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This study aimed to evaluate risk factors for endometrial intraepithelial neoplasia/malignancy in premenopausal women with abnormal uterine bleeding or oligomenorrhea. Specifically, we aimed to elucidate whether body mass index (BMI) or age confers a higher risk. A retrospective cohort study was performed at a large academic center examining risk factors for endometrial hyperplasia/malignancy in premenopausal women undergoing endometrial sampling. Of the 4170 women ages 18–51 who underwent endometrial sampling from 1987 to 2019, 77 (1.85%) were found to have endometrial intraepithelial neoplasia or malignancy. Clinical predictors of EIN/malignancy in this population included obesity (OR: 3.84, 95%,  p  &lt; .001), Body mass index [(OR30  vs.  25:2.11,  p  &lt; .001) and OR35  vs.  30: 1.65,  p  &lt; .001], Diabetes (OR: 3.6,  p -value &lt;.001), hormonal therapy use (OR: 2.93,  p  &lt; .001), personal history of colon cancer (OR: 9.90,  p  = .003), family history of breast cancer (OR: 2.65,  p  &lt; .001), family history of colon cancer (OR: 3.81,  p  &lt; .001), and family history of endometrial cancer (OR: 4.92,  p  = .033). Age was not significantly associated with an increased risk of disease. Adjusting for other factors, a model using BMI to predict the risk of EIN/malignancy was more discriminative than a model based on age. Increased BMI, may be more predictive of endometrial hyperplasia/malignancy than age in premenopausal women with abnormal uterine bleeding. Modification of evaluation guidelines in a contemporary demographic setting could be considered.

Should body mass index replace age to drive the decision for endometrial sampling in premenopausal women with abnormal uterine bleeding?