Atypical Endometrial Hyperplasia in Women Wishing to Preserve Fertility or for Whom Surgery Is Not an Option

Clinical Scenario

This protocol addresses atypical endometrial hyperplasia in women who wish to retain their fertility or who are not suitable candidates for surgical management.

Key Consideration

Women in this situation should be informed that atypical endometrial hyperplasia carries a meaningful risk of underlying malignancy and of progression to endometrial cancer — a risk that directly shapes management intensity and follow-up requirements.

Treatment Approach

Management in this setting may involve progestogen-based hormonal therapy; the full structured protocol specifies the pathway, eligibility criteria, monitoring schedule, and the circumstances under which surgical management should subsequently be reconsidered.

Instant Access to Structured Evidence-Based Regimens

References

Women wishing to retain their fertility should be counselled about the risks of underlying malignancy and subsequent progression to endometrial cancer.

Once fertility is no longer required, hysterectomy should be offered in view of the high risk of disease relapse.

If this is not possible or declined, a further cycle of progestogen treatment can be attempted.

In a study of 33 women with relapsed atypical hyperplasia, 85% (28/33) regressed following retreatment with oral medroxyprogesterone given for 6 months.

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