Classification and diagnosis of endometrial hyperplasia
- Robert L Giuntoli, II, MD
Robert L Giuntoli, II, MD
- Associate Professor, Department of Gynecology and Obstetrics
- Division of Gynecologic Oncology
- Perelman School of Medicine at the University of Pennsylvania
- Howard A Zacur, MD, PhD
Howard A Zacur, MD, PhD
- Professor of Gynecology and Obstetrics
- Johns Hopkins University 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
Endometrial hyperplasia is 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 virtually always results from chronic estrogen stimulation unopposed by the counterbalancing effects of progesterone .
The classification, clinical manifestations, 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 cancer (See "Endometrial carcinoma: Epidemiology and risk factors".)
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- HISTOLOGY AND CLASSIFICATION
- World Health Organization classification
- - Categories
- Normal endometrium
- Simple versus complex hyperplasia
- Nuclear atypia
- - Risk of carcinoma
- Endometrial intraepithelial neoplasia system
- Comparing the WHO and EIN systems
- 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
- SUMMARY AND RECOMMENDATIONS