Thickening of the womb lining is something that concerns all gynaecologists. Why? It’s a condition called endometrial hyperplasia that may go on to become cancer of the womb.

Endometrial hyperplasia comes in two types – atypical and non-atypical. The atypical form carries an increased cancer risk. Non-atypical means the womb lining is thicker than normal but it is less likely to become cancerous. For women with the more dangerous atypical form, UK-wide guidance for care recommends a ­hysterectomy – surgery to remove the womb.

Those with non-atypical endometrial hyperplasia are recommended to have a trial of hormone treatment which is given directly into the womb. Regular follow-up monitoring with biopsies is vital to track potential progression to cancer. Edinburgh University researchers have now compared the ­effectiveness of the treatment patients received before and after the introduction of national guidance to see if things improved.

The study was conducted by lead teams from the universities of ­Edinburgh, Birmingham, Warwick, Oxford and University College London. They worked with the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UK ARCOG) – an organisation of doctors in speciality training in ­obstetrics and gynaecology that undertakes national audits to identify opportunities to improve the quality of care patients receive.

Researchers looked at anonymous patient records from more than 3,000 women across the UK who had been diagnosed with endometrial ­hyperplasia between 2012 and 2020. Half had non-atypical and half had atypia – the more dangerous form. The proportion of women with ­non-atypical endometrial hyperplasia who had successful hormone ­treatment increased from 38% to 52% after the new guidelines were introduced.

The initial treatment of women with atypia barely changed – 68% had a hysterectomy in 2012-15 compared to 67% in 2016-19. This dropped to 52% of women at the start of the Covid-19 pandemic in 2020, which indicated a shift away from best practice. But only one in five women with atypia, who didn’t have a ­hysterectomy, received the ­recommended schedule of follow-up ­monitoring.

In 2016-19, 37% of those diagnosed with atypical endometrial hyperplasia who had a hysterectomy had evidence of cancer when their wombs were examined after surgery. This means that women with atypia who don’t have a hysterectomy must have meticulous follow-up monitoring as a necessity.

Dr Michael Rimmer of Edinburgh University emphasises the crucial nature of follow-up appointments, pointing out there’s a need for better care of women who don’t have a hysterectomy, particularly considering their risk of developing cancer in the future.