What Is Endometrial Hyperplasia? Understanding the Condition and Its Causes
In a healthcare system that prides itself over progress and constant innovation, some conditions still remain in the margins. One such condition is endometrial hyperplasia, a precancerous condition that most commonly affects women who are transitioning to or completed menopause. Even though it affects a large proportion of our population, a recent 2024 study by University of Birmingham stated that “women diagnosed with endometrial hyperplasia need better care to avoid future cancer development”. Let’s find out more about the condition.
Introduction to Endometrial Hyperplasia
What is endometrial hyperplasia?
Endometrial hyperplasia is a precancerous condition characterized by an abnormal thickening of the uterine lining, that is known as the endometrium. The endometrium is responsible for many essential functions in a woman’s reproductive system. Usually, the endometrium thickens and sheds during a woman’s monthly menstruation, and provides a nourishing environment for a fertilized egg during pregnancy. However, endometrial hyperplasia disrupts this process, often causing heavy menstrual bleeding, postmenopausal bleeding, and anemia due to excessive blood loss. This condition is most commonly seen in women in their 50s and 60s who have gone through menopause, but it can also affect those in perimenopause—a transitional phase where menstrual cycles become irregular.
The role of the endometrium in the menstrual cycle
During each monthly menstrual cycle, the endometrium thickens to nourish a potential fetus, supported by increased levels of estrogen and progesterone. If fertilization does not occur, the body sheds this lining – along with the blood and mucus – during the period of menstruation. Therefore, endometrial hyperplasia occurs when an imbalance between estrogen and progesterone prevents the complete shedding of the uterine lining. This can then lead to abnormal thickening causing heavy menstrual bleeding. Understanding this link between hormonal imbalance and endometrial hyperplasia is crucial for early detection and treatment.
Types of Endometrial Hyperplasia
Simple vs. complex endometrial hyperplasia
There are two main types of endometrial hyperplasia, depending on whether the cell growth is more uniform or more disorganised. The two types of endometrial hyperplasia are simple and complex endometrial hyperplasia. Another factor in diagnosing endometrial hyperplasia is the involvement of unusual cells, known as atypia. Whether it is simple or complex endometrial hyperplasia, endometrial hyperplasia with atypia has a higher chance of becoming cancerous.
- Pattern of Cell Growth: Simple endometrial hyperplasia shows relatively regular and uniform cell growth in the uterine lining while complex endometrial hyperplasia exhibits crowded and irregular growth within the uterine lining.
- Risk of Cancer: While both conditions are considered precancerous, complex hyperplasia has a slightly higher risk of advancing to cancer due to its abnormal cell growth arrangement.
Symptoms of Endometrial Hyperplasia
Common signs to watch for
Some of the common symptoms of endometrial hyperplasia are
- Heavy of prolonged periods
- Bleeding between periods
- Bleeding after menopause
- Shorter or longer menstrual cycles
- Anemia due to heavy bleeding
When to seek medical attention
As endometrial hyperplasia is a precancerous condition, women experiencing any of the symptoms mentioned above should immediately consult a healthcare provider for further evaluation and management options. Timely consultation can allow women to effectively manage their condition and further lower the risk of endometrial hyperplasia to advance to a cancerous stage.
Diagnosis of Endometrial Hyperplasia
Tests and procedures to confirm the condition
To determine whether further treatment or tests are required, doctors take extensive medical history to learn about any history of irregular bleeding, as well as the length of your menstrual cycles, and any history of pregnancy. Doctors are also advised to ask questions about medication, specifically related to estrogen, as endometrial hyperplasia is linked to imbalance of estrogen and progesterone.
After taking the medical history, if a doctor suspects endometrial hyperplasia, they further recommend an ultrasound and biopsy.
Role of ultrasound and biopsy in diagnosis
A transvaginal ultrasound is an imaging tool or technique used to see the inside of the uterus in order to determine whether the uterine lining is thicker than it should be.
Once it’s determined that the uterine lining is thick, the next diagnostic step is an endometrial biopsy. At this stage, a small tissue sample will be taken from the lining of the uterus using a small tube (equipped with a camera and light) inserted through the cervix. The tissue sample is then examined under a microscope to check for any abnormal cell growth. This is considered to be the primary tool to diagnose endometrial hyperplasia. The results of the biopsy can show that the lining cells are normal; abnormal yet non-cancerous; abnormal and precancerous or abnormal and cancerous. The treatment options are different based on the biopsy results.
Endometrial Hyperplasia Treatment Options
Medical treatments and medications
Progestin therapy – If your biopsy results show abnormal yet non cancerous cell growth, then doctors will usually recommend progestin therapy. Progestin is a synthetic hormone that helps in balancing estrogen in the system, which can reduce or eliminate symptoms of endometrial hyperplasia. The type and severity of the condition will determine the length and dosage of the treatment.
For this, doctors can prescribe
- Birth control pills which contain progestin, or pills that contain a combination or progestin and estrogen.
- Progestin injections
- Vaginal cream that contain progestin
- An Intrauterine Device (IUD) which releases progestin like levonorgestrel
Note- Women who have reached menopause should not take birth control pills that have a combination of estrogen and progestin. Any other method can be prescribed for them.
Surgical options and their effectiveness
If you are diagnosed with abnormal, pre-cancerous cells (especially if it’s diagnosed as endometrial hyperplasia with atypia), then hysterectomy is recommended which involves removing the uterus and eliminating the possibility of developing endometrial cancer at a future stage.
While the treatment is highly effective as it significantly reduces the risk of cancer, factors like a patient’s age, severity of hyperplasia and their desire to preserve fertility is taken into account, as having a hysterectomy means the patient will no longer be able to get pregnant.
Complications and Risks of Endometrial Hyperplasia
Potential for developing endometrial cancer
One of the primary and most risky complications of endometrial hyperplasia is its potential to develop into endometrial cancer, especially if the diagnosis is endometrial hyperplasia with atypia or atypical hyperplasia. If left untreated, a substantial number of cases can also develop into uterine cancer.
Some other complications of endometrial hyperplasia are
- Abnormal uterine bleeding which can severely impact quality of life
- Pelvic pain and discomfort
Managing and monitoring the condition
Managing endometrial hyperplasia involves seeking diagnosis and risk assessment based on the biopsy results. The presence of atypia can alter treatment decisions significantly which makes the biopsy essential for proper treatment.
Even after treatment, endometrial hyperplasia can sometimes recur (especially if hysterectomy is not recommended). In such cases, it needs continuous monitoring. Therefore, regular endometrial biopsies are considered necessary to monitor treatment and detect any progression of hyperplasia. Typically, the checks should happen every 6 months until the condition is controlled. However, the checks can be in shorter durations depending on the severity of the condition.
Prevention and Lifestyle Changes
Tips for reducing risk factors
Factors that can increase the risk of endometrial hyperplasia are:
- Being over the age of 35
- Starting menstruation at a young age
- Experiencing late menopause
- Conditions like diabetes, thyroid or gallbladder disease
- A family history of uterine, ovarian or colon cancer
- Using medications that imitate estrogen
To reduce the risk of endometrial hyperplasia, you should focus on maintaining a healthy diet and weight. If you are using hormone therapy after menopause, take progesterone alongside estrogen.
Diet, exercise, and hormonal management
Increase physical activity – Obesity is considered to be the strongest risk factor for endometrial cancer. Therefore, losing weight is one of the most important steps to reduce the risk of endometrial hyperplasia. Regular physical activity and diet management can significantly help to lower the risk of developing endometrial hyperplasia.
Adopt a Balanced Diet – A balanced diet with plenty of fruits, vegetables and whole grains will keep you healthy and help you manage your weight in the long run.
Quit Smoking- Studies associate smoking with an increased risk of endometrial hyperplasia. Therefore, it is strongly advised to quit smoking.
Hormonal Therapy and Contraception – Using birth control pills with progestin can help to regulate menstrual cycles effectively to reduce the risk of endometrial hyperplasia. Similarly, hormonal therapy after menopause should involve medication with progestin to reduce the risk of developing endometrial hyperplasia.
Conclusion
Endometrial hyperplasia is a condition that requires immediate attention as it can lead to serious complications if left untreated. Understanding the symptoms and the role of hormonal imbalance in the body is crucial for early detection and timely intervention. While symptoms like heavy menstrual bleeding and postmenopausal bleeding can be concerning, medical treatment options such as progestin therapy and surgical procedures like hysterectomy can effectively manage the condition. Maintaining a healthy lifestyle, monitoring hormonal levels, and seeking medical advice for irregular menstrual patterns are essential steps in preventing endometrial hyperplasia.
If you’re experiencing symptoms or need expert guidance on reproductive health, visit Ovum Fertility Hospital for more information and consult a fertility specialist in Bangalore for personalized care and treatment.
FAQ’s
1. What is cystic endometrial hyperplasia?
Cystic endometrial hyperplasia is a type of simple endometrial hyperplasia where the uterine lining thickens due to hormonal imbalance, particularly prolonged estrogen stimulation without enough progesterone. This condition, formation of fluid-filled cysts are detected within the endometrial glands. Unlike atypical hyperplasia or endometrial hyperplasia with atypia, this type of cancer has a lower chance of progressing to endometrial cancer.
2. Can endometrial hyperplasia go away on its own?
While some mild forms of endometrial hyperplasia may resolve with hormonal balance, it is strongly advised to seek medical treatment to prevent any future complications. Taking hormonal medication without medical consultation might also lead to further complications that can be avoided.
3. Is endometrial cancer the same as endometrial hyperplasia?
No, endometrial hyperplasia is a precancerous condition, and may advance to endometrial cancer if left untreated, especially those diagnosed with endometrial hyperplasia with atypia.
4. What are the main risk factors for endometrial hyperplasia?
Major risk factors include obesity, hormonal imbalances, early menstruation, late menopause, family history of uterine cancer, and other conditions like diabetes.
5. What is endometrial hyperplasia with atypia?
Endometrial hyperplasia with atypia is a precancerous condition where the uterine lining becomes abnormally thick and contains atypical or abnormal cells. These cells have an irregular structure and have the tendency to behave unpredictably, increasing the risk of endometrial cancer if left untreated. Early detection is crucial in these cases.
6. What treatment options are available for endometrial hyperplasia?
Treatment options, based on the severity and the age of the patient, ranges from progestin therapy (via pills, injections or IUDs) to hysterectomy to prevent cancer development.