Regular evaluation of uterine health can reduce cancer risk

Analysis of UK compliance with endometrial hyperplasia guidelines.


Since 2016, treatment for endometrial hyperplasia has gotten better following national guidelines. But many women still don’t get enough follow-up care. Experts say it’s crucial to keep supporting and managing those with this condition.

People with endometrial hyperplasia must have continuous assistance and treatment. This condition is categorized into two types: atypical and non-atypical. Atypical hyperplasia carries a higher chance of turning into cancer. At the same time, non-atypical refers to a thickened womb lining with a lower risk.

In the UK, medical guidelines suggest surgery (hysterectomy) to remove the womb for women with atypical hyperplasia. For non-atypical cases, hormone treatments applied directly to the womb are recommended. Regular follow-up appointments are vital to catch any early signs of cancer.

Researchers from the University of Edinburgh compared how patients were treated before and after the national guidelines were introduced.

Researchers studied records of over 3,000 UK patients with endometrial hyperplasia from 2012 to 2020. Half had the non-atypical type, and half had atypical. After the guidelines, more women with non-atypical hyperplasia were successfully treated with hormones, from 38% to 52%.

While the initial treatment for atypical hyperplasia (an abnormal cell growth in the uterus) remained relatively stable from 2012 to 2019, with around 67% of women undergoing hysterectomy, a significant shift occurred during the pandemic in 2020. Only 52% of women opted for hysterectomy, indicating a deviation from established treatment guidelines.

It’s essential to have regular follow-up checkups after a diagnosis of atypical hyperplasia, mainly if a hysterectomy has not been performed. Only 20% of women with atypical hyperplasia who chose not to have a hysterectomy followed the recommended follow-up guidelines.

Among women who did undergo a hysterectomy, 37% were found to have cancer during the examination of the womb after surgery. This suggests the importance of hysterectomy in preventing cancer development in cases of atypical hyperplasia.

Experts stress the importance of better monitoring for women with atypia who don’t have a hysterectomy, given their high cancer risk. While treatment for endometrial hyperplasia has improved, there’s a need for better care, especially for women not having a hysterectomy, as they’re at risk of future cancer development.

Efforts to monitor and manage endometrial hyperplasia according to national guidelines can play an essential role in reducing cancer risk. Enhancing follow-up care and ensuring adherence to recommended treatment approaches are essential steps toward improving outcomes and enhancing the quality of care for individuals at risk of endometrial cancer.

Journal reference:

  1. Ian Henderson, Naomi Black, et al., Diagnosis and management of endometrial hyperplasia: A UK national audit of adherence to national guidance 2012–2020.PLOS Medicine. DOI: 10.1371/journal.pmed.1004346.
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