• Overgrowth of the endometrial glands due to estrogen stimulation and insufficient progestin
  • Gland to stroma ratio of > 50%
  • Can progress to endometrial cancer

Classified as:

• Hyperplasia without atypia (low risk of transformation)
• Hyperplasia with atypia (pre-cancerous)

Pathophys:

more endometrium → more bleeding with menstrual phase

Aetiology/RFs

• Excess estrogen (note estrogen has a cumulative effect throughout life)
  • Early menarche
  • Late menopause
  • Nulliparity
  • Obesity
  • Chronic anovulation (PCOS)
  • HRT without progestin
  • Estrogen producing ovarian tumours (granulosa cell tumours)
• Iatrogenic
  • Tamoxifen in postmenopausal women
  • HRT

Lynch syndrome

Clinical Features

• Pre menopause:
  • Abnormal vaginal bleeding
  • Anovulation
• Menopause:
  • Intermenstrual bleeding
  • Heavy periods lasting over 7 days
  • Cycles < 21 days
• Post menopause: Uterine Bleeding
• Bimanual examination:
  • Pelvic mass
  • Fixed enlarged uterus