Background: Endometrial hyperplasia is defined as a thickening of the endometrium, characterized by an increased gland-to-stroma ratio and proliferation of glands that are irregular in size and shape. It is primarily caused by prolonged exposure to unopposed estrogen. The exact source of this hormonal imbalance is still under investigation, with the ovarian stroma emerging as a possible contributor that may enhance estrogen production. Studying these histomorphological changes in both the endometrium and ovary may help to elucidate the hormonal interplay between these two organs in endometrial hyperplasia.

Objectives: To evaluate the histopathological patterns of endometrial hyperplasia in and to identify and categorize ovarian stromal changes (such as stromal hyperplasia, luteinization, or hyperthecosis) in the same patients and to assess the association endometrial hyperplasia and specific ovarian stromal changes.

Materials: This retrospective study included 53 women diagnosed with endometrial hyperplasia on total hysterectomy specimens with unilateral or bilateral salpingo-oophorectomy, received in the Department of Pathology at our institute from January 2023 to January 2025. Endometrial findings were correlated with histomorphological changes in the ovaries.

Results: Most patients were between 45 and 50 years of age. Of the 53 cases, 49 (92. 45%) were classified as hyperplasia without atypia and 4 (7. 54%) as atypical hyperplasia. Ovarian stromal changes were observed in 46 cases (86. 79%), while 7 cases (13. 2%) showed no notable changes. Among the 46 cases with ovarian alterations, the following changes were noted (some in combination)-Stromal hyperplasia (which was Major finding): 75% (40 cases), Stromal luteinization: 67% (36 cases), Stromal thecosis: 7. 5% (4 cases), Interstitial glands:5% (8 cases), Serous cysts: 43% (23 cases), Mucinous cysts: 9% (5 cases), Follicular cysts: 56% (30 cases).