Endometrial hyperplasia is not actually a condition, but a group of diseases in which abnormal hyperplasia of endometrial glands is the main manifestation. Specifically, they include simple hyperplasia of the endometrium (also called simple hyperplasia of the endometrium), complex hyperplasia of the endometrium, and atypical hyperplasia of the endometrium. How do these types of diseases arise? It comes down to how the normal menstrual cycle comes about. Clinical presentation of endometrial hyperplasia: Most patients are seen for menstrual disorders with irregular vaginal bleeding. It is important to mention that many patients say, “My periods are normal, I have them every month”. However, normal menstruation is characterized by periodic vaginal bleeding, and the amount and duration of each bleed is relatively constant. In patients with menstrual disorders, they may also have vaginal bleeding every month, but the amount of bleeding is sometimes more or less, and the duration is sometimes longer or shorter. In this case, the ovaries are actually not ovulating normally, and the breakthrough bleeding occurs due to long-term stimulation by ovarian estrogen, causing excessive thickening of the endometrium, which cannot maintain its integrity, and local rupture. If this condition exists, it is time to be alert. Other patients may have “normal” menstruation, but the endometrial thickening is not homogeneous on ultrasound. This should not be taken lightly and should be followed up closely under the guidance of a physician and, if necessary, diagnostic curettage should be performed. Probability of endometrial hyperplasia: The incidence of endometrial hyperplasia is still quite high. Approximately 133 out of every 10,0000 women will be affected by endometrial hyperplasia. The high incidence is between 50 and 54 years of age, but, in recent years, the age of onset has gradually decreased and even many young women who are not yet married and have children are at risk for endometrial hyperplasia. Risk factors for endometrial hyperplasia: As we mentioned earlier, abnormal ovarian function, long-term non-ovulation (e.g. polycystic ovary syndrome, perimenopausal ovarian abnormalities); long-term use of estrogenic drugs; high intake of animal estrogen-containing supplements (e.g. hashish ant, royal jelly, etc.); and insulin resistance (obesity, diabetes, hypertension, etc.) are all risk factors for endometrial hyperplasia. risk factors for the development of endometrial hyperplasia. Hazards of endometrial hyperplasia: Endometrial hyperplasia can lead to menstrual disorders, hemorrhage, and anemia. Long-term untreated endometrial hyperplasia may progress to endometrial cancer. Also in young women it can lead to infertility. Therefore, it should be given high priority. Diagnosis of endometrial hyperplasia: The diagnosis of endometrial hyperplasia relies on pathology. It is usually diagnosed by diagnostic scraping of the uterus by the patient due to menstrual disorders or uneven thickening of the endometrium, and is clearly diagnosed by pathological examination of the scraped endometrial specimen. Pathologists make different diagnoses depending on the ratio of glandular to mesenchymal structures in the endometrium and the presence or absence of nuclear heterogeneity. 1.Simple hyperplasia of endometrium: The degree of glandular hyperplasia is the lightest, and cancer rarely occurs, and the possibility of developing into endometrial cancer is only 1%. Treatment is also relatively easy and can be reversed in 3 months with cyclic progesterone treatment. 2.Complex endometrial hyperplasia: the degree of glandular hyperplasia increases, the glandular/mesenchymal ratio is greater than 50%, and there are abnormal glandular structures. The incidence of carcinoma in complex endometrial hyperplasia is about 3%. The general efficiency of progestin treatment is 75-80%. 3.Atypical hyperplasia: Enlarged nuclei and heterogeneity are present. Atypical hyperplasia can be combined with endometrial simple hyperplasia or endometrial complex hyperplasia. The chance of simple hyperplasia combined with atypia progressing to endometrioid adenocarcinoma is about 8%, while the chance of complex hyperplasia combined with atypia progressing to endometrial cancer is much higher, about 29%. It should be noted that 17-52% of cases diagnosed with endometrial atypical hyperplasia by diagnostic curettage are also associated with endometrial cancer, which is missed only because the endometrial cancer lesion is not scraped by diagnostic curettage. Therefore, in cases diagnosed with endometrial atypical hyperplasia, the possibility of combined endometrial cancer should be considered for further evaluation. Endometrial atypical hyperplasia can also be reversed by pharmacological treatment, which is generally 75-80% effective, but the treatment time is longer and may take up to 1 year. The average time from initial diagnosis to progression to cancer for all endometrial hyperplastic lesions is approximately 6 years. Treatment of endometrial hyperplasia: Endometrial hyperplasia is not cancer and can be reversed with medication, and there is hope for successful pregnancy in young women after treatment. However, in perimenopausal women who are found to have atypical endometrial hyperplasia, it is advisable to have the uterus surgically removed. It is also important to note that the cause of endometrial hyperplasia does not lie in the endometrium itself, but in other causes such as abnormal ovarian function. Therefore, if the correct measures are not taken to prevent endometrial hyperplasia after successful reversal of the endometrium, it is likely that endometrial hyperplasia will return and even progress to endometrial cancer.