Author summary Why was this study done? New national guidance was introduced in the United Kingdom with recommendations for the care and surveillance of people with endometrial hyperplasia (EH). Comparing patterns of care with these recommendations has identified opportunities for improvement. What did the researchers do and find? After the guidance, medical treatment of non-atypical hyperplasia increased and more patients achieved histological regression, avoiding hysterectomy. Surveillance of hyperplasia for those who do not undergo hysterectomy could be improved. A greater proportion of women with atypia diagnosed in 2020 commenced medical management and fewer underwent hysterectomy; the impact of the pandemic on care must be considered as a contributory factor towards this. What do these findings mean? This work has identified where the care of patients with EH diverged from recommended guidance. Clinicians may use these findings to review their local care pathways and qu