EP20.10: Does disordered proliferative endometrium require treatment and surveillance?

Histological diagnosis of disordered proliferative endometrium (DPE) is commonly found following endometrial sampling in those with concerning symptoms or ultrasound findings. There is no nationally approved management strategy for the follow up of these patients. This is a retrospective audit of 272 women who underwent endometrial sampling which detected DPE. Diagnosis was made between January 2016 and December 2021, between four hospitals across North West London. Data were collected for follow-up endometrial histology, patient demographics, ultrasound findings, hysteroscopic findings and treatments applied. 272 women received a diagnosis of DPE. Data for demographics and treatment were available for 91 patients. Of these patients, mean patient age was 47, mean BMI was 29.1, and most common indication for referral was heavy menstrual bleeding (30%),and irregular bleeding (20%). Ultrasound showed a range of endometrial thickness from 2.8-31mm (mean 11.9mm), with cystic features in 50%, uniform hyperechoic appearance in 29%, and a possible polyp detected on scan in 12%. Regarding treatment, 43% of patients received no treatment, 38% received hormonal therapy (oral progesterone or levonorgestrel IUS), 3% underwent surgery. 22% of patients were followed up, 27% of which were routine and 46% were re-referred for persistent symptoms. At diagnosis, 13 women (4%) had a concurrent diagnosis of endometrial hyperplasia (EH) (with or without atypia). During follow-up, a further 6 women (2%) developed EH. There were no cases of endometrial carcinoma. Of those patients receiving no treatment, 20% had persistent DPE, 10% developed EH and 70% regressed. Of those patients receiving progesterone treatment 9% had persistent DPE, 0% progressed to EH, and resolution of DPE was seen in 91%. The findings of this study suggest that long-term monitoring is warranted for women with disordered proliferative endometrium on histology, given its association with EH. Further studies are needed to determine a specific treatment regimen and follow-up protocol.