Endometrial hyperplasia is a group of diseases characterized by abnormal proliferation of endometrial glands. It is usually considered that long-term estrogen stimulation without progestin antagonism is the main reason for the development of endometrial hyperplasia. Therefore, conservative progestin therapy and surgery are the main treatment modalities for endometrial hyperplasia. Endometrial hyperplasia includes simple hyperplasia, complex hyperplasia, and atypical hyperplasia of the endometrium. Treatment modalities and efficacy vary for different types of endometrial hyperplasia. The treatment of patients should be individualized and based on the type of pathology, age, whether or not they are menopausal, and whether or not they have fertility requirements. It is important to emphasize that endometrial hyperplasia should be treated under strict medical supervision, with ultrasound and endometrial biopsy being monitored to determine the effectiveness of treatment. After successful treatment to completely reverse the endometrial lesions, preventive measures should also be taken under the guidance of the doctor, otherwise, the endometrial lesions can easily recur or even progress. Simple hyperplasia of the endometrium Simple hyperplasia of the endometrium is the least severe form of hyperplastic endometrial lesion. Treatment is relatively simple and usually involves 3 courses of treatment with medroxyprogesterone acetate (progesterone enanthate, MPA). MPA 10mg is given orally once daily for 15 days during the second half of the menstrual cycle. After discontinuation of the drug, menstruation usually occurs within 1-2 weeks, and the next course of treatment is started again on the 10th day of the next menstrual period. Some patients may experience irregular vaginal bleeding during the first course of MPA treatment or after discontinuation due to poor endothelial response to progesterone. If this occurs, you should consult your doctor promptly. If you experience heavy bleeding, it is time to seek medical attention as soon as possible and take the necessary measures to stop the bleeding. Generally, after 3 months of progestogen therapy for simple endometrial hyperplasia, ultrasound should be repeated on the 5th day of menstruation or just after menstruation to check the thickness of the endometrium. If the ultrasound indicates that the thickness of the endometrium (bilayer) is less than or equal to 5 mm and there is no indication of unevenness in the endometrium, then the treatment is effective. The effectiveness of progestin therapy for complex hyperplasia of the endometrium is about 75-80%. Treatment is the same as for simple hyperplasia and may take up to 6 months. However, since the efficiency of progestin treatment for complex endometrial hyperplasia does not reach 100%, it is emphasized that endometrial biopsy must be performed after 3 cycles of progestin treatment to determine the effectiveness of treatment. There are also doctors abroad who use MPA 10mg/day for 3-6 months continuously for treatment. The advantage is that the patient does not have to be concerned about the onset of menstruation, but the dosage is obviously higher than in the second half of the treatment cycle. If endometrial biopsy after 6 months of MPA treatment shows that progesterone therapy is not effective or even that the endometrial lesions have progressed, it is time to adjust the treatment regimen. In addition, many patients with complex endometrial hyperplasia are in perimenopause, when ovarian function is gradually declining and cannot produce enough estrogen, so treatment with progestin alone may not be effective in these patients. In such patients, treatment with a cyclic oral contraceptive containing a small amount of estrogen, such as Mafron, may be considered. In rare cases, postmenopausal patients may also develop complex endometrial hyperplasia. If such patients are not obese, taking supplements or other exogenous estrogens, conservative treatment with progestin is generally not effective and may progress to endometrial cancer. For such patients, surgical removal of the uterus is a safer treatment measure. Endometrial atypical hyperplasia Endometrial atypical hyperplasia is a precancerous lesion of endometrial cancer. If left untreated, the chance of progression to endometrial cancer can be nearly 30%. Therefore, the treatment of choice for this type of disease is total hysterectomy. A simple extrafascial total hysterectomy is usually sufficient, without the need to remove both ovaries. It should be noted that 17-52% of patients diagnosed with atypical endometrial hyperplasia by diagnostic curettage may also have endometrial adenocarcinoma. Therefore, if endometrial carcinoma is found on intraoperative frozen section pathology or postoperative pathology, bilateral ovaries should also be resected retrospectively. In recent years, the age of onset of endometrial atypical hyperplasia tends to be younger, and many young women, even before they have boyfriends or are married with children, unfortunately develop endometrial atypical hyperplasia. For this group of young women with a strong desire to preserve their reproductive function, conservative pharmacological treatment may be considered. We generally limit the age of pharmacological conservative treatment to less than 45 years. The treatment regimen is continuous high-dose progestin therapy, currently the most commonly used is megestrol acetate (Elysium) 160 mg orally once daily, taken continuously. Endometrial biopsy is required every three months during treatment to determine the effectiveness of treatment. The efficiency of conservative progestin treatment for endometrial atypical hyperplasia is 75%-80%. Usually endometrial reversal occurs after 3-6 months of progestin treatment, up to 12 months. If the endometrial lesions persist after 3-6 months of treatment, the dose of Elicitor may be increased to 320 mg/day. Patients who fail to respond to treatment or progress should receive prompt surgical treatment to avoid progression of the disease and delayed treatment. Precautions to be taken during treatment with Eliciclovir: Since Eliciclovir is a high-dose progestin, liver and kidney function should be followed up during treatment. In addition, since progestins may cause abnormal breast enlargement, patients should also perform self-examination of the breast if breast discomfort or lumps occur during treatment. Other treatments for endometrial hyperplasia The above are the most common and classic treatments for endometrial hyperplasia. For patients who are not suitable for these treatments, there are alternative options: Vaginal administration of micronized progesterone. 100-200 mg/day vaginally. Daily dosing or second half of cycle treatment. Medroxyprogesterone acetate (Depo-Provera) 150mg intramuscularly once every three months. Levonorgestrel contraceptive ring (Mannophora) intrauterine placement. Hysteroscopic endometrial treatment. In conclusion, the treatment of endometrial hyperplasia is both pharmacological conservative and surgical. An individualized treatment plan needs to be developed according to the patient’s specific situation. It is of utmost importance for the patient to follow the prescribed treatment strictly, to follow up closely and to take measures to prevent recurrence.