Endometrial hyperplasia without atypia is a specific histological subgroup defined by the absence of cytological atypia. Management in this setting is guided by whether reversible contributing factors are present and by the clinical goal of restoring normal endometrial histology.
Under the current WHO classification, endometrial hyperplasia is divided solely on the basis of cytological atypia — into hyperplasia without atypia and atypical hyperplasia. Architectural complexity is no longer part of the classification. This protocol addresses the non-atypical group.
Initial assessment focuses on identifying reversible contributing factors. Where such factors are present, addressing them forms a key part of the management strategy. In selected cases, a conservative approach with structured follow-up monitoring may be appropriate — the complete structured regimen specifies the full pathway, criteria, and follow-up schedule.
Complete protocol details available below ↓Histological regression of endometrial hyperplasia to normal endometrium.
The 2014 revised WHO classification simply separates endometrial hyperplasia into two groups based upon the presence or absence of cytological atypia, i.e. (i) hyperplasia without atypia and (ii) atypical hyperplasia; the complexity of architecture is no longer part of the classification.
Reversible risk factors such as obesity and the use of hormone replacement therapy (HRT) should be identified and addressed if possible.
Observation alone with follow-up endometrial biopsies to ensure disease regression can be considered, especially when identifiable risk factors can be reversed.
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