RCOG | Endometrial hyperplasia

28th April 2016 by Louise Hudman

RCOG | Endometrial hyperplasia

This is a new guideline from RCOG on diagnosing and managing endometrial hyperplasia. This is a very common condition, so highly relevant for us and I had no idea on some of the management options. I am therefore doing a general summary.


  • Endometrial Hyperplasia without atypia – fewer than 5% will progress to cancer over 20 yrs and most regress spontaneously.
  • Endometrial Hyperplasia with atypia – there is a much high risk of cancer (8% at 4 yrs, 12% at 9 yrs and 27% at 19 yrs and concomitant cancer is found in 43% of women at hysterectomy).

Risk Factors

Oestrogen exposure, whether exogenous (tamoxifen / oestrogen only HRT) or endogenous (obesity, PCOS or perimenopause with anovulation or estrogen secreting tumours).

[Tweet “Obesity and PCOS are both risk factors for endometrial hyperplasia”]By Nephron (Own work) [CC BY-SA 3.0 ) or GFDL , via Wikimedia Commons


  • Heavy menstrual bleeding (beware the over 45s)
  • IMB
  • Irregular bleeding
  • Unscheduled bleeding on HRT
  • Postmenopausal bleeding


  • Endometrial biopsy
  • Hysteroscopic Biopsy (if above undiagnostic or if hyperplasia is found on a polyp)
  • USS transvaginal

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