RCOG World Congress 2025

Evaluating Compliance, Treatment Effectiveness, and Outcomes in Medical Management of Endometrial Hyperplasia (2020-2023 Audit)

Authors: Yashoda Avinash, Anitha Velusamy, Department of Obstetrics & Gynaecology, The Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust, Norfolk, UK

Introduction

•Endometrial Hyperplasia (EH) requires careful management, particularly when patients opt for medical treatment.

•Key challenges include ensuring adequate follow-up, assessing treatment effectiveness, and maintaining complete data.

•This audit evaluates adherence to RCOG/BSGE Green-top Guideline No. 67 recommendations.

Objective

• To assess the management of EH in 37 patients undergoing medical treatment (2020-2023).

Focus Areas

•Compliance with recommended follow-up biopsy intervals.

•Treatment effectiveness (regression, persistence, progression).

•Completeness of clinical data documentation.

Methodology

•Retrospective audit of 37 patients selecting medical management for EH (AH, EH, DPE) between 2020-2023.

•Data collected: Demographics, presentation, diagnosis, treatment (Mirena/oral progesterone), follow-up intervals, biopsy results, and outcomes.

•Exclusion: Patients who underwent hysterectomy.

•Compliance measured against RCOG/BSGE Guideline No. 67 algorithm.

Findings

•Cohort Profile (N=37):

•Age: 28-93 yrs (Median 53-63).

•Referral: 89% via 2WW.

•Status: 78% Post-menopausal.

•BMI: 70% High Risk (BMI ≥ 35).

•Clinical Presentation: PMB (65%), AUB (24%) are most common. Fig.1

•Initial Diagnosis: AH (76%), DPE (16%), EH (8%).

•Treatment: Mirena coil primary treatment (68%).

•Follow-Up Compliance: Fig.2

•Overall: 65% Compliant, 19% Non-Compliant, 16% Unknown.

•AH (Guideline: 3 months):

•1st Biopsy: 86% Non-compliant (Intervals often 6- 9+ months).

•2nd Biopsy: 61% Non-compliant (Similar delays).

•EH (Guideline: 6 months):

•1st Biopsy: 2/3 significantly delayed (>300 days).

•2nd Biopsy: 1/3 significantly delayed (>480 days).

•Treatment Outcomes (Follow-up Biopsies):

•'Progesterone effect' common finding at 1st (11/37) and 2nd (13/37) follow-up.

•AH persisted in 5 patients at 1st FU; 1 patient at 2nd FU.

•Insufficient samples obtained in some cases.

•Overall Outcomes: Resolution (70%), Persistent AH (3%), Unknown (27% - data missing). Fig.3

•Data Gaps: TVS data missing (16%), Unknown compliance (16%), Unknown outcomes (27%).

Observations

•High EH resolution rate (70%) suggests medical management (primarily Mirena) is often effective.

•Major Concern: Significant non-compliance with guideline-recommended follow-up intervals, especially for high-risk AH patients. This poses a risk of delayed detection of persistence or progression.

•Inconsistent follow-up practices observed across all diagnoses (AH, EH, DPE).

•Data incompleteness limits full analysis and outcome tracking.

Recommendations

•Education: Reinforce guideline adherence (follow-up intervals) among clinicians.

•Protocols: Develop/implement standardized follow-up pathways.

•Patient Communication: Discuss the importance of timely follow-up biopsies & provide leaflets.

•Systems: Optimize scheduling, implement reminders, and integrate guidelines into EHR.

•Data Quality: Improve data collection & documentation process for results and outcomes.

•Further Investigation: Explore reasons for non-compliance/delays.

•Monitoring: Implement ongoing audit cycles to track improvements.

Conclusion

• Medical management of EH shows good resolution rates (70%) in this cohort.

•Significant improvements are needed in adherence to follow-up guidelines, particularly for AH, and in data completeness.

•Addressing these gaps through education, standardized protocols, system changes, and improved data capture is crucial for optimizing patient care and safety.

RCOG World Congress 2025

Audit of Endometrial Hyperplasia Management (2020 -2023)

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