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Welcome to Women's Health Matters, an online resource to support healthcare professionals involved in the area of Women's Health.

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Welcome to Women's Health Matters, an online resource to support healthcare professionals involved in the area of Women's Health.

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:

  • Menorrhagia1

  • Intermenstrual bleeding1

  • Postmenopausal bleeding1

  • Unscheduled bleeding on hormone replacement therapy1,2

However, endometrial hyperplasia can also be asymptomatic and can spontaneously regress without being detected.1

  1. Palmer JE, et al. Obstet Gynecol 2008;10211-216
  2. 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
histological-classification-slider 1
Endometrial hyperplasia
histological-classification-slider 1

Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.

Histological classification: Proliferative endometrium
histological-classification-slider-2
  • Glands are tubular and regularly spaced in abundant stroma
  • Glands are lined with pseudostratified nuclei
  • Mitotic figures are easily found in glands and stroma

Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.

Histological classification: Simple hyperplasia
histological-classification-slider-3
  • Irregular glands varying in size and shape, set in abundant stroma
  • Cystic glands present
  • Glandular cells show nuclear pseudostratification
  • No nuclear atypia

Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.

Histological classification: Complex hyperplasia
histological-classification-slider4
  • Glands are closely packed
  • Stroma is relatively sparse
  • Nuclei are uniform, oval and psuedostratified
  • Nucleoli are indistinct

Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.

Histological classification: Complex atypical hyperplasia
histological-classification-slider5
  • Glands are irregular and tightly packed
  • Lack of stroma
  • Nuclei are large and vesicular
  • Prominent nucleoli

Adapted from Palmer JE, et al. Obstet Gynecol 2008;10:211-216.

Aetiology and risk factors 

Oestrogen stimulates endometrial proliferation.1 A relative excess of oestrogen (exogenous or endogenous) compared with progesterone is considered to be one of the principle causes in endometrial hyperplasias.1

Key risk factors in post-menopausal women include:

• Unopposed oestrogen1,2

• Obesity, particularly in nulliparous women1,2

Other risk factors include:

• Diabetes1,3

• Hypertension1

• Polycystic ovary syndrome2,3

  1. Palmer JE, et al. Obstet Gynecol 2008;10211-216.
  2. Fu YS, et al. West J Med 1990;15350-61.
  3. Sanderson PA, et al. Hum Reprod Update 2017;23:232-254.

Incidence and diagnosis 

Transvaginal ultrasound

Transvaginal ultrasound2

There are approximately

25,800

new cases of endometrial hyperplasia in the UK each year.1

Endometrial biopsy2

Transvaginal ultrasound

Hysteroscopy2

  1. 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.
  2. Chandra V, et al. J Gynecol Oncol 2016:27:eB.
mirena

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

no-hyperplasia

No hyperplasia was detected in any of the trials, regardless of dose, method of administration of oestrogen component or duration of therapy.2,3,4

mirena-significantly

Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001).2

no-hyperplasia

Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001, N=200).2

continuing-merina

Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5

no-hyperplasia

Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5

proportion-parents

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

no-hyperplasia

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

no-hyperplasia

No hyperplasia was detected in any of the trials, regardless of dose, method of administration of oestrogen component or duration of therapy.2,3,4

no-hyperplasia

Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001, N=200).2

no-hyperplasia

Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5

no-hyperplasia

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

no-hyperplasia

No hyperplasia was detected in any of the trials, regardless of dose, method of administration of oestrogen component or duration of therapy.2,3,4

mirena-significantly

Mirena significantly decreased menstrual bleeding compared with conventional oral hormone replacement therapy (P=0.001).2

continuing-merina

Continuing Mirena use during the transition from contraception to ERT has no adverse effects on the vaginal bleeding profile.5

proportion-parents

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

  1. FSRH. Intrauterine Contraception [online] October 2015. Available from: https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/. Last accessed March 2019.
  2. Boon J, et al. Maturitas 2003;46:69-77. 
  3. Chandra V, et al. J Gynecol Oncol. 201627e8.
  4. Raudaskoski T, et al. BJOG 2002;109 136-144.
  5. Depypere H, et al. Eur J Obst Gyn Repr Biol 2010;153:176-18O. 

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This website is intended for UK healthcare professionals only. Women’s Health Matters is organised and funded by Bayer and contains promotional content.

Prescribing Information (PI) can be found via the links below:
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Kyleena® (19.5 mg intrauterine delivery system Levonorgestrel)
Jaydess® (13.5 mg intrauterine delivery system Levonorgestrel)
Qlaira® (estradiol valerate/dienogest)
Microgynon® (levonorgestrel/ethinylestradiol)

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