Endometrial hyperplasia
What is endometrial hyperplasia?
Endometrial hyperplasia is broadly defined as an excessive cellular proliferation leading to an increased volume of endometrial tissue. It is characterised by an increase in the endometrial gland-to-stroma ratio greater than 1:1.1
Endometrial hyperplasia is further classified as simple or complex, with or without atypia. This classification system is based on the complexity and crowding of the glandular architecture.1
The most common presenting symptom of endometrial hyperplasia is abnormal uterine bleeding, including:
However, endometrial hyperplasia can also be asymptomatic and can spontaneously regress without being detected.1
- Palmer JE, et al. Obstet Gynecol 2008;10211-216
- RCOG/BSGE Management of Endometrial Hyperplasia [online] February 2016. Available from https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf. Last accessed: October 2019.
Histological classification of endometrial hyperplasia
Normal endometrium
Endometrial hyperplasia
Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.
Histological classification: Proliferative endometrium
Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.
Histological classification: Simple hyperplasia
Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.
Histological classification: Complex hyperplasia
Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.
Histological classification: Complex atypical hyperplasia
Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.
Key risk factors in post-menopausal women include:
Incidence and diagnosis
- RCOG/BSGE Management of Endometrial Hyperplasie [online] February 2016. Available from https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf. Last accessed March 2019.
- Chandra V, et al. J Gynecol Oncol 2016:27:eB.
The only levonorgestrel intrauterine system licensed for four years for endometrial protection during oestrogen replacement therapy (ERT)1
Efficacy and safety
The efficacy of Mirena in preventing oestrogen-induced hyperplasia in peri-menopausal and postmenopausal women has been assessed in various studies.2,3
Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001).2
Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001, N=200).2
Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5
Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5
The proportion of patients who had difficulties in coping with any items from the Women's Health Questionnaire decreased during both the contraception and ERT phases with Mirena.5
The proportion of patients who had difficulties in coping with any items from the Women's Health Questionnaire decreased during both the contraception and ERT phases with Mirena.5
Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001, N=200).2
Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5
The proportion of patients who had difficulties in coping with any items from the Women's Health Questionnaire decreased during both the contraception and ERT phases with Mirena.5
Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001).2
Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5
The proportion of patients who had difficulties in coping with any items from the Women's Health Questionnaire decreased during both the contraception and ERT phases with Mirena.5
- FSRH. Intrauterine Contraception [online] October 2015. Available from: https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/. Last accessed March 2019.
- Boon J, et al. Maturitas 2003;46:69-77.
- Chandra V, et al. J Gynecol Oncol. 201627e8.
- Raudaskoski T, et al. BJOG 2002;109 136-144.
- Depypere H, et al. Eur J Obst Gyn Repr Biol 2010;153:176-18O.
