Current approaches to diagnosing and preventing endometrial hyperplasia: A review

Abstract

The problem of endometrial hyperplasia (EH) has been relevant for many years, primarily due to the association of abnormal endometrial proliferation with uterus malignancies. Endometrial cancer (EC) risk factors are known, with benign EH being one of the most important, while atypical EH is more likely to be a prognostic factor for the development of adenocarcinoma. The main clinical symptom of EH is abnormal uterine bleeding, but this symptom is not specific and occurs in many gynecological and non-gynecological conditions. In order to avoid unnecessary invasive interventions, clinical and laboratory criteria are being developed for selecting patients with a high risk of EH/endometrial neoplasia and for further diagnostic manipulations. The article discusses modern approaches to instrumental diagnosis and clinical assessment of risk factors in women of reproductive age and the postmenopausal period with and without symptoms of uterine bleeding. Treatment of EH, especially in the presence of cellular atypia, is challenging and not consistently effective, so prevention of EH and EC is the best strategic choice. For this purpose, combined oral contraceptives can be used due to their well-known carcinoprotective potential. The options for the choice of combined oral contraceptives most suitable for contraception in women at risk of EH and EC are given.

Keywords

• endometrial hyperplasia
• endometrial cancer
• abnormal uterine bleeding
• postmenopausal bleeding
• risk factors
• combined oral contraceptives
• progestins