What is Endometrial Hyperplasia
Endometrial hyperplasia is abnormal thickening of the tissue that lines the inside of the uterus (endometrium). This condition can also cause cell changes (atypia) that can lead to endometrial cancer.
There are four types of endometrial hyperplasia:
- Endometrial thickening only (simple hyperplasia).
- Endometrial thickening and crowding of cells (complex hyperplasia).
- Endometrial thickening and cell changes (simple atypical hyperplasia). This type has a low risk of becoming cancerous.
- Endometrial thickening, cell crowding, and cell changes (complex atypical hyperplasia). This type has a higher risk of becoming cancerous.
Early diagnosis and treatment are important to reduce the risk of cancer.
What are the causes?
This condition is caused by an imbalance of the reproductive hormones estrogen and progesterone. At the beginning of your menstrual cycle, your ovaries make estrogen. This thickens the lining of your uterus to prepare for pregnancy. If pregnancy does not occur, your estrogen level drops. Then, the hormone progesterone prompts your body to shed the lining of your uterus. This is your menstrual period. Endometrial hyperplasia results from too much estrogen and not enough progesterone.
What increases the risk?
The following factors may make you more likely to develop this condition:
- Being older than 35 years of age. The condition is most common just before or after menopause. Menopause means 12 months without a menstrual period.
- Taking an estrogen medicine or a medicine that acts like estrogen.
- Having polycystic ovary syndrome (PCOS).
- Being overweight.
- Smoking.
- Having diabetes.
- Having irregular periods.
- Having started periods early.
- Having started menopause late.
- Never having been pregnant.
- Having a family history of uterine, ovarian, or colon cancer.
- Having other diseases such as gallbladder or thyroid disease.
What are the signs or symptoms?
The main symptom of this condition is abnormal vaginal bleeding. The bleeding may:
- Be heavier and longer during menstrual periods.
- Happen more often than a normal menstrual cycle.
- Occur after menopause.
How is this diagnosed?
This condition may be diagnosed based on:
- Your symptoms and medical history, including risk factors.
- A physical exam.
- Tests,
such as:
- An imaging study done with sound waves (transvaginal ultrasound) to check the endometrium. This test uses a sound wave probe that is inserted into your vagina.
- A procedure to take a sample of endometrial tissue through the vagina so it can be looked at under a microscope (endometrial biopsy).
- A procedure in which tissue is scraped or suctioned from the inside of the uterus (dilation and curettage).
- A procedure in which a thin, lighted device is inserted into the uterus through the cervix to see inside the uterus (hysteroscopy).
How is this treated?
Treatment for this condition depends on the type of hyperplasia that you have. Synthetic progesterone (progestin) is the most common treatment. Progestin can be given as a pill, injection, or vaginal cream, or as a device that is implanted in your uterus (intrauterine device, IUD).
If you have hyperplasia with atypia, you may need surgery to remove your uterus (hysterectomy). You may be more likely to have this procedure if:
- You have complex atypical hyperplasia.
- You are past menopause.
- You do not want to become pregnant.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
- Lose weight if you are overweight. Ask your health care provider to recommend a diet and exercise program to help you reach and maintain a healthy weight.
Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have periods that are heavier or last longer than usual.
- You have your period more often than usual.
- You have vaginal bleeding after menopause.
Get help right away if:
- You have vaginal bleeding that is so heavy that you need to change your tampon or sanitary napkin after less than 2 hours.
- You pass blood clots that are larger than the size of a quarter.
Summary
- Endometrial hyperplasia is abnormal thickening of the tissue that lines the inside of the uterus (endometrium).
- The main symptom of this condition is abnormal vaginal bleeding. This may be heavier, longer, or more frequent periods, or it may be vaginal bleeding after menopause.
- Some types of hyperplasia also cause cell changes (atypia) that can lead to cancer.
- Always let your health care provider know about abnormal vaginal bleeding.
- Early diagnosis and treatment are important to reduce the risk of cancer.
