Endometrialhyperplasiais a thickening of the lining of the uterus due to a hormonal imbalance.
Endometrial hyperplasia may lead to various symptoms, such as heavy menstrual periods, spotting, and post-menopausal bleeding.
This article discusses the symptoms, causes, and risk factors of endometrial hyperplasia.
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It also covers how it’s diagnosed and treated.
What Are the Symptoms of Endometrial Hyperplasia?
Endometrial hyperplasia can causeabnormal uterine bleeding.
What Causes Endometrial Hyperplasia?
When balanced with the right amount of progesterone, your endometrium builds up, but then thins out.
When there is too much estrogen, the lining is overstimulated and continues to thicken.
Over time, that thickened lining begins to develop abnormal changes.
Is Endometrial Hyperplasia Hereditary?
What Are the Risk Factors of Endometrial Hyperplasia?
If your BMI is over 35, you have a significantly increased risk of developing endometrial hyperplasia.
If you don’t ovulate, your ovary won’t increase its production of progesterone.
This increase in progesterone is necessary for the lining of your uterus to shed.
In other words, you wont get your period.
In some types of anovulatory cycles, this leads to too much estrogen compared to progesterone.
This unbalanced estrogen results in abnormal thickening of the endometrium.
Eventually, you will have some bang out ofabnormal uterine bleeding.
This may cause irregular and heavy periods or bleeding between your periods.
One example is estrogen replacement.
This helps prevent your endometrium from being overstimulated when taking estrogen.
Another hormonal medication that can cause abnormal thickening of the endometrium is tamoxifen.
Tamoxifen is a drug that is called a selective estrogen receptor modulator or SERM.
SERMs are drugs that affect the estrogen-sensitive parts of your body in different ways.
Tamoxifen is often used in the treatment of hormone-sensitive breast cancers.
That’s because it opposes the effects of estrogen in the breast tissue.
However, tamoxifen stimulates the estrogen receptors in the lining of the uterus.
It acts like an estrogen and can cause endometrial hyperplasia.
See your healthcare provider if you are using hormone replacement therapy or tamoxifen and develop abnormal uterine bleeding.
Estrogen-Producing Ovarian Tumors
Hormone-producing tumors are not a common cause of endometrial hyperplasia.
However, there are certain (usually benign) ovarian tumors that produce excess estrogen.
How Is Endometrial Hyperplasia Diagnosed?
The pathologist will then comment on whether there are abnormal looking cells in the thickened endometrium.
If the cells are normal, the condition is classified as hyperplasia without atypia.
If they are abnormal, the condition is classified as atypical hyperplasia.
The abnormal cells seen in atypical hyperplasia are considered precancerous.
Endometrial hyperplasia is notendometrial cancer.
How Is Endometrial Hyperplasia Treated?
It is very important that all endometrial hyperplasia be closely followed or treated.
The course of treatment will depend on whether or not there is atypia, or abnormal cells.
Modifying Risk Factors
The first line of treatment is to look for risk factors that you could change.
This will allow the lining of your uterus to reset itself.
This can include the levonorgestrel IUD (Mirena).
If your BMI is over 35, the progesterone treatment may not work well unless you also lose weight.
You should discuss with your healthcare provider which throw in of progesterone treatment is best for you.
This helps to assure that the endometrial hyperplasia is gone and doesnt come back.
Hysterectomy
Experts say that ahysterectomyshould not be offered as a first-line treatment option for endometrial hyperplasia without atypia.
That’s because of the overall effectiveness of progesterone treatment and the lowrisk of developing endometrial cancer.
Treatment is a bit more aggressive because of that increased risk.
In fact, experts recommendhysterectomyas the first-line treatment for atypical hyperplasia in individuals who are done having children.
Preferably, this would be with the levonorgestrel IUD.
You will have more frequent endometrial sampling to assure that the atypical hyperplasia has been treated adequately.
Your healthcare provider will likely suggest having a hysterectomy after you are done having children.
That’s because atypical endometrial hyperplasia has a high likelihood of recurrence.
Endometrial hyperplasia can be classified as one of two types.
Hyperplasia without atypia has normal-looking cells, and atypical hyperplasia has abnormal cells considered precancerous.
You may also take progesterone treatments.
If you have atypical hyperplasia, a precancerous condition, your healthcare provider may recommend a hysterectomy.
Sobczuk K, Sobczuk A.New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Prz Menopauzalny.
2017;16(3):107-111. doi:10.5114/pm.2017.70589
Mount Sinai.Vaginal or uterine bleeding-overview.
American Cancer Society.Signs and symptoms of endometrial cancer.
Rafique S, Decherney AH.Medical management of endometriosis.Clin Obstet Gynecol.
2020;126(12):2775-2783. doi:10.1002/cncr.32822
American Cancer Society.Endometrial cancer risk factors.
2022;306(2):407-421. doi:10.1007/s00404-021-06380-5
Spaczynski RZ, Duleba AJ.Diagnosis of endometriosis.Semin Reprod Med.
2003;21(2):193-208. doi:10.1055/s-2003-41326
Royal College of Obstetricians and Gynaecologists.Management of endometrial hyperplasia.
2015;58(6):468-474. doi:10.5468/ogs.2015.58.6.468
Yale Medicine.Endometrial hyperplasia.
