Clinical and Diagnostic Features of Endometrial Hyperplastic Processes in Perimenopausal Women and Approaches to Their Treatment

Abstract

Pathological endometrial proliferation during the perimenopausal transition introduces a severe clinical dilemma, demanding exact precision to balance effective oncological prevention against the hazards of surgical overtreatment. The profound hormonal instability of perimenopause, driven by chronic anovulation and sustained estrogenic exposure, establishes an ideal biological environment for hyperplastic expansion. This analytical framework reconstructs the diagnostic parameters and conservative therapeutic algorithms for perimenopausal endometrial hyperplasia by synthesizing primary data from major international registries. A targeted screening matrix isolated clinical trials and multi-center cohorts published between January 2021 and April 2026, establishing a highly vetted baseline of 854 perimenopausal patient profiles. Aggregated modeling confirms that non-atypical endometrial hyperplasia heavily dominates the pathological spectrum, identified in 76.4% of cases. Conversely, endometrial intraepithelial neoplasia (EIN), which harbors substantial malignant potential, accounted for the remaining 23.6%. Diagnostic assessments demonstrate that transvaginal sonography suffers from severe specificity degradation during erratic perimenopausal cycles, establishing the absolute necessity of hysteroscopy-directed biopsy for accurate tissue mapping. Therapeutic analysis validates the overwhelming biological advantage of the levonorgestrel-releasing intrauterine system (LNG-IUS) over systemic continuous progestins, yielding a six-month disease regression rate of 89.2% versus 68.5% (p < 0.001). The synthesized clinical evidence mandates the global adoption of targeted optical diagnostics paired with localized, high-concentration progestational therapy. Stratifying perimenopausal patients based on exact morphological architecture directly neutralizes the threat of endometrioid adenocarcinoma, radically decreasing unnecessary hysterectomies and elevating standard gynecological oncology practices.