Benign and premalignant lesions of the endometrium

Last updated: October 10, 2022

Summarytoggle arrow icon

The most common benign tumors of the endometrium are endometrial hyperplasia and endometrial polyps. Endometrial hyperplasia is caused by an increased estrogen stimulation and manifests with irregular, often heavy vaginal bleeding. There are 2 types of endometrial hyperplasia: endometrial hyperplasia with atypia and endometrial hyperplasia without atypia. Diagnosis involves ultrasound (to assess the thickness of the endometrium) and biopsy (to assess atypia). Treatment of endometrial hyperplasia without atypia consists mainly of progestin therapy, while endometrial hyperplasia with atypia requires hysterectomy. Endometrial polyps are localized overgrowths of endometrial tissue that mainly affect postmenopausal women. Though usually asymptomatic, endometrial polyps can cause irregular vaginal bleeding and, in premenopausal women, infertility. Diagnosis is made with ultrasound or hysteroscopically. Treatment involves watchful waiting in asymptomatic patients and surgical removal in symptomatic patients.

Endometrial hyperplasiatoggle arrow icon




Classification of endometrial hyperplasia based on histology (WHO 2014) [1]
Endometrial hyperplasia without atypia (benign endometrial hyperplasia) Endometrial hyperplasia with atypia (endometrial intraepithelial neoplasm)
  • Both stromal and glandular cells
  • Appearance varies
Risk of carcinoma
  • Low (1–3%)

Clinical features



The choice of treatment primarily depends on the presence of atypia and if menopause has occurred yet. [5]

Treatment of endometrial hyperplasia based on histology
Premenopausal women Postmenopausal women
Endometrial hyperplasia without atypia
Endometrial hyperplasia with atypia

Endometrial polypstoggle arrow icon

Referencestoggle arrow icon

  1. G. Emons, M. W. Beckmann, D. Schmidt, P. Mallmann, and for the Uterus commission of the Gynecological Oncology Working Group (AGO). New WHO Classification of Endometrial Hyperplasias. Obstetrics and Gynecology. 2015.
  2. Emad Rakha, Siew Chee Wong, Irshad Soomro, Zia Chaudry, Aarti Sharma, Suha Deen, Stephen Chan, Jafaru Abu, David Nunns, Karin Williamson, Angus McGregor, Robert Hammond, Laurence Brown. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. The American Journal of Surgical Pathology. 2012.
  3. Wendy Wolfman. Asymptomatic Endometrial Thickening. Journal of Obstetrics and Gynaecology Canada. 2010.
  4. Lee-may Chen, Jonathan S Berek, Barbara Goff, S Dizon. Endometrial carcinoma: Clinical features, diagnosis, prognosis, and screening. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: November 1, 2019. Accessed: July 20, 2020.
  5. Reed SD, Urban RR. Management of Endometrial Hyperplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: November 29, 2017. Accessed: March 1, 2018.
  6. Elizabeth A Stewart. Endometrial polyps. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: May 25, 2020. Accessed: July 20, 2020.
  7. Al Chami A, Saridogan E. Endometrial Polyps and Subfertility. The Journal of Obstetrics and Gynecology of India. 2016; 67 (1): p.9-14.doi: 10.1007/s13224-016-0929-4 . | Open in Read by QxMD
  8. Stephanie L Wethington, Thomas J Herzog, William M Burke, Xuming Sun, Jodi P Lerner, Sharyn N Lewin, Jason D Wright. Risk and predictors of malignancy in women with endometrial polyps. Annals of Surgical Oncology. 2011.
  9. Simple Typical Hyperplasia of Endometrium. Updated: January 30, 2009. Accessed: March 1, 2018.
  10. Reed SD, Urban RR. Classification and Diagnosis of Endometrial Hyperplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: April 27, 2017. Accessed: March 1, 2018.
  11. Wang Chiang J. Premalignant Lesions of the Endometrium. In: Huh WK, Premalignant Lesions of the Endometrium. New York, NY: WebMD. Updated: May 13, 2016. Accessed: March 1, 2018.
  12. Endometrial Hyperplasia. Updated: January 1, 2018. Accessed: March 1, 2018.
  13. Sobczuk K. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Menopause review. 2017.

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