The name might sound jargon, but simply explain it: endometrial hyperplasia is a condition where the uterine lining or endometrium thickens due to hormonal imbalances or any other reasons, resulting in an abnormality.
The endometrium is the tissue lining the womb or uterus, which becomes thin and sheds when you have menses. When there is any abnormality in the uterine line, it could result in several complications and manifest into several conditions.
These include endometriosis, where tissues replicating the uterine lining grow in the outer part of the uterus. Hyperplasia, our topic of discussion, is another abnormality of the uterine lining. In some women, hyperplasia may result in endometrial cancer in severe cases. However, the risk of endometriosis-related cancer is comparatively low.
Now, let’s look at the causes of endometrial hyperplasia alongside the types, symptoms, and treatment.
Types of Endometrial Hyperplasia (EH)
Before moving on to the causes, it is essential to understand the types of endometrial hyperplasia for a better understanding. Healthcare providers have classified the types based on the changes in cells in the uterine lining.
1. Simple or Complex EH (With atypia)
Medically, atypia is a term used to describe a cell’s structural abnormality, primarily referring to cancerous cells . In this type of endometrial hyperplasia, there isn’t any abnormality in the cells since they look normal.
There isn’t much possibility of the cells getting cancerous. For people having EH without atypia, healthcare professionals might recommend hormone therapy as a treatment method. For some, the condition could get better on their own without treatment.
2. Simple or Complex EH (Without atypia)
This one is a more complex form where the cells have a possibility of becoming cancerous when it goes untreated. People with this condition are likely to develop uterine cancer in the future if they don’t act immediately to treat the abnormal cell growth.
Causes of Endometrial Hyperplasia
The hormonal imbalances are the main reasons for endometrial hyperplasia. Those with this condition have an increased estrogen level and a low progesterone level. Perimenopausal and menopausal women are increasingly susceptible to this condition. It rarely occurs in women below 35.
Let’s know the basic mechanisms of these reproductive hormones for a better understanding. When you ovulate, the estrogen thickens your uterine lining (endometrium). At the same time, progesterone readies the uterus to implant a fertilized egg that could result in a pregnancy.
If there isn’t a conception during that cycle, there is a drop in progesterone levels. The uterine lining begins to shed as your period. More specifically, the blood loss  you go through during your menses is your uterine lining.
Individuals with EH have negligible amounts of progesterone. So, instead of shedding and thinning, the uterine lining grows and thickens, resulting in this condition.
Symptoms of Endometrial Hyperplasia
Here are some of the common symptoms of endometrial hyperplasia to make a note of:
- Changes in menstrual bleeding – from heavy to abnormal or even occurring between periods
- Shortened menstrual cycles (< 21 days)
- Bleeding during the postmenopause stage
- No periods
You must note that the symptoms mentioned above coincide with the signs of perimenopause. When you are in the menopause transition phase, you could have irregular cycles or go without periods for a few months. So, if you have issues with your menses, it’s safe to have a word with your doctor to rule out any underlying issues.
How is Endometrial Hyperplasia Diagnosed?
When you have complained of unusual bleeding, your healthcare provider will enquire about your medical details. Mention every detail accurately to help the doctor identify the condition and begin prompt treatment. Do let your doctor know of the following facts:
- If you have heavy bleeding, and it is accompanied by clotting
- If your menses are painful
- If you have other symptoms, even if it might not be associated with your menses
- If you’ve reached the menopausal age
- If you are on any hormone medicines or have had them before
- If cancer runs in the family
Your doctor will prescribe diagnostic tests based on the severity of your condition. These may include:
1. Transvaginal Ultrasound
It involves placing a small device in your vagina. Your uterus’ image is monitored on screen with the help of sound waves. Through this, the thickness of the endometrial lining, alongside the ovaries and uterus, may be viewed.
The doctor might conduct an endometrial biopsy. This involves removing tissues from the lining of your uterus, mainly to check for cancerous cells.
Here, a device with a camera and a light is used to have a clear view of your cervix and uterus. This will help your provider to check for abnormalities in the uterine lining. If needed, he may conduct a biopsy, particularly of the suspicious areas.
How is Endometrial Hyperplasia Treated?
The treatment procedure depends on your age and the severity of the condition. The leading cause of this condition is reduced levels of progesterone. So, to treat this condition, doctors recommend progestin – drugs that mimic the functions of progesterone. Your doctor could prescribe you progestin in several forms. These include:
- As Pills
- As Injections
- As Vaginal creams
- In an IUD (Intrauterineine Device)
The treatment could last for approximately six months. Obese women and those given oral treatment may experience a relapse of EH. So, frequent follow-ups with the doctor are required.
Another line of treatment is a hysterectomy that involves the surgical removal of the uterus. The doctor will advise for a hysterectomy if:
- If your endometrial hyperplasia becomes atypical in the course of treatment
- There’s no improvement in your condition after a year’s treatment
- You have undergone a relapse, or the condition has worsened
- There isn’t a pause in the bleeding
It is essential to note that a hysterectomy isn’t always needed to treat EH. Most people experience good results when treated with progestin. It’s necessary for those at risk of uterine cancer or who have the atypical form of EH.
Who is at Risk of Endometrial Hyperplasia?
You could be at an increased risk of endometrial hyperplasia if you:
- Are in perimenopause or have already experienced menopause
- Are obese
- Have undergone breast cancer treatment
- Haven’t gone through pregnancy ever
- Have a history of smoking
- Started menstruation early
- Have thyroid or gallbladder problems or polycystic ovary syndrome (PCOS)
- Have a history of smoking
- Have gone through irregular menses
- Have a weakened immune system because of medications or autoimmune disease
No, this isn’t a common condition and occurs rarely. As per the data available, only 133 of 100,000 are affected by this condition. As mentioned, it is common among perimenopausal and menopausal women.
Studies  have highlighted the genetic similarity between endometrial hyperplasia and endometrial cancer. Around 5% of uterine cancers could arise from hereditary factors. So, it is pretty likely that some cases of EH could be genetic.
Endometrial hyperplasia is associated with increased bleeding. So, women affected with it are likely to develop anemia when they do not take proper precautions to manage the blood loss.
Moreover, around 8% of individuals with simple atypical hyperplasia could develop cancer in the long run if the condition goes untreated. Similarly, around 30% of females with complex EH are at risk of cancer if they aren’t treated promptly.
The most typical symptom of EH is abnormal and excessive bleeding. However, you may experience pelvic or abdominal pain or pain during sexual intercourse.
You should seek medical help if:
• You have abnormal or heavy bleeding
• Your bleeding persists in the postmenopause phase
• You experience painful cramping and/or painful urination
• You experience pain during intercourse
• There’s unusual vaginal discharge
• Miss periods frequently
Though endometrial hyperplasia needs treatment, you could manage it and prevent it from getting severe by making lifestyle changes. As mentioned, women who smoke and are obese have an increased chance of getting affected by this condition. So, quitting smoking is of utmost importance.
Moreover, if you are obese, managing your weight is also essential. When in the perimenopausal phase, you could be more prone to put on those extra kilos. That’s why eating healthy, sans the extra carbs, and exercising is of immense importance.