Best Practice Recommendations for Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia in the Military Health System.

This article focuses on the management of endometrial intraepithelial neoplasia or atypical endometrial hyperplasia (EIN-AEH), a precancerous condition to endometrial carcinoma (EC), within the U.S. military health system (MHS). It highlights the challenges posed by limited access to gynecologic oncologists (GOs) in military settings and proposes a decision tree to guide referrals and management by either gynecologic specialists (GSs) or GOs based on geographic proximity, risk factors, and patient preferences. The protocol emphasizes thorough evaluation including hysteroscopic biopsy, pelvic ultrasound, and immunohistochemical testing for mismatch repair (MMR) proteins and p53 to identify patients at higher risk of concurrent EC or hereditary cancer syndromes such as Lynch syndrome. Definitive treatment is total hysterectomy for patients who have completed childbearing, while conservative progestin therapy with close surveillance is reserved for select patients desiring fertility preservation or with surgical contraindications. The article advocates for individualized, multidisciplinary care to optimize outcomes while addressing the unique logistical and operational constraints of military medicine.