Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia
Detecting Concurrent Carcinoma
Gynecologists should attempt to exclude concurrent carcinoma in individuals with a working diagnosis of EIN–AEH. Hysteroscopic examination with further sampling of the endometrium is the most accurate method for detecting a concurrent carcinoma.
Surgical Management
Hysterectomy is the definitive treatment for EIN–AEH. Gynecologists should not perform supracervical hysterectomy for the treatment of EIN–AEH.
Gynecologists should not perform endometrial ablation (thermal or electrocautery) for EIN–AEH due to high persistence and recurrence rates, as well as potential difficulty in evaluating future bleeding episodes.
Nonsurgical Management
Clinicians should recommend progestational agents as treatment for EIN–AEH for patients in whom hysterectomy is not an option.
Data on the superiority of either oral or intrauterine progestational agents are lacking, though limited data suggest that intrauterine progestational administration may be associated with a higher rate of disease regression when compared with oral administration alone in patients with EIN–AEH.
There is insufficient evidence to recommend any one formulation of oral progestational agent over another.
Follow-up
Counseling Patients on Lifestyle Modifications
Recommendation Grading
Abbreviations
- AEH: Atypical Endometrial Hyperplasia
- EIN: Endometrial Intraepithelial Neoplasia
Disclaimer
Overview
Title
Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
September 1, 2023
Last Updated Month/Year
September 5, 2023
Document Type
Consensus
Country of Publication
US
Document Objectives
Endometrial intraepithelial neoplasia (EIN) or atypical endometrial hyperplasia (AEH) often is a precursor lesion to adenocarcinoma of the endometrium. Hysterectomy is the definitive treatment for EIN–AEH. When a conservative (fertility-sparing) approach to the management of EIN–AEH is under consideration, it is important to attempt to exclude the presence of endometrial cancer to avoid potential undertreatment of an unknown malignancy in those who have been already diagnosed with EIN–AEH. Given the high risk of progression to cancer, those who do not have surgery require progestin therapy (oral, intrauterine, or combined) and close surveillance. Although data are conflicting and limited, studies have demonstrated that treatment with the levonorgestrel-releasing intrauterine device results in a higher regression rate when compared with treatment with oral progestins alone. Limited data suggest that cyclic progestational agents have lower regression rates when compared with continuous oral therapy. After initial conservative treatment for EIN–AEH, early detection of disease persistence, progression, or recurrence requires careful follow-up. Gynecologists and other clinicians should counsel patients that lifestyle modification resulting in weight loss and glycemic control can improve overall health and may decrease the risk of EIN–AEH and endometrial cancer.
Inclusion Criteria
Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D016889 - Endometrial Neoplasms, D004714 - Endometrial Hyperplasia
Keywords
Endometrial Hyperplasia, Intraepithelial, EIN, Endometrial Intraepithelial Neoplasia
Source Citation
Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5. Obstetrics & Gynecology 142(3):p 735-744, September 2023. | DOI: 10.1097/AOG.0000000000005297