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Endometrial Hyperplasia: Current Insights into Epidemiology, Risk Factors, and Clinical Management
by
, , , , , ,
Apostolia Galani
1,†, 
Sofoklis Stavros
2,*,†,
Efthalia Moustakli
3,
Anastasios Potiris
2,*
,
Athanasios Zikopoulos
4,
Ismini Anagnostaki
5,
Konstantinos Zacharis
6,
Maria Paraskevaidi
1, 
Deirdre Lyons
1,
Stefania Maneta-Stavrakaki
1
,
Nikolaos Thomakos
7,
Maria Kyrgiou
1 and 
Ekaterini Domali
7 1
Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W12 ONN, UK
2
Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
3
Department of Nursing, School of Health Sciences, University of Ioannina, 4th kilometer National Highway Str. Ioannina-Athens, 45500 Ioannina, Greece
4
Torbay and South Devon NHS Foundation Trust Lowes Brg, Torquay TQ2 7AA, UK
5
Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
6
Department of Obstetrics and Gynecology, General Hospital of Lamia, 35100 Lamia, Greece
7
First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2026, 18(1), 148; https://doi.org/10.3390/cancers18010148
Submission received: 1 December 2025
/
Revised: 26 December 2025
/
Accepted: 30 December 2025
/
Published: 31 December 2025
(This article belongs to the Special Issue Cancer Screening and Primary Care)
Simple Summary
Endometrial hyperplasia (EH) is a condition where the lining of the uterus grows too much, sometimes leading to endometrial cancer if not treated. Common risk factors include obesity, polycystic ovarian syndrome, metabolic problems, and long-term exposure to estrogen without progesterone. EH can cause symptoms like irregular bleeding, but sometimes it is found by chance. Diagnosis usually combines imaging, tissue sampling, and sometimes molecular tests. Treatment can involve hormonal therapy with progestins or surgery, depending on how severe the condition is and whether the patient wants to keep fertility. New research using molecular profiling is helping doctors personalize treatment and better predict which cases might progress to cancer. Understanding risk factors, early diagnosis, and individualized care are key to preventing endometrial cancer and improving patient outcomes.
Abstract
Endometrial hyperplasia (EH) comprises a spectrum of abnormal proliferative changes in the endometrium, ranging from benign glandular overgrowth to lesions with substantial malignant potential. The importance of risk stratification and early identification is highlighted by the growing recognition of EH as a precursor to endometrial cancer. The main causes of EH, according to epidemiological research, include obesity, polycystic ovarian syndrome (PCOS), metabolic dysfunction, and extended exposure to unopposed estrogen. Emerging molecular markers, histological analysis, and imaging are all necessary for a proper diagnosis of EH because it might appear with vague clinical symptoms such as irregular uterine bleeding. Surgical intervention or progestin therapy are two possible management techniques for EH, depending on the lesion’s intricacy and the patient’s medical history, including fertility issues. Personalized therapy techniques and recent developments in molecular profiling have the potential to enhance patient outcomes by matching treatment to tumor biology and individual risk profiles. This review highlights the translational potential of molecular insights while synthesizing the most recent data on the epidemiology, risk factors, diagnostic techniques, and therapy of EH. A deeper comprehension of these elements is necessary to maximize treatment results and stop the development of endometrial cancer.
Keywords:
PCOS; metabolic dysfunction; AUB; biomarkers; progestin therapy
