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Endometrial Hyperplasia, Management of (Green-top Guideline No. 67)

Published: 26/02/2016

This is the first edition of this guideline.

This is a joint guideline between the RCOG and the British Society for Gynaecological Endoscopy (BSGE).

Update February 2017: Following a review of all guidelines in December 2016, some minor editorial changes have been made to this guideline since the original publication. The version available here is the most up to date. The date on the guideline has not been changed since no amendments were made to the content.

Endometrial hyperplasia is defined as irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium.

Endometrial cancer is the most common gynaecological malignancy in the Western world and endometrial hyperplasia is its precursor. In the UK, 8617 new cases of endometrial cancer were registered in 2012. The incidence of endometrial hyperplasia is estimated to be at least three times higher than endometrial cancer and if left untreated it can progress to cancer.

The most common presentation of endometrial hyperplasia is abnormal uterine bleeding. This includes heavy menstrual bleeding, intermenstrual bleeding, irregular bleeding, unscheduled bleeding on hormone replacement therapy (HRT) and postmenopausal bleeding.

Declaration of interests (guideline developers)

Mr ID Gallos MRCOG, Birmingham: None declared.

Mr M Allazzam MRCOG, Dublin: None declared.

Professor TJ Clark MRCOG, Birmingham: Funding for travel and accommodation at scientific meetings and honoraria for clinician training and educational courses from Hologic, Ethicon, Smith & Nephew and Bayer. Research monies received from Hologic and Smith & Nephew. Advisory board attendee for Bayer and Hologic. 

Mr R Faraj MRCOG, Rotherham: None declared.

Mr A Rosenthal MRCOG, London: Mr Rosenthal has previously received honoraria and had conference attendances paid for by Fujirebio Diagnostics, Inc. and Roche. He has sat on Roche and AstraZeneca advisory panels (renumerated). He is currently a paid consultant of Myriad Genetics and Abcodia. He holds an honorary contract at the Department of Women's Cancer at University College London, which receives research funding from some commercial sponsors, e.g. Amgen, but none of this money comes to him. Mr Rosenthal sat on the UK Cancer Genetics Group Steering committee from 2012–15 and is a medical advisor to The Eve Appeal, Ovacome and Ovarian Cancer Action.

Mr PP Smith MB ChB, Birmingham: None declared.

Professor JK Gupta FRCOG, Birmingham: Professor Gupta’s department and R&D have received grants from the National Institute for Health Research (NIHR), Ethicon, Bayer and Medicem. He has received consulting fees or honoraria for Thermachoice and Essure devices from Ethicon and Bayer respectively, and commercial support for attending meetings or conferences from Thermachoice, Essure and Dilapan devices from Ethicon, Bayer and Medicem respectively. Professor Gupta receives payment as Editor-in-Chief of the European Journal of Obstetrics & Gynecology and Reproductive Biology (EJOG). He has received fees for expert testimony in clinical negligence and criminal cases and has received payment for lectures from Thermachoice, Essure and Mirena devices from Ethicon and Bayer. Professor Gupta has received royalties as editor for various undergraduate books, e.g. Core Clinical Cases in Obstetrics and Gynaecology published by CRC Press, Taylor & Francis Group. He is a Medical Advisor for Femcare-Nikomed (manufacturer of the Filshie clip sterilisation system).