Endometrial hyperplasia describes a condition in which the lining of the uterus, called the endometrium, becomes too thick. The condition itself is not cancerous; however, it sometimes can lead to uterine cancer.
What Causes Endometrial Hyperplasia?
If your body has too much of the hormone estrogen without the hormone progesterone, you may develop endometrial hyperplasia. To understand how endometrial hyperplasia develops, it may help to first understand how hormonal changes during a typical menstrual cycle affect your uterine lining. Estrogen is made by the ovaries during the first part of your cycle. That leads to growth of the lining to prepare your body for pregnancy. However, after an egg is released (ovulation), progesterone increases with the goal of supporting a fertilized egg. But if pregnancy does not happen, levels of both hormones decline. That decrease in progesterone is what triggers your period, the shedding of the lining. If you do not ovulate, progesterone is not made and the lining does not shed. So the lining may keep growing in response to the estrogen and, in time, the cells in the lining can become abnormal. In some women, the overgrowth, called hyperplasia, can lead to cancer.
Risk Factors
While there are many risk factors that increase the chances of developing endometrial hyperplasia, having one or more of these does not mean that you will develop the condition. Some common risk factors include:
Being above age 35Being whiteStarting periods early or menopause lateObesityBeing a cigarette smokerHaving a family history of uterine cancer, colon cancer, or ovarian cancerHaving a history of diabetes, polycystic ovary syndrome (PCOS), gallbladder disease, or thyroid disease
Endometrial Hyperplasia Symptoms
Abnormal uterine bleeding (heavier than usual bleeding between periods) is the most common symptom. If you have a menstrual cycle shorter than 21 days, check with your doctor. Count from the first day of your period to the first day of your next one. If you are post-menopausal, report any uterine bleeding to your healthcare provider.
Endometrial Hyperplasia Diagnosis
If you have abnormal uterine bleeding, your doctor may order certain tests and exams, including:
Transvaginal ultrasoundBiopsyDilation and curettage (D&C)Hysteroscopy
Endometrial Hyperplasia Types
Your doctor and other healthcare providers will look to see whether certain cell changes are present before diagnosing the exact type of endometrial hyperplasia. If abnormal changes are found, the diagnosis is called atypical. If the diagnosis is endometrial hyperplasia, it could be called:
Simple hyperplasia (the most benign type)Complex hyperplasiaSimplex atypical hyperplasiaComplex atypical hyperplasia
Endometrial Hyperplasia Treatment
Endometrial hyperplasia can often be treated with progestin. This synthetic hormone is given either orally, topically as a vaginal cream, in an injection, or with an intrauterine device. If you have simple or “mild” hyperplasia, which is the most common type, the risk of it becoming cancerous is very small. If you have atypical hyperplasia, the chances of cancer developing are higher. For simple atypical, the chances of it turning into cancer is about 8 percent if left untreated. Complex atypical turns into cancer in 29 percent of untreated cases. If the diagnosis is atypical, and you are done bearing children, your doctor may recommend removal of the uterus (hysterectomy), as the risk of uterine cancer rises with atypical hyperplasia.
