Endometrial hyperplasia, presenting without atypia (EH) or as atypical hyperplasia (AH), is considered a precursor of endometrial cancer and affects women of reproductive or perimenopausal age, posing a major public health concern. The aim of this study was to review and compare the most recently published influential guidelines providing recommendations on the management of endometrial hyperplasia. Thus, a comparative review of guidelines from the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the American College of Obstetricians and Gynecologists was conducted. There is a consensus regarding the optimal management strategies for EH, with observation and medical treatment being the first-line options and surgical treatment with total hysterectomy offering a second line in specific cases. Moreover, there is agreement regarding patients with AH, with surgical treatment being the recommended approach, while medical therapy is preferred for women who seek fertility preservation. Notably, close surveillance with endometrial biopsies every 3 or 6 months is suggested unanimously, as well as long-term follow-up in high-risk patients. Controversy exists regarding the initial diagnostic approach, with RCOG and SOGC suggesting outpatient endometrial biopsy, while ACOG recommends diagnostic hysteroscopy, as well as the therapeutic regimens for the oral treatment of EH. Surgical techniques such as endometrial ablation, intraoperative frozen section analysis, intraoperative visual inspection of the uterus, and morcellation constitute areas of controversy among the reviewed guidelines, and the surveillance protocols for women with EH are addressed differently between RCOG and SOGC. Notably, RCOG is the only medical society offering recommendations regarding women under HRT and those on therapy for breast cancer. The development of consistent international practice protocols for timely management strategies and surveillance protocols is of paramount importance to safely guide clinical practice and subsequently improve women’s health.
子宫内膜增生，包括无非典型性增生（EH）及非典型增生（AH），被认为是子宫内膜癌的前期病变，影响育龄期及围绝经期女性，已成为一项重要的公共卫生问题。本研究旨在回顾并比较近期发布的关于子宫内膜增生管理建议的权威指南。为此，我们对英国皇家妇产科学院、加拿大妇产科学会以及美国妇产科学会发布的指南进行了对比分析。各指南在EH的最佳管理策略上存在共识：观察与药物治疗作为一线选择，全子宫切除术则在特定情况下作为二线治疗方案。对于AH患者，各指南一致推荐手术治疗，而对于有生育意愿的女性则优先考虑药物治疗。值得注意的是，所有指南均建议对患者进行密切监测，每3至6个月进行一次子宫内膜活检，并对高危患者进行长期随访。然而，在初始诊断方法上存在分歧：RCOG和SOGC建议门诊子宫内膜活检，而ACOG则推荐诊断性宫腔镜检查；EH口服治疗方案也存在争议。此外，子宫内膜消融术、术中冰冻切片分析、术中子宫直视检查以及组织粉碎术等手术技术在所比较的指南中均为争议领域，且RCOG与SOGC在EH患者的监测方案上处理方式不同。值得关注的是，RCOG是唯一对接受激素替代疗法及乳腺癌治疗女性提出建议的医学机构。制定统一的国际实践规范，以确立及时的管理策略与监测方案，对于安全指导临床实践并进而改善女性健康至关重要。
Management of Endometrial Hyperplasia: A Comparative Review of Guidelines
肿瘤(癌症)患者之家