Endometrial hyperplasia epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2] , Soujanya Thummathati, MBBS [3]

Overview

Women of all age groups may develop endometrial hyperplasia.However, endometrial hyperplasia is more common in postmenopausal women.

Epidemiology and Demographics

Age

• Women of all age groups may develop endometrial hyperplasia..
• However, endometrial hyperplasia is more common in postmenopausal women.

Most patients (75%) with endometrial cancer present with postmenopausal bleeding; however, only 10% of women with postmenopausal bleeding have endometrial carcinoma.28 The remaining women with postmenopausal bleeding have atrophic or inactive endometrium or benign endometrial conditions such as polyps. The clinical predictive model proposed by Feldman and colleagues30 (i.e., 70 years of age or older, diabetes, nulliparity, and postmenopausal status) is not predictive enough to distinguish between women with perimenopausal or postmenopausal bleeding at low versus high endometrial carcinoma risk.31 The traditional risk indicators associated with EIN/carcinoma are shown in Table 2. Most of the indicators are estrogen related, either from endogenous or exogenous sources. In women with these risk factors, the relative risk of developing carcinoma is 1.2–35.32 Experience also suggests that a significant proportion of patients fail to have these risk indicators but develop endometrial carcinoma. In these cases, either the disease may not be hormone related, or hyperestrogenism is metabolically inapparent. In a literature review, 74% of patients with adenocarcinoma of the endometrium were not obese, 58% were not nulliparous, 22% experienced menopause before age 49 years, and 43–89% were not exposed to hormone replacement therapy (HRT).33 It seems that the only constant endometrial carcinoma risk indicator is age. In women aged 65 years or older, endometrial cancer is generally aggressive and has a high mortality rate (75%) compared with that (15%) in the younger age group with hormone-related cancer.34