What follow-up protocols should be implemented for patients treated for endometrial hyperplasia to monitor for progression or recurrence?

Follow-up protocols for patients treated for endometrial hyperplasia should include regular clinical assessment and endometrial sampling to monitor for disease progression or recurrence.

Specifically, patients should have periodic endometrial biopsies or hysteroscopies to detect persistent or recurrent hyperplasia, especially if initial treatment was conservative or hormonal.

Follow-up intervals depend on the initial histological findings and treatment modality but typically involve reassessment within 3 to 6 months after treatment initiation, then annually if stable.

Women with atypical hyperplasia or those at higher risk (e.g., obese, tamoxifen users) require closer surveillance due to increased risk of progression to endometrial carcinoma.

Any new or persistent abnormal uterine bleeding should prompt urgent re-evaluation.

Imaging such as transvaginal ultrasound may be adjunctive but is not sufficient alone to exclude recurrence or progression.

Referral to specialist gynaecology services is advised if there is suspicion of progression or if conservative management fails.

These protocols align with NICE recommendations on managing endometrial pathology and heavy menstrual bleeding, emphasizing targeted biopsy during hysteroscopy and avoiding blind sampling.