Your pathology report for disordered proliferative endometrium

by Adnan Karavelic, MD FRCPC
September 5, 2025

Disordered proliferative endometrium is a non-cancerous change that affects the endometrium, which is the inner lining of the uterus. It develops when the endometrium is repeatedly exposed to estrogen without the balancing effect of progesterone. Under the microscope, the glands in the endometrium look irregular and disorganized, but the changes are not considered precancerous.

If untreated, disordered proliferative endometrium can sometimes progress to another benign condition called endometrial hyperplasia, but it does not by itself increase the risk of endometrial cancer.

What causes disordered proliferative endometrium?

This condition develops when the endometrium is exposed to long-term, unopposed estrogen stimulation. Unopposed means that estrogen is not balanced by progesterone, the hormone that normally counteracts estrogen’s effect on the endometrium.

Situations where unopposed estrogen may occur include:

  • Perimenopause, when hormone levels fluctuate and ovulation becomes less regular.

  • Polycystic ovary syndrome (PCOS), which can cause chronic anovulation (lack of ovulation).

  • Excess body fat, because fat tissue can produce estrogen.

  • Prolonged estrogen therapy without progesterone.

Over time, this unbalanced hormone exposure causes the endometrial glands to grow abnormally, resulting in the changes seen in disordered proliferative endometrium.

What are the symptoms of disordered proliferative endometrium?

Some women may not have symptoms, and the condition may only be discovered during a biopsy for another reason. When symptoms do occur, they may include:

  • Irregular menstrual bleeding.

  • Heavy or prolonged periods.

  • Bleeding between periods.

  • In postmenopausal women, unexpected vaginal bleeding.

These symptoms can also be caused by other conditions, so further evaluation is often needed.

Is disordered proliferative endometrium associated with an increased risk of cancer?

No. Current evidence suggests that disordered proliferative endometrium is not directly linked to an increased risk of endometrial cancer. However, because it reflects unopposed estrogen exposure, which is itself a risk factor for endometrial hyperplasia and cancer, it is important to monitor and address the underlying cause.

How is this diagnosis made?

The diagnosis is made after a sample of endometrial tissue is removed and examined under the microscope by a pathologist.

This can be done with:

  • An endometrial biopsy, which removes a small piece of tissue.

  • A dilation and curettage (D&C), which scrapes tissue from the uterus.

The pathologist looks for irregular and crowded glands with an abnormal growth pattern but without the atypical features that would suggest precancer or cancer.

What are the treatment options for disordered proliferative endometrium?

Treatment depends on the underlying cause, symptoms, and whether the woman is premenopausal or postmenopausal.

Options may include:

  • Hormonal therapy, such as progesterone pills or an intrauterine device (IUD) that releases progesterone, to balance the effects of estrogen.

  • Lifestyle changes, such as weight loss, which can reduce excess estrogen production.

  • Treatment of PCOS or other hormonal disorders.

  • Monitoring with repeat biopsies or imaging in some cases.

Because this diagnosis often reflects hormone imbalance, treating the cause of the imbalance is the most effective approach.

What happens next?

Disordered proliferative endometrium is a descriptive diagnosis that should be considered together with your symptoms, medical history, physical examination, and other test results. Your doctor will use this information to decide if treatment is needed.

Questions to ask your doctor

  • What is the likely cause of my disordered proliferative endometrium?

  • Do I need treatment with hormones or other therapy?

  • How will this condition affect my risk of developing endometrial hyperplasia or cancer in the future?

  • Should I have follow-up testing, such as a repeat biopsy or ultrasound?

  • What changes should I watch for in my symptoms?

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