Endometrial Hyperplasia: What You Should Know

Essential Facts To Look Out for When Understanding Endometrial Hyperplasia

Endometrial Hyperplasia: What You Should Know

What is Endometrial Hyperplasia?

Endometrial Hyperplasia is a condition where the endometrium (the internal lining of the uterus) has overgrown and becomes thicker than normal. This can result in abnormal bleeding including heavy periods or bleeding after menopause. Some types of this hyperplasia are associated with an increased risk of endometrial cancer. 

The endometrium is the internal lining of the uterus and serves an important role in the reproduction process. It typically thickens with estrogen production and thins out when progesterone is released during ovulation, which then shed during periods. The endometrium is normally thin when estrogen decreases with onset of menopause. Endometrial hyperplasia can occur when there is imbalance of excess estrogen or inadequate progesterone. Therefore, its main risk factors include:

  • Being overweight or obese – fat cells increase production of estrogen
  • Not regularly ovulating, therefore not regularly releasing progesterone – such as in polycystic ovarian syndrome

Other risk factors are:

  • Age – older than 35 years old
  • Never having been pregnant
  • Cigarette smoking

The condition categorises as either simple or complex, with or without cellular atypia. Treatment options include progesterone therapy or a hysterectomy if the woman is not planning to have any future pregnancies. 

The Symptoms

There are many potential symptoms associated with hyperplasia but it is important to understand that many of these symptoms are shared with other conditions, so consult with your local doctor or gynaecologist for an evaluation.

These symptoms include:

  • Sudden changes in menstrual pattern
  • Bleeding in-between menstrual periods
  • Heavier periods 
  • Longer lasting periods
  • Bleeding after menopause

Symptoms of Endometrial Hyperplasia

How is it Diagnosed?

Endometrial Hyperplasia can be seen on transvaginal ultrasound scan. A thin elongated handheld device called a transducer is inserted into the vagina to allow close examination of the pelvic organs, including the uterus and its internal lining. Women with abnormal bleeding including any bleeding after menopause should have a transvaginal ultrasound scan to examine the endometrium. Abnormally thickened endometrium may suggest endometrial hyperplasia or cancer. 

Biopsy of the endometrium is obtained to clarify whether there is endometrial hyperplasia. This is commonly done through endometrial pipelle sampling in the gynaecologist’s rooms, or through hysteroscopy under general anaesthetic. Hysteroscopy also allows visualisation of the endometrium and removal of any other growth such as polyps if present. 

A biopsy will confirm endometrial hyperplasia, whether it is simple or complex, with or without atypia. The different types are associated with different risks of endometrial cancer. Endometrial cancer is the commonest type of uterine cancer (cancer of the womb). Simple endometrial hyperplasia without atypia has 1 % risk of uterine cancer, while complex hyperplasia with atypia is associated with up to 30% risk of uterine cancer. Up to 50% of complex atypical hyperplasia already have coexisting cancer at the time of diagnosis. 

Treatment

Treatment would depend on the type of hyperplasia, the risk factors for endometrial cancer and patient factors, particularly whether there is a wish for future pregnancies. 

Progesterone therapy can be trialed to treat endometrial hyperplasia without atypia. Oral progestin or progesterone containing intrauterine device such as Mirena are commonly prescribed. Progesterone counteracts the effects of estrogen on the endometrium and thins it out. Repeat endometrial biopsy should be taken whilst on treatment to assess this effect and confirm resolution of hyperplasia. 

A definitive treatment in the form of a hysterectomy should be considered if there is no plan for future pregnancies, especially with complex atypical hyperplasia (contains a large number of abnormal cells that have a chance of becoming cancerous). If future pregnancy is wanted, a trial of progesterone therapy may be suitable if the endometrium responds to treatment.

Hysterectomy

Hysterectomy is the definitive treatment for endometrial hyperplasia. It is the recommended treatment especially with complex atypical hyperplasia due to the significant risk of uterine cancer. The hysterectomy can usually be performed in a minimally invasive way through laparoscopic key-hole surgery, with or without robotic instruments. 

 

If you or someone you know have suspected endometrial hyperplasia, you should seek a referral to a gynaecologist for further evaluation. Contact us today to book an appointment.



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