Atypical endometrial hyperplasia carries a real risk of underlying malignancy and subsequent progression to endometrial cancer. When a woman wishes to retain her fertility — or when surgery is not suitable — conservative hormonal management becomes the treatment pathway.
Atypical endometrial hyperplasia (ICD-11 GA16.0 / ICD-10 N85.0; N85.1) in a woman wishing to preserve fertility, or in whom surgery is not an appropriate option. These women must be counselled about the risks of underlying malignancy and the potential for progression to endometrial cancer before non-surgical management is undertaken.
Management centres on a progestogen-based hormonal approach, with intrauterine delivery preferred as the primary route and an oral alternative available in selected cases. The complete regimen — including the specific agents, their sequencing, and the full clinical decision algorithm — is contained in the structured protocol.
The aim is histological regression of atypical hyperplasia, confirmed by two consecutive negative endometrial biopsies. Review is carried out every three months until that endpoint is reached.
Women wishing to retain their fertility should be counselled about the risks of underlying malignancy and subsequent progression to endometrial cancer.
First-line treatment with the LNG-IUS should be recommended, with oral progestogens as a second-best alternative (see section 7.2).
Review intervals should be every 3 months until two consecutive negative biopsies are obtained.
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