Endometrial hyperplasia thickens your uterine lining, causing heavy or abnormal bleeding. Atypical endometrial hyperplasia raises your risk of endometrial cancer and uterine cancer. The condition tends to occur during or after menopause. Progestin therapy can reduce your symptoms. People at risk for cancer may choose to have a provider remove their uterus.
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.
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:
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.
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).
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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 your healthcare provider about your symptoms so they 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 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.
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:
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:
Your healthcare provider may recommend a hysterectomy to remove your uterus if:
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.
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. 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.
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.
You should call your healthcare provider if you experience:
If you have endometrial hyperplasia, you may want to ask your healthcare provider:
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.
Last reviewed by a Cleveland Clinic medical professional on 02/16/2023.
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