Endometrial Hyperplasia

What is endometrial hyperplasia?

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 and people assigned female at birth (AFAB), endometrial hyperplasia can lead to endometrial cancer, a type of uterine cancer.

What are the types of endometrial hyperplasia?

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.

Your healthcare provider may use the terms simple and complex when they classify your condition. Simple and complex refer to the types of patterns they see when they look at your cells. Be sure to discuss any questions and concerns you have about your diagnosis with your provider.

How common is endometrial hyperplasia?

Endometrial hyperplasia is rare. It affects approximately 133 out of 100,000 people AFAB. It most commonly occurs in people who are transitioning to or just completed menopause (when you stop getting a menstrual period).

What are the symptoms of endometrial hyperplasia?

People with endometrial hyperplasia may experience:

• Abnormal menstrual bleeding or bleeding between periods.
• Short menstrual cycles (less than 21 days).
• Heavy menstrual bleeding.
• Bleeding after menopause.
• Not having a period at all (amenorrhea).

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 your healthcare provider about your symptoms so they can determine if checking for endometrial hyperplasia is necessary.

Does endometrial hyperplasia cause pain?

It’s possible that it can cause abdominal/pelvic pain or pain during intercourse (dyspareunia). However, abnormal bleeding is the most common symptom.

What are the most common causes of endometrial hyperplasia?

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.

What are risk factors for endometrial hyperplasia?

People in perimenopause or menopause are more likely to have endometrial hyperplasia. It rarely occurs in people younger than 35. Other risk factors include:

• Certain breast cancer treatments (tamoxifen).
• Diabetes.
• Early age for menstruation or late onset of menopause.
• Family history of ovarian, uterine or colon cancer.
• Gallbladder disease.
• Hormone therapy using only estrogen when you still have a uterus.
• Never being pregnant.
• Obesity.
• Polycystic ovary syndrome (PCOS).
• Smoking cigarettes.
• Thyroid disease.
• Long history of irregular or absent menstruation.
• History of pelvic irradiation (radiation on your pelvis).
• Compromised immune system due to autoimmune disease or medications.

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 people AFAB with untreated simple atypical endometrial hyperplasia. Close to 30% of people AFAB with complex atypical endometrial hyperplasia who don’t get treatment develop cancer.

How is endometrial hyperplasia diagnosed?

Many conditions can cause abnormal uterine bleeding. To identify what’s causing your symptoms, your healthcare provider 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.

What is the treatment for endometrial hyperplasia?

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:

• Oral progesterone therapy (you swallow a pill).
• Intrauterine device (IUD) containing progesterone.
• Injection (Depo-Provera®).
• Vaginal cream or gel.

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

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

Should I have a hysterectomy for endometrial hyperplasia?

A hysterectomy is usually not necessary for treating endometrial hyperplasia. Most people respond well to progestin treatment. If your risk for uterine cancer is high and your healthcare provider diagnoses you with complex atypical endometrial hyperplasia, hysterectomy may be a possible treatment option.

How can I prevent endometrial hyperplasia?

Certain steps may reduce your chances of developing endometrial hyperplasia:

• Use progesterone along with estrogen after menopause (if you use hormone therapy).
• Consider taking a birth control pill with estrogen and progestin if you have irregular periods.
• Quit smoking.
• Maintain a weight that’s healthy for you.

What is the 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 ultrasound exams, biopsies or a hysterectomy to eliminate the chances of it turning into cancer. Your provider will base this recommendation on your diagnosis and health history.

Does endometrial hyperplasia lead to cancer?

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 healthcare provider can discuss the type you have and recommend the best treatment based on your health history and your overall risk for cancer.

When should I see my healthcare provider?

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 healthcare provider?

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?

What is the most common age to get endometrial hyperplasia?

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.

A note from Cleveland Clinic

Endometrial hyperplasia is a condition that causes abnormal uterine bleeding. These symptoms can be uncomfortable and disruptive. Many people find relief through progestin hormone treatments. People 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.