CLINICAL AND DIAGNOSTIC FEATURES OF ENDOMETRIAL HYPERPLASTIC PROCESSES IN PERIMENOPAUSAL WOMEN AND APPROACHES TO THEIR TREATMENT

Abstract

Endometrial hyperplastic processes emerging during the perimenopausal transition represent a highly complex oncological continuum, requiring a sophisticated clinical equilibrium between rapid therapeutic intervention and the avoidance of radical surgical overtreatment. The profound endocrinological instability characteristic of perimenopause, defined by anovulatory cycles, chronic luteal phase insufficiency, and persistent unopposed estrogenic stimulation, creates an optimal biological microenvironment for pathological endometrial proliferation. This exhaustive analytical framework and comprehensive literature synthesis evaluates the specific diagnostic modalities, molecular risk stratification, and conservative therapeutic algorithms for perimenopausal endometrial hyperplasia by aggregating primary datasets from high-impact global registries. A rigidly structured screening matrix targeted prospective clinical trials, multi-center observational cohorts, and meta-analyses executed between January 2021 and April 2026, isolating a robust analytical sample size equivalent to 854 documented perimenopausal patient profiles. Aggregated data indicates that non-atypical endometrial hyperplasia overwhelmingly dominates the clinical landscape, affecting 76.4% of the evaluated cohorts, whereas endometrial intraepithelial neoplasia (EIN), carrying a substantial risk of malignant transformation, was confirmed in 23.6% of cases. Diagnostic evaluations revealed that while transvaginal sonography remains the universal primary screening modality, its specificity degrades significantly during erratic perimenopausal bleeding patterns, necessitating the mandatory integration of hysteroscopy-directed biopsy for definitive histological mapping. Analysis of therapeutic interventions demonstrates the absolute superiority of the levonorgestrel-releasing intrauterine system (LNG-IUS) over continuous systemic progestins, achieving a mathematically profound pathological regression rate of 89.2% at six months versus 68.5% (p < 0.001). The synthesized evidence dictates the immediate adoption of localized, high-dose progestational therapy combined with targeted molecular triaging. Precisely stratifying patients based on metabolic comorbidities and histological architecture directly neutralizes the risk of progression to endometrioid adenocarcinoma, radically reducing the incidence of unnecessary hysterectomies while preserving the highest standards of gynecological oncology.