Treatment of Postmenopausal Uterine Bleeding with Endometrial Hyperplasia Without Atypia
Clinical Scenario
This protocol applies to postmenopausal vaginal bleeding where investigation reveals endometrial hyperplasia without atypia — a histological finding that requires structured management to achieve regression and monitor for progression.
Endometrial hyperplasia without atypia (EH) commonly presents with postmenopausal bleeding. The risk of progression to endometrial cancer is low — under 5% over 20 years — but active management is indicated when symptomatic or when conservative measures are insufficient.
Treatment Approach
The regimen for this scenario involves progestogen-based active management sustained over a minimum defined period, with the preferred delivery route and alternatives determined by patient suitability — the complete regimen is available in the full protocol.
Treatment Goal
Regression of endometrial hyperplasia, confirmed by endometrial biopsy at scheduled follow-up intervals.
References
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.
- If women are symptomatic or conservative management fails, clinicians should recommend active management for a minimum of 6 months with progestogens.
- Some 74—81% of women have spontaneous regression without treatment and 89—96% will achieve regression with treatment.
- Patients should be followed up with an endometrial biopsy 6 monthly and require at least 2 consecutive normal results before discharge.
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