Background: In the hyperplasia cases of the endometrium, benign stromal and endometrial cells are seen in groups depicting the change in their growth patterns. Aim: The present study aimed to assess the role of BCL-2 and p53 (apoptosis markers) and hypoxia as shown by Hif-1α in developing the hyperplastic processes of the endometrium. Methods: The study assessed 92 tissues from the endometrium of perimenopausal age range females aged 45-55 years and late reproductive-aged females in the age range of 35-45 years that were arranged in 6 groups along with two control groups for late reproductive and perimenopausal age range. 1, 2, 3, 4, 5, and 6 included 16, 18, 11, 15, 19, and 13 females respectively from normal endometrium, females from late reproductive age having hyperplasia without atypia, females from late reproductive age having atypical hyperplasia, perimenopausal females with no proliferative tissue changes, perimenopausal females with no atypical hyperplasia, and perimenopausal females with atypical hyperplasia. All females were subjected to immunohistochemical assessment. Results: Increased Hif-1α levels in endometrial cells having atypical hyperplasia depicting hypoxia of endometrium which can lead to pathology. However, it was statistically non-significant, it can lead to atypia hyperplasia in females of perimenopausal and late reproductive age with Hif-1α of 2.07±0.05 and 1.87±0.07 units respectively. In perimenopausal and late reproductive-aged females, in epithelial cells, raised p53 levels were seen. In females with atypia in late reproductive and perimenopausal age, BCL-2 indicator levels were high compared to females without hyperplasia (p=0.01). Conclusion: The present study concludes that in the development of hyperplastic processes of the endometrium, hypoxia plays a vital role along with the apoptotic marker changes seen in the endometrium tissues.