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Image of a woman in a blue vest sat on a sofa while wrapping her arms around her stomach in pain.

Research conducted by the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UK ARCOG) has shown that improvements to care are needed for women diagnosed with endometrial hyperplasia to reduce the risk of developing endometrial cancer. The study is published in PLOS Medicine.

Endometrial hyperplasia is a condition where the lining of the womb is thicker than normal and, in some cases, can lead to endometrial cancer (cancer of the womb lining). Endometrial hyperplasia is grouped into two types; non-atypical (without atypia), where the womb lining is thicker than normal but less likely to become cancerous, and atypical (with atypia), where there is both the risk of an occult (undetected) womb cancer and a higher risk of becoming cancerous if untreated.

In the UK, national guidance for the care of women diagnosed with both types of endometrial hyperplasia was introduced in 2016. The guidance recommends a trial of intra-uterine (given directly into the womb) hormonal treatment for women without atypia but a hysterectomy for those with atypia.

This study aimed to find out whether or not the guidance was being followed by comparing the recommendations with the actual care received by 3,307 women who were diagnosed with endometrial hyperplasia between 2012 and 2020. 1,655 of the 3,307 women had non-atypical endometrial hyperplasia and 1,652 had atypical endometrial hyperplasia.

Key findings:

  • The initial treatment of women without atypia changed following the introduction of national guidance. In 2012-15, 9% without atypia received no initial treatment, 31% received an initial intra-uterine hormone and 15% had an initial hysterectomy. In 2016-19, only 3% received no initial treatment, 48% received an initial intra-uterine hormone, and 12% had an initial hysterectomy;
  • At two years from the initial diagnosis, the proportion of women without atypia who had successful treatment without requiring a hysterectomy increased from 38% to 52%;
  • The initial treatment of women with atypia did not change, with 68% having an initial hysterectomy in 2012-15 and 67% in 2016-19;
  • However, in 2020, coinciding with the COVID-19 pandemic, only 52% of women with atypia had an initial hysterectomy;
  • For women who did not have a hysterectomy, only 27% without atypia and only 19% with atypia received the recommended schedule of follow up biopsies after the introduction of the guidance;
  • Between 2016-19, 37% of the women who were diagnosed with atypical endometrial hyperplasia on a biopsy and who had an initial hysterectomy were found to actually have endometrial cancer on histological analysis of their womb after surgery, reinforcing the need for high quality counselling when deciding on treatment.

Dr Ian Henderson, Clinical Research Fellow at Oxford Population Health and a lead author of the study, said ‘The results of our study demonstrate that, while the care of women diagnosed with endometrial hyperplasia has improved with the introduction of national guidance, care of women with endometrial hyperplasia who are not treated with a hysterectomy in particular must be improved given the risk of developing cancer.’

UK ARCOG is an organisation of doctors in specialty training in obstetrics and gynaecology in the UK that undertakes national audits to identify opportunities to improve the quality of care that patients receive.