Endometrial Hyperplasia

Endometrial hyperplasia is when the lining of your uterus (endometrium) becomes too thick. It often causes abnormal uterine bleeding. In some cases, it can lead to endometrial cancer, a type of uterine cancer.

Endometrial hyperplasia most commonly affects people who are transitioning to or have just completed menopause (when you stop getting a period).

Hormone therapy helps manage most cases of this condition. But you may need other treatments.

Types

Healthcare providers classify endometrial hyperplasia based on the number of cells and the presence of cell changes in your endometrium. Types include:

• Endometrial hyperplasia (without atypia): The cells look normal and aren’t likely to become cancerous. It may improve without treatment, or your provider may recommend hormonal treatment. This is the most common type.
• Endometrial intraepithelial neoplasia (EIN): The cells have a high chance of becoming cancerous. Treatment is necessary to prevent endometrial cancer. Hysterectomy is the only way to cure it. Another name for this type is atypical endometrial hyperplasia.

Your healthcare provider may also use the terms “simple” or “complex” when they classify the condition. Simple means the cells are mildly crowded. Complex means the cells are highly crowded.

Symptoms of endometrial hyperplasia

The main symptom of endometrial hyperplasia is abnormal uterine bleeding. This can look like:

• Bleeding between periods
• Short menstrual cycles (fewer than 21 days)
• Heavy menstrual bleeding
• A longer period than usual
• Bleeding after menopause

A lot of these symptoms are common when you go into menopause. Talk to your healthcare provider about your symptoms and medical history. They can determine if checking for a thickened endometrium is necessary.

Endometrial hyperplasia causes

Endometrial hyperplasia happens when your body has too much estrogen and not enough progesterone.

As a result, your uterus doesn’t shed its lining. Instead, the lining continues to grow and thicken. The cells that make up the lining can grow close together and become irregular.

Risk factors

You’re more likely to develop endometrial hyperplasia if you’re in perimenopause or menopause. It rarely occurs in people younger than 35.

Other risk factors include:

• Obesity
• Early age for menstruation (under 12 years)
• Late onset of menopause (over 55 years)
• Long history of irregular or absent periods
• Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as PCOS
• Estrogen-secreting tumors
• Lynch syndrome
• Never being pregnant (nulliparity)

Complications

All types of endometrial hyperplasia can cause heavy bleeding that leads to anemia. You may often feel weak, tired and dizzy. Anemia needs treatment.

Untreated atypical endometrial hyperplasia may become cancerous.

How doctors diagnose endometrial hyperplasia

Many conditions can cause abnormal uterine bleeding. To find what’s causing your symptoms, your healthcare provider may recommend one or more of these tests:

• Transvaginal ultrasound: Your provider inserts a small, thin wand into your vagina. It uses sound waves to create pictures, which can show if you have a thickened endometrium.
• Endometrial biopsy: Your provider removes tissue samples from your uterine lining. Pathologists study the cells under a microscope.
• Hysteroscopy: Your provider uses a thin, lighted tool to look inside your uterus. They can check for abnormalities and take a biopsy of any suspicious areas.

How is it treated?

For most cases of endometrial hyperplasia, treatment involves taking progestin. Progestin is the manufactured version of progesterone. Progestin comes in many forms, including:

• Birth control pills
• Hormonal intrauterine device (IUD)
• Injection (Depo-Provera^®)
• Vaginal cream or gel

Your healthcare provider may recommend a hysterectomy to remove your uterus if:

• The condition worsens, or cancerous cells develop.
• The condition doesn’t improve with progestin treatment.

What can I expect if I have this condition?

Endometrial hyperplasia often responds well to progestin treatments.

Your healthcare provider may recommend more frequent ultrasound exams and biopsies to keep an eye on cell changes. They may recommend a hysterectomy to eliminate the chances of atypical endometrial hyperplasia turning into cancer.

Stay in touch with your provider and don’t hesitate to ask questions.

How long does it take before endometrial hyperplasia becomes cancer?

Endometrial hyperplasia doesn’t always lead to cancer. The risk is higher when it’s atypical. One study shows the risk of atypical endometrial hyperplasia progressing to endometrial cancer is about 8% per year after diagnosis. But each case is different.