Endometrial hyperplasia is a thickening of the endometrium. The endometrium is the inside lining of the uterus. The thickened lining is not cancer however in some cases it can progress to uterine cancer.
Endometrial hyperplasia is most often seen in menopause when hormone changes are present. It can also occur in pre-menopausal women when certain conditions or risk factors exist. The most common cause is excess estrogen along with low or absent progesterone. This hormone imbalance leads to a thickened uterine lining.
Risk factors for endometrial hyperplasia include:
- Estrogen only HRT (hormone replacement therapy) with uterus present
- Never been pregnant
- Age greater than 35
- Tamoxifen therapy which is given to treat patients with a history of breast cancer
- A history of diabetes or Polycystic Ovarian Syndrome (PCOS)
- A family history of uterine cancer
- Cigarette smoking
The most common symptom is abnormal bleeding. Any bleeding in menopause should be evaluated. Pre-menopausal women may experience heavier or longer periods. Others have spotting or bleeding between periods. Also there are some women that have an abnormal Pap smear.
If you are over 35 with abnormal bleeding or under 35 with persistent bleeding that is not relieved with medication then an evaluation for hyperplasia should be performed. The first step in the process is a pelvic ultrasound to evaluate and measure the thickness of the uterine lining. If the endometrium is thick and/or appears irregular then a sample of the lining is performed to rule out hyperplasia. A sample can be obtained by an office biopsy (endometrial biopsy) or a surgical procedure called a dilation and curettage (D&C).
Endometrial hyperplasia is categorized as simple or complex with or without atypical cells. The risk for uterine cancer increases as the lining becomes more complex or contains atypical cells. Treatment options include hormone therapy with progesterone or surgical treatment with a hysterectomy (remove the uterus). If there are no atypical cells or there is a desire for childbearing then hormone treatment is a consideration. Atypical cells increase the risk of uterine cancer therefore surgery is preferred if a woman is done with having children.
Endometrial hyperplasia is a condition of the uterine lining that can be treated. Prevention is the goal whenever possible. To decrease the risk of hyperplasia. It is recommended to lose weight if you are obese, use birth control if your periods are very irregular or infrequent, and if on HRT be sure to take progesterone if you are taking estrogen and have your uterus.
Kimberly Hartzfeld, DO, FACOG