{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:53:39Z","timestamp":1791543219187,"version":"4.3.4"},"reference-count":80,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:00:00Z","timestamp":1758931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>Endometrial hyperplasia, presenting without atypia (EH) or as atypical hyperplasia (AH), is considered a precursor of endometrial cancer and affects women of reproductive or perimenopausal age, posing a major public health concern. The aim of this study was to review and compare the most recently published influential guidelines providing recommendations on the management of endometrial hyperplasia. Thus, a comparative review of guidelines from the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the American College of Obstetricians and Gynecologists was conducted. There is a consensus regarding the optimal management strategies for EH, with observation and medical treatment being the first-line options and surgical treatment with total hysterectomy offering a second line in specific cases. Moreover, there is agreement regarding patients with AH, with surgical treatment being the recommended approach, while medical therapy is preferred for women who seek fertility preservation. Notably, close surveillance with endometrial biopsies every 3 or 6 months is suggested unanimously, as well as long-term follow-up in high-risk patients. Controversy exists regarding the initial diagnostic approach, with RCOG and SOGC suggesting outpatient endometrial biopsy, while ACOG recommends diagnostic hysteroscopy, as well as the therapeutic regimens for the oral treatment of EH. Surgical techniques such as endometrial ablation, intraoperative frozen section analysis, intraoperative visual inspection of the uterus, and morcellation constitute areas of controversy among the reviewed guidelines, and the surveillance protocols for women with EH are addressed differently between RCOG and SOGC. Notably, RCOG is the only medical society offering recommendations regarding women under HRT and those on therapy for breast cancer. The development of consistent international practice protocols for timely management strategies and surveillance protocols is of paramount importance to safely guide clinical practice and subsequently improve women\u2019s health.<\/jats:p>","DOI":"10.3390\/cancers17193143","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:40:52Z","timestamp":1759146052000},"page":"3143","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of Endometrial Hyperplasia: A Comparative Review of Guidelines"],"prefix":"10.3390","volume":"17","author":[{"given":"Eirini","family":"Boureka","sequence":"first","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4337-7871","authenticated-orcid":false,"given":"Ioannis","family":"Tsakiridis","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8021-7693","authenticated-orcid":false,"given":"Georgios","family":"Kapetanios","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5646-8572","authenticated-orcid":false,"given":"Georgios","family":"Michos","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Giouleka","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios","family":"Liberis","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-0765","authenticated-orcid":false,"given":"Apostolos","family":"Mamopoulos","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-5839","authenticated-orcid":false,"given":"Themistoklis","family":"Dagklis","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Kalogiannidis","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"key":"ref_1","unstructured":"Young, R. (2014). Monodermal Teratomas and Somatic-Type Tumours Arising from a Dermoid Cyst. WHO Classification of Tumours of Female Reproductive Organs, World Health Organisation."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"678.e1","DOI":"10.1016\/j.ajog.2009.02.032","article-title":"Incidence of endometrial hyperplasia","volume":"200","author":"Reed","year":"2009","journal-title":"Am. J. Obs. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Doherty, M.T., Sanni, O.B., Coleman, H.G., Cardwell, C.R., McCluggage, W.G., Quinn, D., Wylie, J., and McMenamin, \u00da.C. (2020). Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0232231"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1055\/s-0034-1396256","article-title":"New WHO Classification of Endometrial Hyperplasias","volume":"75","author":"Emons","year":"2015","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/aje\/kwn168","article-title":"Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history","volume":"168","author":"Epplein","year":"2008","journal-title":"Am. J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1136\/ijgc-00009577-200205000-00004","article-title":"Risk factors for endometrial hyperplasia: Results from a case-control study","volume":"12","author":"Ricci","year":"2002","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.3802\/jgo.2016.27.e8","article-title":"Therapeutic options for management of endometrial hyperplasia","volume":"27","author":"Chandra","year":"2016","journal-title":"J. Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1080\/13625187.2022.2112169","article-title":"Investigation and management of abnormal uterine bleeding in reproductive-aged women: A descriptive review of national and international recommendations","volume":"27","author":"Tsakiridis","year":"2022","journal-title":"Eur. J. Contracept. Reprod. Health Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1055\/s-0031-1287662","article-title":"The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding","volume":"29","author":"Fraser","year":"2011","journal-title":"Semin. Reprod. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/AOG.0b013e3181e3e7e8","article-title":"Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: A systematic review and meta-analysis","volume":"116","author":"Timmermans","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/0002-9378(88)90011-7","article-title":"A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: A review of 276 cases","volume":"158","author":"Gimpelson","year":"1988","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","first-page":"433","article-title":"Management of endometrial hyperplasia","volume":"62","author":"Dogan","year":"2010","journal-title":"Minerva Ginecol."},{"key":"ref_13","first-page":"125","article-title":"Management of endometrial hyperplasia","volume":"67","author":"No","year":"2016","journal-title":"RCOG BSGE Jt. Guidel."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/j.jogc.2019.03.025","article-title":"Guideline No. 390-Classification and Management of Endometrial Hyperplasia","volume":"41","author":"Auclair","year":"2019","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"(2023). Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5. Obstet. Gynecol., 142, 735\u2013744.","DOI":"10.1097\/AOG.0000000000005297"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1034\/j.1600-0412.2001.080009784.x","article-title":"Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia","volume":"80","author":"Clark","year":"2001","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ygyno.2014.10.008","article-title":"Clinically significant endometrial cancer risk following a diagnosis of complex atypical hyperplasia","volume":"135","author":"Costales","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/AOG.0b013e3181b190d5","article-title":"Complex atypical endometrial hyperplasia: The risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage","volume":"114","author":"Hung","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ejogrb.2020.05.010","article-title":"Hysteroscopic resectoscope-directed biopsies and outpatient endometrial sampling for assessment of tumor histology in women with endometrial cancer or atypical hyperplasia","volume":"251","author":"Dueholm","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_20","first-page":"400","article-title":"Hysteroscopy with directed biopsy versus dilatation and curettage for the diagnosis of endometrial hyperplasia and cancer in perimenopausal women","volume":"28","author":"Bedner","year":"2007","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1200\/JCO.2009.24.1315","article-title":"Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia","volume":"28","author":"Lacey","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/1097-0142(19850715)56:2<403::AID-CNCR2820560233>3.0.CO;2-X","article-title":"The behavior of endometrial hyperplasia. A long-term study of \"untreated\" hyperplasia in 170 patients","volume":"56","author":"Kurman","year":"1985","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/j.1447-0756.1997.tb00836.x","article-title":"The behavior of endometrial hyperplasia: A prospective study. Endometrial Hyperplasia Study Group","volume":"23","author":"Terakawa","year":"1997","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"350.e1","DOI":"10.1016\/j.ajog.2015.05.015","article-title":"Referring survivors of endometrial cancer and complex atypical hyperplasia to bariatric specialists: A prospective cohort study","volume":"213","author":"Jernigan","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/1471-0528.12100","article-title":"Bariatric surgery and endometrial pathology in asymptomatic morbidly obese women: A prospective, pilot study","volume":"120","author":"Argenta","year":"2013","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"547.e1","DOI":"10.1016\/j.ajog.2010.07.037","article-title":"Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: A systematic review and metaanalysis","volume":"203","author":"Gallos","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/j.1365-2265.1982.tb01625.x","article-title":"Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD","volume":"17","author":"Nilsson","year":"1982","journal-title":"Clin. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ajog.2015.03.037","article-title":"Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: A systematic review and metaanalysis of randomized trials","volume":"213","author":"Ghayaty","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e12150","DOI":"10.1016\/j.heliyon.2022.e12150","article-title":"Comparison of the effectiveness of the levonorgestrel-intrauterine device and oral progestogens on regression of endometrial hyperplasia without atypia","volume":"8","author":"Shen","year":"2022","journal-title":"Heliyon"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1177\/1933719115623643","article-title":"Depo-Provera Versus Norethisterone Acetate in Management of Endometrial Hyperplasia Without Atypia","volume":"23","author":"Nooh","year":"2016","journal-title":"Reprod. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/1933719112459243","article-title":"Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia","volume":"20","author":"Ismail","year":"2013","journal-title":"Reprod. Sci."},{"key":"ref_32","first-page":"686","article-title":"Levonorgestrel-releasing intrauterine system (Mirena) in compare to medroxyprogesterone acetate as a therapy for endometrial hyperplasia","volume":"19","author":"Behnamfar","year":"2014","journal-title":"J. Res. Med. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/1471-0528.12499","article-title":"Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: A national multicentre randomised trial","volume":"121","author":"Orbo","year":"2014","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_34","first-page":"122","article-title":"The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study","volume":"40","author":"Dolapcioglu","year":"2013","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2966","DOI":"10.1093\/humrep\/det320","article-title":"LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: A long-term comparative cohort study","volume":"28","author":"Gallos","year":"2013","journal-title":"Hum. Reprod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/path.2091","article-title":"A candidate precursor to serous carcinoma that originates in the distal fallopian tube","volume":"211","author":"Lee","year":"2007","journal-title":"J. Pathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/S1470-2045(10)70143-1","article-title":"Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: A randomised trial","volume":"11","author":"Mourits","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jmig.2006.08.007","article-title":"Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia","volume":"14","author":"Edris","year":"2007","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jmig.2014.07.009","article-title":"Long-term clinical outcomes following resectoscopic endometrial ablation of non-atypical endometrial hyperplasia in women with abnormal uterine bleeding","volume":"22","author":"Vilos","year":"2015","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.fertnstert.2010.07.1044","article-title":"Levonorgestrel-releasing intrauterine system (LNG-IUS) as an effective treatment option for endometrial hyperplasia: A 15-year follow-up study","volume":"95","author":"Scarselli","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1097\/AOG.0b013e31828cb563","article-title":"Prediction of regression and relapse of endometrial hyperplasia with conservative therapy","volume":"121","author":"Gallos","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.ygyno.2012.01.003","article-title":"Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: A systematic review","volume":"125","author":"Gunderson","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ygyno.2010.10.004","article-title":"Conservative treatment of early endometrial cancer: Preliminary results of a pilot study","volume":"120","author":"Laurelli","year":"2011","journal-title":"Gynecol. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kopatsaris, S., Apostolopoulou, A., Tsakiridis, I., Tranidou, A., Zachomitros, F., Papanikolaou, E., Daponte, A., Kalogiannidis, I., and Dagklis, T. (2024). Accuracy of Frozen Section Biopsy in the Diagnosis of Endometrial Cancer: A Systematic Review and Meta-Analysis. Cancers, 16.","DOI":"10.3390\/cancers16061200"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1016\/j.ajog.2006.10.886","article-title":"The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy","volume":"196","author":"Indermaur","year":"2007","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_46","first-page":"435","article-title":"Accuracy of frozen section diagnosis at surgery in pre- malignant and malignant lesions of the endometrium","volume":"29","author":"Coutts","year":"2008","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"609.e1","DOI":"10.1016\/j.ajog.2022.05.055","article-title":"Hysterectomy with a general gynecologist vs gynecologic-oncologist in the setting of endometrial intraepithelial neoplasia: A cost-effectiveness analysis","volume":"227","author":"Chaiken","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/j.1600-0412.2011.01166.x","article-title":"Accuracy of intraoperative gross visual assessment of myometrial invasion in endometrial cancer","volume":"90","author":"Marcickiewicz","year":"2011","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1080\/00016340701322077","article-title":"Accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with endometrial cancer","volume":"86","author":"Traen","year":"2007","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1002\/cncr.21650","article-title":"Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study","volume":"106","author":"Trimble","year":"2006","journal-title":"Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1093\/jnci\/djn397","article-title":"Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial","volume":"100","author":"Panici","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"ASTEC Study Group, Kitchener, H., Swart, A.M., Qian, Q., Amos, C., and Parmar, M.K. (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet, 373, 125\u2013136.","DOI":"10.1016\/S0140-6736(08)61766-3"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"191.e1","DOI":"10.1016\/j.ajog.2020.08.032","article-title":"Prospective phase II trial of levonorgestrel intrauterine device: Nonsurgical approach for complex atypical hyperplasia and early-stage endometrial cancer","volume":"224","author":"Westin","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.ygyno.2015.12.010","article-title":"Effect of oral versus intrauterine progestins on weight in women undergoing fertility preserving therapy for complex atypical hyperplasia or endometrial cancer","volume":"140","author":"Cholakian","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ijgo.2015.06.046","article-title":"Oncologic and reproductive outcomes after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer","volume":"132","author":"Chen","year":"2016","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1097\/IGC.0000000000000467","article-title":"Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential","volume":"25","author":"Pronin","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00404-014-3417-z","article-title":"Efficacies and pregnant outcomes of fertility-sparing treatment with medroxyprogesterone acetate for endometrioid adenocarcinoma and complex atypical hyperplasia: Our experience and a review of the literature","volume":"291","author":"Sawada","year":"2015","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3802\/jgo.2014.25.3.214","article-title":"Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia","volume":"25","author":"Shan","year":"2014","journal-title":"J. Gynecol. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/annonc\/mdv539","article-title":"Phase II study of medroxyprogesterone acetate plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer","volume":"27","author":"Mitsuhashi","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Kopatsaris, S., Tsakiridis, I., Kapetanios, G., Zachomitros, F., Michos, G., Papanikolaou, E., Athanasiadis, A., Dagklis, T., and Kalogiannidis, I. (2024). Management of Endometrial Cancer: A Comparative Review of Guidelines. Cancers, 16.","DOI":"10.3390\/cancers16213582"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"266.e1","DOI":"10.1016\/j.ajog.2012.08.011","article-title":"Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: A systematic review and metaanalysis","volume":"207","author":"Gallos","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/AOG.0b013e3181e93330","article-title":"Complex hyperplasia with and without atypia: Clinical outcomes and implications of progestin therapy","volume":"116","author":"Reed","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/humrep\/det049","article-title":"Relapse of endometrial hyperplasia after conservative treatment: A cohort study with long-term follow-up","volume":"28","author":"Gallos","year":"2013","journal-title":"Hum. Reprod."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.rbmo.2021.06.007","article-title":"IVF impact on the risk of recurrence of endometrial adenocarcinoma after fertility-sparing management","volume":"43","author":"Vaugon","year":"2021","journal-title":"Reprod. Biomed. Online"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1177\/1933719114561553","article-title":"Efficacy of the Levonorgestrel-Releasing Intrauterine System on IVF-ET Outcomes in PCOS With Simple Endometrial Hyperplasia","volume":"22","author":"Bian","year":"2015","journal-title":"Reprod. Sci."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"103.e1","DOI":"10.1016\/j.ajog.2019.12.273","article-title":"Progestin therapy for obese women with complex atypical hyperplasia: Levonorgestrel-releasing intrauterine device vs systemic therapy","volume":"223","author":"Mandelbaum","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/AOG.0b013e31826bb121","article-title":"Management of endometrial precancers","volume":"120","author":"Trimble","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1111\/1471-0528.13763","article-title":"Relapse risk of endometrial hyperplasia after treatment with the levonorgestrel-impregnated intrauterine system or oral progestogens","volume":"123","author":"Arnes","year":"2016","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/j.1471-0528.2007.01391.x","article-title":"Endometrial hyperplasia involving endometrial polyps: Report of a series and discussion of the significance in an endometrial biopsy specimen","volume":"114","author":"Kelly","year":"2007","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/AOG.0000000000001566","article-title":"Atypical Endometrial Polyps and Concurrent Endometrial Cancer: A Systematic Review","volume":"128","author":"Steenbergen","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_71","first-page":"Cd000402","article-title":"Hormone therapy in postmenopausal women and risk of endometrial hyperplasia","volume":"2012","author":"Furness","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1136\/bmj.325.7358.239","article-title":"Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: Follow up study","volume":"325","author":"Wells","year":"2002","journal-title":"BMJ"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1111\/j.1471-0528.2000.tb11654.x","article-title":"The endometrial response to sequential and continuous combined oestrogen-progestogen replacement therapy","volume":"107","author":"Sturdee","year":"2000","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/S0140-6736(94)92692-1","article-title":"Risk of endometrial cancer after tamoxifen treatment of breast cancer","volume":"343","author":"Benraadt","year":"1994","journal-title":"Lancet"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1093\/jnci\/dji372","article-title":"Tamoxifen for the prevention of breast cancer: Current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study","volume":"97","author":"Fisher","year":"2005","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_76","first-page":"Cd003370","article-title":"Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women","volume":"2009","author":"Gibson","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_77","first-page":"Cd007245","article-title":"Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen","volume":"2015","author":"Dominick","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_78","first-page":"492","article-title":"The role of levonorgestrel-releasing intrauterine system for endometrial protection in women with breast cancer taking tamoxifen","volume":"35","author":"Shi","year":"2014","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1097\/AOG.0b013e31828bf80c","article-title":"Prophylactic use of levonorgestrel-releasing intrauterine system in women with breast cancer treated with tamoxifen: A randomized controlled trial","volume":"121","author":"Wong","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.fertnstert.2007.05.033","article-title":"Use of the levonorgestrel-releasing intrauterine system in breast cancer patients","volume":"90","author":"Trinh","year":"2008","journal-title":"Fertil. Steril."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3143\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:52:09Z","timestamp":1759146729000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,27]]},"references-count":80,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193143"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193143","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,27]]}}}