The most common presenting symptom of endometrial hyperplasia is abnormal uterine bleeding. In the UK, hysteroscopy remains the gold standard of investigations for abnormal uterine bleeding. The clinical importance of endometrial hyperplasia largely relates to the risk of progression to endometrial carcinoma. Progestin therapy is appropriate for most women with endometrial hyperplasia without atypia. The risk of endometrial carcinoma in the presence of cytological atypia deems hysterectomy an appropriate management. Learning objectives: To learn about the aetiology and pathology of endometrial hyperplasia. To be able to select appropriate investigations and treatment. Ethical issues: When is it appropriate to perform hysterectomy for the treatment of endometrial hyperplasias? Please cite this article as: Palmer JE, Perunovic B, Tidy JA. Endometrial hyperplasia. The Obstetrician & Gynaecologist 2008;10:211–216.