How should I approach the management of a patient diagnosed with simple endometrial hyperplasia without atypia?

Management of simple endometrial hyperplasia without atypia primarily involves progestogen therapy to reverse the hyperplasia and reduce the risk of progression to endometrial cancer. This can be achieved using oral progestogens or a levonorgestrel-releasing intrauterine system (LNG-IUS), which is often preferred due to its efficacy and local effect.

Regular follow-up with endometrial sampling is recommended to ensure regression of hyperplasia. If the hyperplasia persists or recurs despite medical treatment, referral to specialist care for further evaluation and management is advised.

Hysterectomy is generally reserved for women who do not respond to medical treatment, have recurrent hyperplasia, or have other indications such as coexisting pathology or completed childbearing.