Management of Patients Diagnosed with Endometrial Hyperplasia: Comparison of Guidelines

Endometrial hyperplasia (EH) is an estrogen-driven proliferative disorder with a measurable risk of progression to endometrial carcinoma. Although many guidelines have been issued over the years, clinical practice remains heterogeneous. In this paper, we aim to compare and summarize key recommendations and disagreements among major international guidelines for managing endometrial hyperplasia, focusing especially on conservative and fertility-sparing strategies. All guidelines align with some key principles: they all adopt the 2020 WHO classification, strongly prefer hysteroscopy-directed sampling, and recommend progestin therapy as the first-line treatment for non-atypical EH, favoring the levonorgestrel-releasing intrauterine system (LNG-IUS) over oral regimens. They designate total hysterectomy as definitive management for atypical hyperplasia/intraepithelial endometrial neoplasia (AEH/EIN) due to the substantial prevalence of concurrent carcinoma. Nevertheless, several key discrepancies appear, mainly concerning how long to continue progestin therapy and when to escalate treatment; and how intensively and for how long to conduct post-treatment surveillance. Variations in diagnostic and therapeutic protocols reflect evidence gaps and differences across healthcare settings. Future research should focus on harmonized outcomes, comparative studies of conservative strategies, and the integration of new pathology tools for personalized management.

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Publication Details

Journal
Cancers
Published
2026-06-24
DOI
https://doi.org/10.3390/cancers18132048
Primary Topic
Gynecological conditions and treatments
Type
article
Field-Weighted Citation Impact
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article

Management of Patients Diagnosed with Endometrial Hyperplasia: Comparison of Guidelines

Anna Biasioli, Tommaso Simoncini, Lorenza Driul, Stefano Restaino et al.
Cancers
Gynecological conditions and treatments
article

Management of Patients Diagnosed with Endometrial Hyperplasia: Comparison of Guidelines

Anna Biasioli, Tommaso Simoncini, Lorenza Driul, Stefano Restaino, Stefano Uccella, Chiara Paglietti, Giorgio Bogani, Andrea Ciavattini, Maria ­Orsaria, Paolo Scollo, Giuseppe Scibilia, Renato Seracchioli, Vito Andrea Capozzi, Giuseppe Vizzielli, Carlo Ronsini, Martina Arcieri, Antonio Raffone, Monica Della Martina, Ursula Catena, Violante Di Donato, Giampiero Capobianco, Ramon Rovira Negre, Pierandrea De Iaco, Errico Zupi, Federico Paparcura, Diego Raimondo, Muhammed Elhadi, Anna Miryam Perrone, on behalf of the Collaborative Group, Francesco Fanfani, Mariuzzi Laura
article en

Abstract

Endometrial hyperplasia (EH) is an estrogen-driven proliferative disorder with a measurable risk of progression to endometrial carcinoma. Although many guidelines have been issued over the years, clinical practice remains heterogeneous. In this paper, we aim to compare and summarize key recommendations and disagreements among major international guidelines for managing endometrial hyperplasia, focusing especially on conservative and fertility-sparing strategies. All guidelines align with some key principles: they all adopt the 2020 WHO classification, strongly prefer hysteroscopy-directed sampling, and recommend progestin therapy as the first-line treatment for non-atypical EH, favoring the levonorgestrel-releasing intrauterine system (LNG-IUS) over oral regimens. They designate total hysterectomy as definitive management for atypical hyperplasia/intraepithelial endometrial neoplasia (AEH/EIN) due to the substantial prevalence of concurrent carcinoma. Nevertheless, several key discrepancies appear, mainly concerning how long to continue progestin therapy and when to escalate treatment; and how intensively and for how long to conduct post-treatment surveillance. Variations in diagnostic and therapeutic protocols reflect evidence gaps and differences across healthcare settings. Future research should focus on harmonized outcomes, comparative studies of conservative strategies, and the integration of new pathology tools for personalized management.

CancersVol. 18(13)
University of Siena (IT), University of Pisa (IT), University of Verona (IT), Marche Polytechnic University (IT), University of Parma (IT), University of Udine (IT), University of Sassari (IT), University of Campania "Luigi Vanvitelli" (IT), Policlinico Umberto I (IT), Hospital de Sant Pau (ES), Agostino Gemelli University Polyclinic (IT), Ospedale San Paolo (IT), Azienda USL di Bologna (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Ospedale Cannizzaro (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Korea University (JP), Sapienza University of Rome (IT)
Openalex Percentile: Top 6%
Gynecological conditions and treatments
DOIOpen Access PDFOpenAlex
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