Endometrial hyperplasia is a group of proliferative lesions that occur in the endometrial glandular epithelium or glandular structures. It has a certain tendency to become cancerous and is therefore classified as a precancerous lesion. According to long-term observations, the majority of endometrial hyperplasia is a reversible lesion or remains a persistent benign state. Only a few cases may develop into cancer after a longer interval, and the prognosis is usually good. Long-term estrogen stimulation is the main causative factor. It is mostly seen in perimenopausal or postmenopausal women and young chronic anovulatory women. Diagnosis: 1. Pathogenic factors: long-term estrogen stimulation without progesterone antagonism, such as anovulation (polycystic ovary syndrome PCOS), obesity, functional endocrine tumors and estrogen therapy. Breast cancer patients on long-term oral triamcinolone acetonide after surgery can also cause endometrial hyperplasia.2. Clinical manifestations: abnormal vaginal bleeding is the prominent symptom of this disease, and young women may be combined with infertility.3. Ancillary tests: endometrial aspiration device diagnostic hysteroscopy Classification WHO classification 1. Simple hyperplasia Increased number of glands but regular glandular structure 2. Complex hyperplasia Crowded, irregular glandular structure 3. Simple atypical hyperplasia Simple hyperplasia with cellular anisotropy 4. Complex atypical hyperplasia Complex hyperplasia with cellular anisotropy Treatment 1. Treatment of simple and complex hyperplasia: Progesterone can effectively treat and prevent recurrence in high-risk groups After cyclic progesterone treatment, more than 98% of lesions can be regressed within 3-6 months. progesterone vaginal suppositories for 12-14 days per month, and also placement of levonorgestrel extended-release intrauterine device (Mannorrhea). 2. Treatment of atypical hyperplasia Drug treatment a Mild atypical hyperplasia: Generally, cyclic medication is used and the protocol is the same as above. b Moderate or severe atypical hyperplasia: High-dose continuous medication is used, such as methacholine (progesterone), megestrol acetate, progesterone caproate, etc. Other drugs include danazol and gonadotropin-releasing hormone (GnRHa). Pathology testing: 3 months is a course of treatment, with a curettage for pathology at the end of each course. To detect the response to the drugs and to decide the next treatment plan. If the endometrial glands show secretory phase endometrium or atrophic changes, drug therapy can be discontinued, and for infertility patients promptly switch to ovulation-promoting drugs. If the endometrium does not respond well to the drugs, the drug dose must be increased and treatment continued. For persistent cases that do not heal, the possibility of cancer should be alerted. Surgical treatment is suitable for patients over 40 years of age who do not require fertility. Once diagnosed, hysterectomy (transvaginal, laparoscopic or transabdominal) can be performed. Younger patients who fail to respond to medication and whose endometrium continues to proliferate or worsens with suspicion of cancer may also be considered for surgical removal of the uterus.