
- Departments of Obstetrics and Gynecology & Epidemiology
- Harborview Medical Center
- University of Washington
- Renata R Urban, MD
Renata R Urban, MD
- Assistant Professor
- Gynecologic Oncology
- University of Washington School of Medicine
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Rochelle L Garcia, MD
Rochelle L Garcia, MD
- Section Editor — Obstetric and Gynecologic Pathology
- Professor of Pathology
- Adjunct Professor of Obstetrics & Gynecology
- University of Washington Medical Center
The endometrium (lining of the uterus) may develop endometrial hyperplasia, which include precancerous (intraepithelial) neoplasms (atypical complex hyperplasia) and nonneoplastic entities (simple and many complex hyperplasias without atypia); these are characterized by a proliferation of endometrial glands of irregular size and shape. Compared with proliferative endometrium, there is an increase in the endometrial gland-to-stroma ratio. Endometrial hyperplasia frequently results from chronic estrogen stimulation unopposed by the counterbalancing effects of progesterone .
The classification, epidemiology, risk factors, diagnosis, and evaluation of endometrial hyperplasia are reviewed here. Related topics can be found separately:
●Management of endometrial hyperplasia (See "Management of endometrial hyperplasia".)
●Other etiologies of abnormal uterine bleeding (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Postmenopausal uterine bleeding".)
●Endometrial carcinoma (See "Endometrial carcinoma: Epidemiology and risk factors".)
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- HISTOPATHOLOGY AND CLASSIFICATION
- Classification systems
- - World Health Organization classification
- - Endometrial intraepithelial neoplasia classification
- - Comparing the WHO and EIN systems
- Distinguishing hyperplasia from endometrial carcinoma
- - Potential biomarker use
- Squamous morules and atypical polyps
- RISK OF ENDOMETRIAL CARCINOMA
- Coexistent carcinoma
- Progression to carcinoma
- RISK FACTORS
- CLINICAL PRESENTATION
- DIAGNOSTIC EVALUATION
- DIFFERENTIAL DIAGNOSIS
- FURTHER EVALUATION AFTER ENDOMETRIAL SAMPLING
- Negative endometrial sampling
- - Insufficient cells on endometrial biopsy
- - Persistent or recurrent bleeding
- Positive endometrial sampling
- - Follow-up of biopsy or curettage results
- - Postmenopausal women with no known estrogen source
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS