Postmenopausal vaginal bleeding in the presence of endometrial hyperplasia without atypia requires structured assessment and targeted management. The clinical approach focuses on the underlying drivers of unopposed oestrogen exposure rather than empirical treatment alone.
Postmenopausal vaginal bleeding occurring alongside endometrial hyperplasia without atypia. This form of endometrial hyperplasia commonly develops in the context of unopposed oestrogen exposure and carries a low long-term risk of progression to endometrial cancer.
First-line management is directed at identifying and addressing modifiable risk factors that contribute to unopposed oestrogen exposure. For selected asymptomatic women, observation alone may be an appropriate option.
The complete structured protocol — including the full decision pathway, specific interventions, and follow-up criteria — is available via the link below.
DOI: 10.1016/j.ogrm.2025.09.009
endometrial hyperplasia (EH) commonly presents with postmenopausal bleeding and develops in association with unopposed oestrogen exposure e.g. obesity, granulosa cell tumours, HRT and SERM use.
EH without atypia has a low risk of progressing to endometrial cancer at less than 5% over 20 years.
Initial management includes modifying reversible risk factors such as referral to weight management services, optimizing diabetic control, discussion of ongoing requirement for SERM with oncology team, modifying or stopping HRT, checking for over the counter high potency oestrogens.
Asymptomatic women may be offered observation alone.
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