What are the indications for referral to a specialist for patients with suspected endometrial hyperplasia?

Indications for referral to a specialist for patients with suspected endometrial hyperplasia include:

• Women with persistent intermenstrual or persistent irregular bleeding, or infrequent heavy bleeding who are obese or have polycystic ovary syndrome, as these are risk factors for endometrial pathology including hyperplasia.
• Women taking tamoxifen, due to increased risk of endometrial changes.
• Women for whom treatment for heavy menstrual bleeding (HMB) has been unsuccessful, suggesting underlying pathology such as hyperplasia.
• Women aged 55 and over with post-menopausal bleeding, as this is a red flag for endometrial cancer and warrants urgent referral via a suspected cancer pathway.
• Consider referral for women under 55 with post-menopausal bleeding, especially if risk factors or persistent symptoms are present.

Referral should be made to a gynaecological service for further investigation and management, including diagnostic hysteroscopy with endometrial biopsy, as blind biopsy is not recommended.

Referral via a suspected cancer pathway is mandatory if cancer is suspected based on clinical features or investigations.

These recommendations align with NICE guidance on heavy menstrual bleeding and suspected cancer recognition and referral.

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