Abstract
BackgroundEndometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear.ObjectivesTo conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding.Search strategySearch of PubMed, Embase and the Cochrane Library from database inception to August 2015.Selection criteriaStudies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding.Data collection and analysisData were independently extracted by two reviewers and cross‐checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study.Main resultsSixty‐five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23–0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96–1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04–0.32%, n = 8352; 9 cases) compared with inter‐menstrual bleeding (IMB) (0.52%, 95% CI 0.23–1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases.ConclusionsThe risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co‐morbidities is needed.Tweetable abstractContrary to practice, premenopausal women with heavy periods or inter‐menstrual bleeding rarely require biopsy.
Highlights
Endometrial cancer has a world-wide incidence of 9 per 100 000 women, with a 1% lifetime risk.[1]
This review aimed to estimate the risk of endometrial cancer and atypical hyperplasia in premenopausal women presenting with abnormal uterine bleeding and to make some judgement about whether current guidelines are appropriate
The risk of endometrial cancer in women with HMB was low (0.11%, 95% CI 0.04–0.32) and no cases of atypical hyperplasia were observed in studies of women with HMB
Summary
Endometrial cancer has a world-wide incidence of 9 per 100 000 women, with a 1% lifetime risk.[1] Most cases are in women aged >50 years.[1] Unopposed oestrogen exposure is a significant risk factor,[2] where prolonged exposure causes continual endometrial proliferation and, potentially, endometrial carcinoma.[2] Other factors influencing oestrogen exposure include obesity, polycystic ovarian syndrome (PCOS), anovulation, nulliparity, and type 2 diabetes mellitus[3] and these are thought to increase the risk of endometrial cancer. Endometrial hyperplasia, that is, irregular proliferation of the endometrial glands, may, in some cases, be a precursor to endometrial cancer. Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear
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