Endometrial hyperplasia: a clinician's review

Endometrial hyperplasia is defined as an increase in the glandular to stromal tissue ratio to more than 1. Further classification derives from architectural and cytological features. It typically results from excess or unopposed oestrogenic stimulation. Although it is often asymptomatic, endometrial hyperplasia can present with abnormal uterine bleeding. Transvaginal ultrasonography (to measure endometrial thickness), endometrial sampling and hysteroscopy are common investigations used to diagnose this condition. Management depends on cellular atypia, the presence of which confers a high risk of concurrent or subsequent endometrial cancer. Such cases should usually therefore be treated with hysterectomy. The absence of atypia allows a conservative approach, usually with progestogen therapy combined with ongoing surveillance.