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RCOG release: ‘Abnormal bleeding’ strong indication of pre-womb cancer condition, warns new guideline

News 26 February 2016

Women should be aware of the signs and symptoms of endometrial hyperplasia, a condition which may develop into cancer, states new national guidance published today by the RCOG and British Society for Gynaecological Endoscopy (BSGE).

Endometrial hyperplasia is a thickening of the lining of the womb which is caused by overgrowth of the cells that line the womb. In some women it can develop into womb cancer, the most common gynaecological cancer with over 8,500 diagnoses each year. The incidence of endometrial hyperplasia is estimated to be at least three times higher. Most women diagnosed with womb cancer have had their menopause with almost three quarters of cases in women aged 40 to 74.

The most common symptom of endometrial hyperplasia is abnormal vaginal bleeding. This can include heavy menstrual bleeding, bleeding in between periods, irregular bleeding whilst on hormone replacement therapy (HRT) and bleeding after the menopause. Risk factors include age, an increased BMI, polycystic ovarian syndrome, the use of tamoxifen as a treatment for breast cancer and the use of HRT for menopausal symptoms.

Professor Justin Clark, Consultant Gynaecologist and co-author of the guideline said:

“We estimate that at least 25,000 women in the UK are suffering from endometrial hyperplasia but many women aren’t aware of the condition. We hope the publication of this guideline will help to raise awareness of the signs and symptoms which can be a precursor to womb cancer and our key message is that any woman experiencing abnormal bleeding or discharge, particularly after the menopause, should report this to their GP. It may be nothing to worry about but it’s best to get it checked out.

“Endometrial hyperplasia is treatable and with early diagnosis, we can minimise the risks of developing womb cancer in the future.”

The guideline highlights that there are two types of endometrial hyperplasia; hyperplasia without atypia and atypical hyperplasia. The risk of endometrial hyperplasia without atypia progressing to cancer is less than 5% over 20 years and for the majority of women, the lining of the womb will return to normal without any treatment, especially if risk factors can be identified and reversed. For some women, progestogen treatment (levonorgestrel-releasing intrauterine system [LNG-IUS]) for a minimum of six months should be offered as a first line treatment; it is the most effective way of thinning the lining of the womb, has minimal side effects and treats abnormal bleeding.

Atypical hyperplasia has an 8% risk of cancer within 4 years which increases to 27.5% after 19 years and should therefore be treated with a total hysterectomy. This decision should be individualised, in particular, for women who are premenopausal and wish to preserve their fertility.

Professor Clare McKenzie, Consultant Gynaecological Oncologist and Vice President of Education for the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“This is the first ever national guideline on the diagnosis and treatment of women with endometrial hyperplasia and we very much hope it will lead to improvements in the care that women with the condition receive. We strongly encourage health professionals to use the guideline as an opportunity to remind the women they see about the signs and symptoms so that more cases of endometrial hyperplasia can be identified and treated before they develop into womb cancer.”


For media enquiries, please contact the RCOG press office on 020 7772 6444 or email


For more information on endometrial hyperplasia, visit the Cancer Research UK website.

The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.