Endometrial hyperplasia is when the lining of your uterus (endometrium) becomes too thick. Your endometrium is the lining that you shed during your menstrual period. It’s also the tissue that a fetus grows into during pregnancy. In some women endometrial hyperplasia can lead to endometrial cancer, a type of uterine cancer.
Healthcare providers classify endometrial hyperplasia based on the kinds of cell changes in your endometrial lining. Some types of endometrial hyperplasia greatly increase your risk for cancer and others don’t.
Types of endometrial hyperplasia include:
Simple or complex endometrial hyperplasia (without atypia): This type of endometrial hyperplasia has normal-looking cells that aren’t likely to become cancerous (“without atypia” means less likely to become cancer). This condition may improve without treatment or your provider may recommend treatment with hormones.
Simple or complex atypical endometrial hyperplasia (with atypia): If the type of endometrial hyperplasia is “atypical” or is “with atypia,” it has a higher chance of becoming cancer. Without treatment, your risk of endometrial or uterine cancer increases.
Endometrial hyperplasia is rare. It affects approximately 133 out of 100,000 women. It most commonly occurs in women who are transitioning to or just completed menopause (when you stop getting a menstrual period).
People with endometrial hyperplasia may experience:
A lot of these symptoms are common in people transitioning to menopause. Transitioning to menopause often means erratic periods or skipping periods and irregular bleeding. Talk to us about your symptoms so we can determine if checking for endometrial hyperplasia is necessary.
It’s possible that it can cause abdominal/pelvic pain or pain during intercourse (dyspareunia). However, abnormal bleeding is the most common symptom.
People with endometrial hyperplasia produce too much estrogen and not enough progesterone. These hormones play essential roles in menstruation and pregnancy. During ovulation, estrogen thickens your endometrium, while progesterone prepares your uterus for pregnancy. If conception doesn’t occur, progesterone levels drop. The progesterone drop triggers your uterus to shed its lining as your menstrual period.
People who have endometrial hyperplasia make little, if any, progesterone. As a result, your uterus doesn’t shed its endometrial lining. Instead, the lining continues to grow and thicken. The cells that make up the lining can grow close together and become irregular.
People in perimenopause or menopause are more likely to have endometrial hyperplasia. It rarely occurs in people younger than 35. Other risk factors include:
All types of hyperplasia can cause abnormal and heavy bleeding that can make you anemic. Anemia develops when your body doesn’t have enough iron-rich red blood cells.
Untreated atypical endometrial hyperplasia can become cancerous. Endometrial or uterine cancer develops in about 8% of women with untreated simple atypical endometrial hyperplasia. Close to 30% of women with complex atypical endometrial hyperplasia who don’t get treatment develop cancer.
Many conditions can cause abnormal uterine bleeding. To identify what’s causing your symptoms, the IWI team may order one or more of these tests:
Ultrasound: A transvaginal ultrasound uses sound waves to produce images of your uterus. The images can show if your uterine lining is too thick.
Biopsy: An endometrial biopsy removes tissue samples from your uterine lining. Pathologists study the cells under a microscope to confirm or rule out cancer.
Hysteroscopy: Your provider uses a thin, lighted tool called a hysteroscope to examine your cervix and look inside your uterus. Your provider may perform this procedure along with a dilation and curettage (D&C) or biopsy. With hysteroscopy, your provider can see abnormalities within the endometrial cavity and take a biopsy of any suspicious areas.
Treatment for most cases of endometrial hyperplasia involves taking progestin. Progestin is the human-made version of progesterone, the hormone your body is lacking. Progestin comes in many forms:
The IWI team may recommend a hysterectomy to remove your uterus if:
Certain steps may reduce your chances of developing endometrial hyperplasia:
Endometrial hyperplasia responds well to progestin treatments. Atypical endometrial hyperplasia can lead to endometrial or uterine cancer. We may recommend more frequent ultrasound exams, biopsies or a hysterectomy to eliminate the chances of it turning into cancer. We will base our recommendation on your diagnosis and health history.
No, not always. The risk of developing cancer ranges anywhere from 8% to 30% depending on the type of endometrial hyperplasia you have. Only certain types of endometrial hyperplasia lead to cancer. Your II team member can discuss the type you have and recommend the best treatment based on your health history and your overall risk for cancer.
If you have endometrial hyperplasia, you may want to ask your healthcare provider:
What type of endometrial hyperplasia do I have?
Am I at increased risk for endometrial or uterine cancer? If so, how can I lower that risk?
What’s the best treatment for the type of endometrial hyperplasia I have?
What are the treatment risks and side effects?
Are my family members at risk for developing endometrial hyperplasia? If so, what can they do to lower that risk?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?
Endometrial hyperplasia tends to occur in people who are transitioning to menopause or who have gone through menopause. The average age of menopause is 51 years old. People between 50 and 60 are most likely to develop endometrial hyperplasia.
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