# Clinical characteristics, prognosis, and fertility outcomes in patients with simple and complex endometrial hyperplasia: a comparative analysis

## TL;DR

This study compares clinical features, outcomes, and fertility in patients with simple and complex endometrial hyperplasia, finding that complex hyperplasia has worse prognosis and lower fertility rates.

## Contribution

The study identifies specific risk factors and treatment effects for complex versus simple endometrial hyperplasia, particularly on fertility outcomes.

## Key findings

- Complex hyperplasia has lower reversal rates and higher progression and canceration risks compared to simple hyperplasia.
- Live birth rates are significantly lower in patients with complex hyperplasia.
- LNG-IUS treatment improves prognosis for endometrial hyperplasia patients.

## Abstract

To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometrial hyperplasia (SH).

Collected the medical records of 616 premenopausal endometrial hyperplasia (EH) patients from January 2012 to October 2023, of which 419 SH patients and 197 CH patients were included in the study. All the patients were followed up at least 12 months, and asked about the follow-up treatment plan, review, pregnancy and reproductive outcome of the patients with reproductive needs.

Obesity (P = 0.044), having diabetes or insulin resistance (P = 0.032) and polycystic ovary syndrome (PCOS) (P < 0.001) are risk factors for the occurrence of CH, while gravidity ≥ 1 (P = 0.045) is a protective factor for the occurrence of CH. Compared with the SH group, the reversal rate in the CH group was significantly lower (69.7% vs 83.6%, P < 0.001), while the rate of persistence, progression, recurrence and canceration were higher (P < 0.001). Compared with no treatment, oral progesterone (P < 0.001) and levonorgestrel-releasing intrauterine system (LNG-IUS) treatment (P < 0.001) could improve the prognosis of patients with EH. The live birth rate of the CH group was obviously lower than that of the SH group ( 42.3% VS 61.1%, P = 0.038). CH (OR = 2.68, 95%CI 1.12–6.39, P = 0.043) is an independent risk factor affecting the live birth rate of patients with EH.

Obesity, diabetes, insulin resistance, PCOS and nulligravidity are risk factors for patients with EH, while gravidity ≥ 1 served as a protective factor, particularly against CH. The type of hyperplasia is associated with a low live birth rate. The prognosis of EH patients is usually poor, with a low reversal rate and a long reversal time. However, LNG-IUS can improve their prognosis.

The online version contains supplementary material available at 10.1007/s00404-026-08356-9.