An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding

OBJECTIVE: We sought to determine the clinical risk factors for endometrial hyperplasia in premenopausal women with abnormal bleeding. STUDY DESIGN: A laboratory database was searched to identify all endometrial samples taken in 1033 premenopausal women over a 30-month period from January 1995 to July 1997. Clinical data were extracted from the patients' clinical records retrospectively, and univariate and multivariate analyses were performed. The setting was the gynecologic service of a large teaching hospital. RESULTS: There were 46 cases of endometrial hyperplasia and 5 cases of endometrial cancer diagnosed. The following factors were independently associated with increased risk of endometrial hyperplasia or the presence of carcinoma: age greater than or equal to 45 years (odds ratio, 3.1;95% confidence interval, 1.5-6.1), weight greater than or equal to 90 kg (odds ratio, 5.5; 95% confidence interval, 2.9-10.6), history of infertility (odds ratio, 3.6; 95% confidence interval, 1.3-9.9), family history of colonic carcinoma (odds ratio, 5.0; 95% confidence interval, 1.3-19.1), and nulliparity (odds ratio, 2.8; 95% confidence interval, 1.1-7.2). There was no increased association of endometrial hyperplasia on the basis of irregularity of menstrual cycle or duration of menstrual bleeding. CONCLUSIONS: The following are risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding: body weight greater than or equal to 90 kg, age greater than or equal to 45 years, infertility, family history of colonic carcinoma, and nulliparity. Current guidelines may need to be reconsidered.