Definition

Endometrial hyperplasia is a condition characterized by the excessive thickening of the innermost lining of the uterine wall, which can lead to heavy bleeding during menstruation. Normally, during menstruation, the uterine lining, or endometrium, sheds and exits the body as menstrual blood. In cases of endometrial hyperplasia, bleeding is more profuse due to the thicker uterine lining.

This condition is not cancerous, but for some women, endometrial hyperplasia can increase the risk of developing endometrial cancer. It occurs in approximately 133 out of 100,000 women.

Endometrial hyperplasia is caused by an imbalance between the hormones estrogen and progesterone. The thickening of the uterine wall is due to an excess of estrogen, while the shedding of the uterine lining is hindered by a lack of progesterone.

There are two types of endometrial hyperplasia:

• Simple endometrial hyperplasia without atypical cells. This type consists of normal cells that do not turn into cancer cells. It can improve or resolve on its own without specific treatment.
• Simple or complex endometrial hyperplasia with atypical cells. This type is a precancerous condition resulting from abnormal cell growth. If left untreated, it can develop into endometrial or uterine cancer.

Risk Factor

The following things can increase the risk of endometrium hyperplasia, such as:

• Age above 35 years or has entered the age of permenopaus and menopause
• Never been pregnant
• Weight excess
• Family history with endometric hyperplasia, uterine cancer, or endometrium cancer
• Disorders related to menstrual cycles such as PCOS (Polycytic Ovariant Syndrome)
• Other health disorders that affect hormones or metabolism, such as diabetes mellitus or thyroid disorders
• Smoking
• Hormological substitute therapy, such as estrogen therapy

Read more about estrogen in the following Ai Care article Estrogen Drugs - How To Work, Contraindication, Side Effects.

Symptoms

The main symptoms of endometrium hyperplasia are abnormal bleeding during menstruation. Some of the other symptoms are as follows:

• The menstrual cycle is longer and heavier than usual.
• An abnormal menstrual cycle, such as shorter (less than 21 days) or longer (more than 45 days).
• There is bleeding from the vagina even though it is already menopause.

Diagnosis

Heavy menstrual bleeding does not directly indicate endometrial hyperplasia. Other conditions can cause similar symptoms. Therefore, to diagnose endometrial hyperplasia, doctors will perform an initial evaluation that includes a medical interview, physical examination, and additional diagnostic tests.

Your doctor may recommend one or more of the following diagnostic tests:

• Vaginal ultrasound: In this procedure, a small device is inserted into the vagina, and it uses sound waves to create images. If the endometrium is thickened, it may indicate endometrial hyperplasia.
• Biopsy: A tissue sample is taken from the endometrium and examined under a microscope.
• Hysteroscopy: This procedure uses a hysteroscope to examine the inside of the uterus. The physician may also perform a dilation and curettage (D&C) or biopsy during this procedure.

Management

In some cases, endometrial hyperplasia can be treated with progestin, a synthetic form of the hormone progesterone. Progestin can be administered orally, by injection, through an intrauterine device (IUD), or as a vaginal cream. The dosage and duration of progestin treatment depend on the patient's age and the type of hyperplasia.

Treatment with progestin can cause vaginal bleeding similar to menstruation. Generally, progestin therapy is effective for treating endometrial hyperplasia. If you are at a higher risk for cancer due to atypical endometrial hyperplasia, your doctor may recommend more frequent direct examinations, such as hysteroscopies, or suggest a hysterectomy (removal of the uterus).

A hysterectomy may be recommended if there is no improvement or if the condition worsens after 12 months of treatment. After a hysterectomy, you will not be able to conceive, so it's important to consult your doctor to determine the best treatment plan for you.

Endometrial hyperplasia may sometimes resolve on its own. Generally, endometrial hyperplasia is not malignant and responds well to treatment. Regular check-ups are necessary to ensure that hyperplasia does not progress to atypical cells, which have the potential to become cancerous.

Complications

All types of hyperplasia can cause heavy and abnormal bleeding, potentially leading to anemia. Anemia develops when your body lacks sufficient iron-rich red blood cells. Hyperplasia without atypical cells can progress to atypical cell formation.

The main complication of endometrial hyperplasia is its potential to develop into endometrial or uterine cancer.

Prevention

While you cannot entirely prevent endometrial hyperplasia, you can reduce your risk by:

• Stop smoking
• Maintaining a healthy weight
• Taking progestin with estrogen if you are on hormone replacement therapy
• Taking birth control pills to regulate your menstrual cycle and hormones
• Taking progestin or progesterone if you consume estrogen after menopause

When to See a Doctor?

You should consult a doctor if you experience heavy or abnormal bleeding during your menstrual cycle. Additionally, contact a doctor if you have any of the following symptoms:

• Vaginal bleeding after menopause
• Abdominal pain or cramps during menstruation (dysmenorrhea)
• Pain during urination
• Pain during sexual intercourse (dyspareunia)
• Hip pain
• Abnormal vaginal discharge (leucorrhea)
• Frequently missed menstrual cycles

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