What is endometrial hyperplasia?
Endometrial hyperplasia is a condition of the female reproductive system. The lining of the uterus (endometrium) becomes unusually thick because of having too many cells (hyperplasia). It’s not cancer, but in certain women, it raises the risk of developing endometrial cancer, a type of uterine cancer.
How common is endometrial hyperplasia?
Endometrial hyperplasia is rare. It affects approximately 133 out of 100,000 women.
Who might have endometrial hyperplasia?
Women who are perimenopausal or menopausal are more likely to have endometrial hyperplasia. It rarely occurs in women younger than 35. Other risk factors include:
- Certain breast cancer treatments (tamoxifen).
- Early age for menstruation or late onset of menopause.
- Family history of ovarian, uterine or colon cancer.
- Gallbladder disease.
- Hormone therapy.
- Never being pregnant.
- Polycystic ovary syndrome (PCOS).
- Thyroid disease.
- White race.
- Long history of irregular or absent menstruation.
What are the types of endometrial hyperplasia?
Doctors classify endometrial hyperplasia based on the kinds of cell changes in the endometrial lining. Types of endometrial hyperplasia include:
- Simple endometrial hyperplasia (without atypia): This type of endometrial hyperplasia has normal-looking cells that aren’t likely to become cancerous. This condition may improve without treatment. Hormone therapy helps in some cases.
- Simple or complex atypical endometrial hyperplasia: An overgrowth of abnormal cells causes this precancerous condition. Without treatment, your risk of endometrial or uterine cancer increases.
Symptoms and Causes
What causes endometrial hyperplasia?
Women who develop endometrial hyperplasia produce too much estrogen and not enough progesterone. These female hormones play essential roles in menstruation and pregnancy. During ovulation, estrogen thickens the endometrium, while progesterone prepares the uterus for pregnancy. If conception doesn’t occur, progesterone levels drop. The progesterone drop triggers the uterus to shed its lining as a menstrual period.
Women who have endometrial hyperplasia make little, if any, progesterone. As a result, the uterus doesn’t shed the endometrial lining. Instead, the lining continues to grow and thicken.
Additionally, obesity contributes to the elevation of estrogen levels. The adipose tissue (fat stores in the abdomen and body) can convert the fat producing hormones to estrogen. This is the how obesity contributes to elevated circulating levels of estrogen and increases the risk of endometrial hyperplasia.
What are the symptoms of endometrial hyperplasia?
Women with endometrial hyperplasia may experience:
Diagnosis and Tests
How is endometrial hyperplasia diagnosed?
Many conditions can cause abnormal bleeding. To identify what’s causing symptoms, your healthcare provider may order one or more of these tests:
- Ultrasound: A transvaginal ultrasound uses sound waves to produce images of the uterus. The images can show if the lining is thick.
- Biopsy: An endometrial biopsy removes tissue samples from the uterus lining. Pathologists study the cells to confirm or rule out cancer.
- Hysteroscopy: Your provider uses a thin, lighted tool called a hysteroscope to examine the cervix and look inside the uterus. Your provider may perform this procedure along with a dilation and curettage (D&C) or biopsy. It’s most advantageous to couple this with a visually directed dilation and curettage of the endometrium. With hysteroscopy, your provider can see abnormalities within the endometrial cavity and take a targeted (directed) biopsy of any suspicious areas.
Management and Treatment
What are the complications of endometrial hyperplasia?
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.
How is endometrial hyperplasia managed or treated?
If you’re at increased risk of cancer due to atypical endometrial hyperplasia, your healthcare provider may recommend a hysterectomy to remove the uterus. After a hysterectomy, you won’t be able to get pregnant. Many people see symptoms improve with less invasive progestin treatments. Progestin comes in many forms:
How can I prevent endometrial hyperplasia?
Certain steps may reduce your chances of developing endometrial hyperplasia:
Outlook / Prognosis
What is the prognosis (outlook) for people who have endometrial hyperplasia?
Endometrial hyperplasia responds well to progestin treatments. Atypical endometrial hyperplasia can lead to endometrial or uterine cancer. Your healthcare provider may recommend more frequent direct (hysteroscopic) assessment or a hysterectomy to eliminate cancer risk.
When should I call the doctor?
You should call your healthcare provider if you experience:
- Heavy or abnormal bleeding.
- Vaginal bleeding after menopause.
- Painful cramping (dysmenorrhea).
- Painful urination (dysuria).
- Painful intercourse (dyspareunia).
- Pelvic pain.
- Unusual vaginal discharge.
- Frequently missed menstrual periods.
What questions should I ask my doctor?
If you have endometrial hyperplasia, you may want to ask your healthcare provider:
- Why did I get endometrial hyperplasia?
- 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?
- If I’m overweight, can I be referred to a weight management consultant?
- What is 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?
A note from Cleveland Clinic
Endometrial hyperplasia is a condition that causes abnormal uterine bleeding. These symptoms can be uncomfortable and disruptive. Many women find relief through progestin hormone treatments. Women who have atypical endometrial hyperplasia have a higher risk of developing uterine cancer. A hysterectomy stops symptoms and eliminates cancer risk. Talk to your healthcare provider about the best treatment for you.