Treatment of Endometrial Hyperplasia Without Atypia
Clinical Scenario
This protocol applies to women with endometrial hyperplasia without atypia —
the group defined by the absence of cytological atypia. Under the 2014 revised WHO classification,
endometrial hyperplasia is divided into two categories solely on the presence or absence of atypia;
architectural complexity is no longer used for classification.
Treatment Approach (overview)
For women requiring operative intervention, the protocol specifies a preferred minimally invasive
surgical approach — with distinct recommendations depending on menopausal status regarding
additional surgical considerations. The full regimen, eligibility criteria, and decision pathway
are detailed in the complete protocol.
References
- 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.
- Postmenopausal women requiring surgical management for endometrial hyperplasia without atypia should be offered a bilateral salpingo-oophorectomy together with the total hysterectomy.
- For premenopausal women, the decision to remove the ovaries should be individualised; however, bilateral salpingectomy should be considered as this may reduce the risk of a future ovarian malignancy.
- A laparoscopic approach to total hysterectomy is preferable to an abdominal approach as it is associated with a shorter hospital stay, less postoperative pain and quicker recovery.
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