Endometrial hyperplasia refers to the thickening of the endometrium. This is the layer of cells that line the inside of your uterus. When your endometrium thickens, it can lead to unusual bleeding.
While the condition isn’t cancerous, it can sometimes be a precursor to uterine cancer, so it’s best to work with a doctor to monitor any changes.
Read on for tips on how to recognize symptoms and get an accurate diagnosis.
There are two main types of endometrial hyperplasia, depending on whether they involve unusual cells, known as atypia.
The two types are:
- Endometrial hyperplasia without atypia. This type doesn’t involve any unusual cells.
- Atypical endometrial hyperplasia. This type is marked by an overgrowth of unusual cells and is considered precancerous. Precancerous means that there’s a chance it could turn into uterine cancer without treatment.
Knowing the type of endometrial hyperplasia you have can help you better understand your cancer risk and choose the most effective treatment.
The main symptom of endometrial hyperplasia is unusual uterine bleeding. But what does this actually look like?
The following can all be signs of endometrial hyperplasia:
- Your periods are getting longer and heavier than usual.
- There are fewer than 21 days from the first day of one period to the first day of the next.
- You’re experiencing vaginal bleeding even though you’ve reached menopause.
And, of course, unusual bleeding doesn’t necessarily mean you have endometrial hyperplasia. But it can also be the result of a number of other conditions, so it’s best to follow up with a doctor.
Your menstrual cycle relies primarily on the hormones estrogen and progesterone. Estrogen helps grow cells on the lining of the uterus. When no pregnancy takes place, a drop in your progesterone level tells your uterus to shed its lining. That gets your period started and the cycle begins again.
When these two hormones are in balance, everything runs smoothly. But if you have too much or too little, things can get out of sync.
The most common cause of endometrial hyperplasia is having too much estrogen and not enough progesterone. That leads to cell overgrowth.
There are several reasons you might have a hormonal imbalance:
- You’ve reached menopause. This means you no longer ovulate and your body doesn’t produce progesterone.
- You’re in perimenopause. Ovulation doesn’t happen regularly anymore.
- You’re beyond menopause and have taken or are currently taking estrogen (hormone replacement therapy).
- You have an irregular cycle, infertility, or polycystic ovary syndrome.
- You take medications that imitate estrogen.
- You’re considered obese.
Other things that can increase your risk of endometrial hyperplasia include:
- being over age 35
- starting menstruation at a young age
- reaching menopause at a late age
- having other health conditions such as diabetes, thyroid disease, or gallbladder disease
- having a family history of uterine, ovarian, or colon cancer
If you’ve reported having unusual bleeding, your doctor will probably start by asking questions about your medical history.
During your appointment, make sure to discuss:
- if there’s clotting in the blood and if the flow is heavy
- if the bleeding is painful
- any other symptoms you may have, even if you think they’re unrelated
- other health conditions you have
- whether or not you could be pregnant
- whether you’ve reached menopause
- any hormonal medications you take or have taken
- if you have a family history of cancer
Based on your medical history, they’ll likely proceed with some diagnostic tests. These might include one or a combination of the following:
- Transvaginal ultrasound. This procedure involves placing a small device in the vagina that turns sound waves into pictures on a screen. It can help your doctor measure the thickness of your endometrium and view your uterus and ovaries.
- Hysteroscopy. This involves inserting a small device with a light and camera into your uterus through your cervix to check for anything unusual inside the uterus.
- Biopsy. This involves taking a small tissue sample of your uterus to check for any cancerous cells. The tissue sample can be taken during hysteroscopy, a dilation and curettage, or as a simple in-office procedure. The tissue sample is then sent to a pathologist for analysis.
Treatment generally consists of hormone therapy or surgery.
Your options will depend on a few factors, such as:
- if atypical cells are found
- if you’ve reached menopause
- future pregnancy plans
- personal and family history of cancer
If you have simple hyperplasia without atypia, your doctor might suggest just keeping an eye on your symptoms. Sometimes, they don’t get worse and the condition may go away on its own.
Otherwise, it can be treated with:
- Hormonal therapy. Progestin, a synthetic form of progesterone, is available in pill form as well as injection or intrauterine device.
- Hysterectomy. If you have atypical hyperplasia, removing your uterus will lower your cancer risk. Having this surgery means you won’t be able to get pregnant. It may be a good option if you’ve reached menopause, don’t plan on getting pregnant, or have a high risk of cancer.
The uterine lining may get thicker over time. Hyperplasia without atypia can eventually develop atypical cells. The main complication is the risk that it will progress to uterine cancer.
Atypia is considered precancerous.
Endometrial hyperplasia sometimes resolves on its own. And unless you’ve taken hormones, it tends to be slow growing.
Most of the time, it isn’t cancerous and responds well to treatment. Follow up is very important to ensure that hyperplasia isn’t progressing into atypical cells.
Continue to have regular checkups and alert your doctor to any changes or new symptoms.