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What is Endometrial Hyperplasia – Symptoms & Treatment
Endometrial hyperplasia, which we also may refer to as uterine hyperplasia, is a condition that develops when there is an overgrowth of the lining of the uterus, or endometrium. We can diagnose the condition by performing an endometrial hyperplasia ultrasound, biopsy, or hysteroscopy.
We also offer treatment plans depending on the type of hyperplasia a patient has because if they develop atypical hyperplasia, this can lead to cancer.
This article describes the types of endometrial hyperplasia, its causes, and risk factors. We also discuss symptoms, diagnosis, endometrial hyperplasia treatment, and prevention.
What Are The Types of Endometrial Hyperplasia?
A 2015 study notes that the World Health Organization (WHO) categorizes endometrial hyperplasia into two, as this depends on whether there are any unusual cells present, referred to as “atypia.”
Endometrial hyperplasia without atypia: This is not cancerous as it does not consist of any unusual cells or atypia.
Atypical hyperplasia: It develops when there is an overgrowth of abnormal cells, and is considered precancerous. According to the American Cancer Society, if a patient has simple atypical hyperplasia, 8% of cases can lead to cancer if left untreated. If they have complex atypical hyperplasia (CAH), it can also cause cancer if we do not provide a treatment plan.
What Causes Endometrial Hyperplasia?
Endometrial hyperplasia occurs when there is a hormone imbalance, as the body starts producing excessive amounts of estrogen and not enough progesterone.
Estrogen controls the uterine lining during menstruation and at the beginning of the pregnancy. It also regulates food intake, body weight, and insulin sensitivity, among others. The progesterone hormone is responsible for the thickening of the uterus to prepare for pregnancy and support implantation.
If there is no conception, progesterone levels drop, and these cause the uterus to shed its lining as menstrual period.
As a result, uterine hyperplasia can cause a thickened endometrium as you experience low progesterone levels.
Obesity can also increase estrogen levels and your chances of developing endometrial hyperplasia.
In the next section, we will discuss the risk factors that can lead to the thickening of the uterus.
What Are the Risk Factors Of a Thickened Endometrium?
Some women may have a higher risk of developing a thickened endometrium. Such risk factors include:
- Obesity.
- Other health conditions such as diabetes, thyroid disease, and polycystic ovarian syndrome (PCOS).
- Cigarette smoking.
- Women aged 35 or older.
- Having a family record of colon, uterine, or colon cancer.
- Women who got their first period at an early age.
The American Cancer Society notes that if you have a body mass index (BMI) over 25, you may have an increased risk of developing endometrial cancer. This is because fat tissue can increase estrogen levels, increasing cancer risk.
What Are the Symptoms of Endometrial Hyperplasia?
Symptoms can vary, but some include:
- Shorter menstrual cycles
- Menstrual cycles that last for more than seven days.
- Regular pelvic pain that worsens on one side.
- Vaginal bleeding in postmenopausal women.
How Do We Diagnose Hyperplasia?
When you visit your doctor’s clinic, they may ask about your medical history and we suggest that you discuss:
- Whether you have experienced any abnormal bleeding.
- Whether you have a family history of cancer.
- Whether you have other health conditions.
- Any medications that you have or are currently taking.
Then, we can diagnose endometrial hyperplasia by performing one or more of the following tests based on your medical history:
Endometrial Hyperplasia Ultrasound
We may perform a transvaginal ultrasound exam to measure the density of the endometrium. The endometrial hyperplasia ultrasound uses sound waves to produce images of your uterus. This can help us determine whether you have endometrial hyperplasia if you have a thickened endometrium.
Endometrial Biopsy
We can diagnose endometrial hyperplasia by performing a biopsy with or without hysteroscopy.
We may refer to a biopsy without hysteroscopy as blind biopsy. We insert a thin plastic tube into the uterus and collect a small tissue sample from your uterus lining. You may feel some discomfort as we do not perform this exam under anesthesia. If we are unable to collect enough tissue samples, we then may have to perform another biopsy.
If we perform a biopsy with hysteroscopy, we insert a camera into the uterine cavity to help us collect the sample. We use a numbing injection and may recommend that you take ibuprofen or paracetamol before the procedure, as these can help reduce discomfort.
Hysteroscopy and Dilation and Curettage (D&C)
We may suggest that you undergo a hysteroscopy with a dilation and curettage (D&C). We insert a long, thin tube known as a hysteroscope into your vagina to examine your uterus. A hysteroscopy can help your doctor to diagnose or treat the causes of abnormal bleeding. We perform this exam under anesthesia, so the patient does not experience any discomfort.
Endometrial Hyperplasia Treatment
Our endometrial hyperplasia treatment plans depend on the type of hyperplasia a patient has developed, whether they have reached menopause or whether they plan on getting pregnant.
Hyperplasia Without Atypia
If the patient has endometrial hyperplasia without atypia, we may recommend progesterone therapy. It is available in pill form, as an injection, and as an Intrauterine Device (IUD). If atypia develops, we may have to perform a hysterectomy (removal of uterus).
Hyperplasia With Atypia
We offer a non-surgical treatment plan to patients that have hyperplasia with atypia. First, we may have to perform a D&C as this can help us confirm that there are no cancerous cells present in the uterine tissue.
We also recommend a high dose of oral progesterone to women who have not had children or those who can’t undergo surgical treatments. This can also cause side effects such as increased appetite and weight gain.
Three months after initiating treatment, we may perform a D&C to check how your body has responded to progesterone. If the medication is ineffective and you still have endometrial hyperplasia, we may prescribe a higher dose of progesterone and perform another D&C after three months.
If we do not see any improvement after nine months, the patient may have to consider getting a hysterectomy.
Furthermore, if you have hyperplasia with atypia and have completed childbearing, it would be best to remove the uterus and cervix (partial hysterectomy).
We may remove the bilateral tubes and ovaries if you have reached menopause. This is because postmenopausal women with uterine cancer have cancer cells in their ovaries.
Premenopausal women that have uterine cancer may also have cancer cells in their ovaries. However, we
If you have not reached menopause and have uterine cancer, we may have to remove the uterus to confirm whether it contains cancerous cells. If there is cancer present, we may then remove the ovaries.
What Can You Do to Prevent Endometrial Hyperplasia?
You can reduce your chances of developing endometrial hyperplasia by:
- Using birth control to regulate your menstrual cycle.
- Following a healthy diet and exercising regularly as this can help you maintain a moderate weight. It can also reduce your risk of developing diabetes.
- Avoiding cigarette smoking.
When to See a Doctor
If you experience abnormal bleeding, we recommend you visit your doctor’s clinic, as they can ask about your medical history, perform diagnostic tests and confirm if you have hyperplasia.
You should also contact your doctor if you have vaginal bleeding and have reached menopause.
Dr. David Ellman is a board-certified OB/GYN that will provide expert medical experience for your needs. His team will gladly meet you to discuss your concerns, provide preventive tips and treatment plans depending on your symptoms.
Come into our office or call us today to schedule your appointment.
Sources
Emons, G., et al. (2015). New WHO Classification of Endometrial Hyperplasias. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361167/
Endometrial Cancer Risk Factors. (2019). https://www.cancer.org/cancer/endometrial-cancer/causes-risks-prevention/risk-factors.html
Dr. Ellman is a Board Certified OBGYN who established his medical practice in South Florida over 25 years ago. His office, Women’s Healthcare of Boca Raton, is located in Boca Raton, Florida at West Boca Medical Center. Dr. Ellman attended Albert Einstein College of Medicine of Yeshiva University, where he received his medical degree. He went on to intern at Beth Israel Hospital in Boston- an affiliate of Harvard Medical School- and continued his residency at North Shore University Hospital in Manhasset, New York- an affiliate of Cornell Medical School.
Dr. Ellman has practiced Obstetrics and Gynecology in the Boca Raton area since 1995. In addition to treating patients at West Boca Hospital, Dr. Ellman also treats patients through his own private practice, Women’s Healthcare of Boca Raton, located on the West Boca Medical Campus.