Assessing the Risk of Endometrial Hyperplasia and Cancer in Recurrent Abnormal Uterine Bleeding

Older age, nulliparity, a history of endometrial polyps, and a short interval between endometrial samplings (less than 12 months) are significant predictors of endometrial hyperplasia and endometrial cancer in women with recurrent abnormal uterine bleeding (AUB) and previously benign endometrial findings. These findings were reported in a study published on August 1, 2024, in Obstetrics & Gynecology.¹

This retrospective study from Thailand aimed to develop predictive models to assess the risk of endometrial hyperplasia and endometrial cancer in women presenting with recurrent AUB after a prior benign endometrial sampling. The study included patients who had undergone initial benign endometrial sampling between January 2013 and December 2021. Using multivariate logistic regression, the researchers identified key risk factors and created a scoring system to stratify patients into risk categories.

Among the 456 patients included in the study, 8.3% developed endometrial hyperplasia and 2.2% developed endometrial cancer. The average interval between the first and second endometrial sampling was 25.1 months.

Key findings include:

• Women older than 45 years had nearly a threefold increased risk (OR 2.86).
• Nulliparous women had a 3.5-fold higher risk (OR 3.50).
• A history of endometrial polyps increased the risk more than threefold (OR 3.69).
• Women who underwent repeat sampling within 12 months had over twice the risk (OR 2.36).

Based on these predictors, a risk scoring system was developed. Patients were stratified into three risk categories:

• Low risk (0–3 points): 4.7% probability
• Intermediate risk (5–8 points): 15.5% probability
• High risk (9–11 points): 57.1% probability

The model demonstrated good discriminatory power, with an area under the curve (AUC) of 73.1% and a mean absolute error of 0.01.

This study underscores the importance of risk stratification in women with recurrent AUB and prior benign endometrial histology. The proposed scoring system may guide individualized clinical management, including intensified surveillance or early intervention for those at high risk. Additionally, patient counseling based on personalized risk can support shared decision-making in clinical practice.

Source:   Obstet Gynecol. 2024 Aug 1;144(2):259–265. doi:10.1097/AOG.0000000000005641.