Endometrial Hyperplasia > Fact Sheets > Yale Medicine

Overview

Endometrial hyperplasia is a precancerous condition in which there is an irregular thickening of the uterine lining. This may cause uncomfortable symptoms for women, including heavy menstrual periods, postmenopausal bleeding, and anemia due to the excess bleeding.  

Endometrial hyperplasia is most common among women in their 50s and 60s who have experienced menopause. It may also occur in women who are in perimenopause, a transitional state during which women still have their menstrual periods but on an irregular basis.  

Left untreated, endometrial hyperplasia may develop into endometrial cancer. Treatments are available to effectively manage the condition, which, in turn, helps to lower the risk that endometrial hyperplasia will advance to cancer.

“All women with changes in menstrual bleeding should be evaluated to see if they are at risk for endometrial hyperplasia. If they are, they can potentially be treated to reduce the chances of it progressing to endometrial cancer,” says Shefali Pathy, MD, MPH, a Yale Medicine obstetrician-gynecologist. 

What is endometrial hyperplasia?

During a woman’s childbearing years, her uterus develops a lining every month. If conception occurs, the uterine lining serves as a cushion for the fetus as it grows within the uterus. If conception does not occur, the uterine lining is shed through menstruation. Each month the cycle begins anew.

The root cause of endometrial hyperplasia is an imbalance between estrogen and progesterone; the condition may mean that the lining is not fully shed each month. When there is an unusual thickening of the uterine lining, it can result in what is known as endometrial hyperplasia. The condition is associated with heavy menstrual periods, short menstrual cycles (oligomenorrhea), and postmenopausal bleeding.

In women with endometrial hyperplasia, cells that amass in the uterine lining are abnormal and may, over time, become cancerous. For this reason, women with heavy periods and other symptoms of endometrial hyperplasia should not wait to seek diagnosis and treatment.

What causes endometrial hyperplasia?

Endometrial hyperplasia develops when a woman has an imbalance of estrogen and progesterone. There are a number of reasons this can occur:

• Having irregular menstrual periods, being obese, or having polycystic ovary syndrome (PCOS) may interfere with ovulation, which reduces progestin exposure.
• During perimenopause, when a woman is not ovulating regularly, her exposure to progesterone is reduced.
• After menopause, a woman no longer ovulates, so she is no longer exposed to progesterone.
• The breast cancer medication tamoxifen mimics the effects of estrogen, without progestin (a synthetic chemical that mimics the effects of progesterone on the body). Some people take prescription estrogen without also taking progestin.

What are the symptoms of endometrial hyperplasia?

Women who have endometrial hyperplasia may experience:

• Heavier-than-normal menstrual periods
• Lengthier-than-normal menstrual periods
• Bleeding between menstrual periods
• Menstrual cycles that are shorter than 21 days
• Menstrual-type bleeding after menopause
• Anemia, in some instances, due to heavy menstrual bleeding

What are the risk factors for endometrial hyperplasia?

Women are more likely to develop endometrial hyperplasia after age 35, particularly if they:

• Started getting their menstrual periods at a young age
• Never became pregnant
• Were diagnosed with infertility
• Went through menopause at an older age
• Are obese
• Take tamoxifen, a breast cancer medication
• Take prescription estrogen without progesterone

Additionally, having these medical conditions may increase risk of endometrial hyperplasia:

• Diabetes
• Polycystic ovary syndrome (PCOS)
• Thyroid disease
• Gallbladder disease
• Lynch syndrome
• Cowden syndrome
• Being diagnosed with a tumor that excretes estrogen
• A personal or family history of uterine cancer, ovarian cancer, or colorectal cancer

How is endometrial hyperplasia diagnosed?

Doctors are able to determine whether or not a woman has endometrial hyperplasia by learning about her medical history and symptoms, performing a physical exam, and offering diagnostic tests.
 

During a medical history, doctors will ask about a woman’s history of irregular menstrual bleeding, as well as details about her menstrual history: When her menstrual periods began, when they ended (if applicable), how long her menstrual cycle is/was and whether she has ever been pregnant. The doctor should also ask about medication usage, specifically tamoxifen or estrogen.
 

A pelvic exam may be normal, because endometrial hyperplasia doesn’t cause physical changes to the reproductive system.  

When a doctor suspects endometrial hyperplasia, they may recommend some additional tests.  A transvaginal ultrasound is an imaging tool that shows the inside of the uterus and allows doctors to see if the uterine lining is thicker than it should be.
 

If the uterine lining is too thick, a biopsy of it will be offered to diagnose the condition. This can be done in the office in most cases. In some cases, however, a procedure, known as dilation and curettage (called a D&C) and hysteroscopy, can be performed with some sedation. In this procedure, a doctor inserts a hysteroscope—a tube equipped with a camera and a light—into the vagina, through the cervix, and into the uterus. This enables  the doctor to see inside the uterus. During the D&C portion of the procedure, the cervix is opened, or dilated, to allow the doctor to access the uterus. The doctor then uses a device called a curette to remove of the lining of the uterus. The results may show that the uterine lining cells are:

• normal
• abnormal yet non-cancerous
• abnormal and precancerous
• abnormal and cancerous

Abnormal findings that are non-cancerous and pre-cancerous indicate endometrial hyperplasia.

How is endometrial hyperplasia treated?

For women with endometrial hyperplasia who have abnormal, non-cancerous cells, progestin therapy may be recommended. This synthetic hormone helps to balance out the effects of estrogen in the system, which should eliminate or minimize symptoms of endometrial hyperplasia.

Women who have not yet reached menopause may be prescribed:

• Birth control pills containing progestin
• Birth control pills containing estrogen plus progestin
• Progestin injections
• Vaginal cream containing progestin
• An intrauterine device (IUD) that gradually releases a progestin (levonorgestrel)

Women who have reached menopause should not take birth control pills containing estrogen plus progestin. They may be prescribed:

• Progestin-only birth control pills
• Progestin injections
• Vaginal cream containing progestin
• An IUD that gradually releases progestin

For women with endometrial hyperplasia who have abnormal, pre-cancerous cells, hysterectomy may be recommended. This procedure removes the uterus, eliminating the possibility that endometrial cancer could develop. It’s important to note that having a hysterectomy means a woman is no longer able to get pregnant.

What is the outlook for people with endometrial hyperplasia?

Treatment helps endometrial hyperplasia to resolve in most patients, so that women no longer experience heavy or abnormal menstrual bleeding. If endometrial hyperplasia is not diagnosed and treated, it may develop into endometrial cancer. For this reason, it’s important for women with symptoms of endometrial hyperplasia to seek treatment.

What makes Yale unique in its treatment of endometrial hyperplasia?

“Yale doctors are experts in evaluating abnormal bleeding and can effectively treat women with hyperplasia,” says Dr. Pathy. “Our team of gynecologists work with the patient to identify their goals and then develop treatment plans accordingly.” 

Endometrial Hyperplasia – Symptoms and Treatment

What is endometrial hyperplasia?

Endometrial hyperplasia is a condition in which the endometrium (lining of the uterus) is abnormally thick. There are four types of endometrial hyperplasia. These vary by the amount of abnormal cells and the presence of cell changes. The types are:

• Simple endometrial hyperplasia
• Complex endometrial hyperplasia
• Simple atypical endometrial hyperplasia
• Complex atypical endometrial hyperplasia

Symptoms of endometrial hyperplasia

The primary symptom of endometrial hyperplasia is abnormal menstrual bleeding. Contact your doctor if you experience:

• Menstrual bleeding that is heavier or longer-lasting than usual
• Menstrual cycles (amount of time between periods) that are shorter than 21 days
• Menstrual bleeding between periods
• Not having a period (pre-menopause)
• Post-menopause bleeding

What causes endometrial hyperplasia?

Endometrial hyperplasia is caused by too much estrogen and/or not enough progesterone. Both hormones play a role in the menstrual cycle. Estrogen makes the cells grow, while progesterone signals the shedding of the cells. A hormonal imbalance can produce too many cells or abnormal cells.

How is endometrial hyperplasia diagnosed?

Abnormal uterine bleeding can be a symptom for many things. Contact your doctor if you experience this. They can perform a physical exam and tests to diagnose the main condition. A transvaginal ultrasound measures your endometrium. It uses sound waves to see if the layer is average or too thick. A thick layer may indicate endometrial hyperplasia. Your doctor will take a biopsy of your endometrium cells to determine if cancer is present.

Can endometrial hyperplasia be prevented or avoided?

You cannot completely prevent endometrial hyperplasia. It is more common in people who have gone through menopause. This is because your body’s hormones and menstrual cycles change. Other risk factors for this condition include:

• Long-term use of medicines that contain high levels of estrogen or chemicals that act like estrogen
• Irregular menstrual cycles, which can be caused by infertility or polycystic ovary syndrome (PCOS)
• Obesity
• Tobacco use
• First menstrual cycle at an early age
• Menopause at an older age
• Never having been pregnant
• Family history of uterine, ovarian, or colon cancer

To help lower your risk, you can:

• Lose weight, if you are obese
• Take progestin (synthetic progesterone), if you already are taking estrogen, due to menopause or another condition
• Take birth control or another medicine to regulate your hormones or menstrual cycle

Endometrial hyperplasia treatment

Treatment options for endometrial hyperplasia depend on what type you have. The most common treatment is progestin. This can be taken in several forms, including pill, shot, vaginal cream, or intrauterine device (IUD).

Atypical types of endometrial hyperplasia, especially complex, increase your risk of cancer. If you have these types, you might consider a hysterectomy. This is a surgery to remove your uterus. Your doctor will only recommend this if you no longer want to become pregnant. There are more conservative treatments for younger women who do not wish to have a hysterectomy.

Talk to your doctor who will help you decide which treatment option is best for you.

Living with endometrial hyperplasia

In most cases, endometrial hyperplasia is very treatable. Work with your doctor to create a treatment plan. If you have a severe type or if the condition is ongoing, you might need to see your doctor more often to monitor any changes.

Questions to ask your doctor

• How do I know if my bleeding is caused by endometrial hyperplasia?
• What is the most common age to get endometrial hyperplasia?
• What is my best treatment option for endometrial hyperplasia?
• What are my chances of developing cancer?

Resources

American Congress of Obstetricians and Gynecologists: Endometrial Hyperplasia

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

90,000 causes, symptoms and diagnosis. ENEL-CLINIC

13.03.2020

The thickness of the uterine mucosa in women of reproductive age depends on the day of the cycle. Before ovulation, the body prepares for a possible conception, so the endometrium thickens. If conception does not occur, during menstruation, the mucous layer is updated. In case of malfunction of the reproductive organs or the endocrine system, there may be a constant thickening of the anterior or posterior wall of the uterus. Find out how dangerous this condition is and what provokes it.

Symptoms

Thickening of the posterior wall of the uterus is sometimes asymptomatic. A doctor can detect it during an ultrasound examination of a woman’s reproductive system. Sometimes pathological changes in the endometrium are accompanied by:

• menstrual disorders,
• severe pain in the abdomen and pelvis during and outside of menstruation,
• pronounced PMS,
• change in the duration and volume of menstrual flow,
• extramenstrual bleeding.

Any unpleasant symptoms are a reason for an urgent appeal to a gynecologist. The specialist will conduct a comprehensive examination, which will eliminate dangerous pathologies.

Causes

An increase in the thickness of the mucous layer is considered normal in the first half of the cycle and when the fetal egg is attached. Pathological causes of thickening of the posterior wall of the uterus include:

• endometriosis,
• myoma,
• endometritis.

Endometriosis is an overgrowth of the endometrium. It penetrates into the muscular layer of the uterus, can form nodules and tumors. The exact causes of the development of the disease are not known. If you do not start treatment at an early stage, the disease can provoke infertility.

Myoma is a benign tumor in the uterine cavity. It can increase rapidly, cause severe pain, miscarriage.

Endometritis is an inflammation of the lining of the uterus. Without treatment, it can become chronic.

Diagnostics

A change in the thickness of the endometrium cannot be detected during a standard examination, therefore, if any pathology is suspected, a comprehensive examination is carried out. It may include:

• Pelvic ultrasound,
• cervical swabs,
• hormone tests, etc.

You can undergo a comprehensive diagnosis and treatment of diseases of the reproductive organs in the gynecology of ENEL-CLINIC on Nagorny Boulevard. We have experienced doctors, we have the necessary equipment for conducting informative studies. The clinic is located near the intersection of Nakhimovsky and Sevastopol avenues, public transport stops. We work seven days a week, so you can make an appointment at any convenient time. Phone number and exact address, see the “Contacts” section.

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Endometrial hyperplasia – symptoms and treatment, causes, diagnosis, prevention

The inner lining of the uterus in a woman of reproductive age is subject to changes under the influence of sex hormones – estrogen. With their excessive stimulation, endometrial hyperplasia occurs – its excessive growth, an increase in thickness and a change in cells. This condition is benign, but in some cases it can lead to uterine cancer. The disease is more common in women with menstrual irregularities, as well as in the postmenopausal period.

Endometrial hyperplasia: causes and classification

The main cause of the disease is an imbalance between the two sex hormones – estrogen and progesterone. Active estrogenic stimulation with a lack of gestagens leads to the growth of endometrial cells, as happens in the first phase of the menstrual cycle, but more pronounced.

Factors that can cause hormonal imbalance:

• polycystic ovary syndrome;
• postmenopausal condition;
• overweight.

Other causes of endometrial hyperplasia:

• endocrine diseases – diabetes, obesity;
• diseases of the ovaries;
• taking tamoxifen for breast cancer.

The following classification of the disease is often used in Russia:

• endometrial polyps;
• simple glandular endometrial hyperplasia;
• glandular cystic focal endometrial hyperplasia;
• diffuse glandular cystic endometrial hyperplasia;
• atypical endometrial hyperplasia (adenomatosis), focal or diffuse, including adenomatous polyps.

According to WHO, there are 2 main types of this pathology – without atypia and atypical. Each of them can be simple or complex. The cells that form the glands of the endometrium undergo changes of varying severity – from minor to precancerous. This classification is useful in that it shows the relationship of the disease with the development of malignant neoplasms.

Endometrium with glandular hyperplasia grows, but its cells do not undergo changes. Cystic restructuring – the formation of rounded formations (cysts) from some glands. This is the least dangerous of all forms of the disease, it responds well to hormone therapy.

Simple atypical endometrial hyperplasia is accompanied by a change in the properties of cells in a separate area. It is amenable to hormone therapy and has a low risk of malignancy. The complex form of this type of pathology is the most dangerous and often transforms into endometrial cancer. Treatment often consists of removing the uterus.

Endometrial hyperplasia – symptoms

The most common signs of endometrial hyperplasia are associated with changes in the menstrual cycle. They can be observed daily or at certain phases of the cycle, their severity can also be different.

Main symptoms of endometrial hyperplasia:

• irregular menstruation;
• acne on the skin;
• vaginal dryness;
• spotting between periods;
• pain during intercourse;
• flushes of heat;
• absence of menstruation;
• palpitations, fatigue;
• mood instability;
• increased body hair growth;
• too copious or prolonged menstruation;
• pain in the lower abdomen.

If you experience these symptoms, you should consult a gynecologist. The specialists of the clinic on Barclay, located in Moscow, will provide such patients with qualified assistance in the diagnosis and treatment of this serious disease.

Diagnosis and treatment of endometrial hyperplasia

The main task of diagnosing the disease is to confirm the thickening of the endometrium and the presence of altered cells in it. This can be done on ultrasound and by taking a biopsy.

Material for microscopic examination can be obtained during diagnostic curettage of the uterine cavity. An aspiration biopsy is also performed – taking material using a probe inserted into the uterus, from which air is removed and thus a vacuum is created. Many patients with this disease require hysteroscopy – examination of the inner surface of the uterus using an optical instrument; during the procedure, you can take a biopsy or remove a polyp.

Ultrasound is used to determine the thickness of the endometrium. The transvaginal method is more informative when the sensor is inserted into the vagina. The doctor evaluates the echo signs of the disease, including in terms of the possible development of cancer.

Endometrial glandular hyperplasia and a simple form of atypical hyperplasia are treated with hormonal drugs. Usually, these are progestogen-based drugs that are taken orally, or regularly in the form of injections, or by inserting an intrauterine hormonal coil. During such a course, pregnancy is not possible.

Other groups of drugs are also used – antigonadotropic drugs and gonadotropin-releasing hormone agonists.

Doctors also use curettage of the walls of the uterus to remove overgrown tissues. Treatment of endometrial hyperplasia without curettage is possible in mild forms of the disease and includes ablation (removal) of the endometrium by diathermocoagulation or laser exposure.

In severe cases, not amenable to medical treatment, with persistent bleeding, recurrent hyperplasia, or with a complex atypical form of pathology, surgical treatment of endometrial hyperplasia – removal of the uterus may be recommended.

Removal of polypoid formations is performed using hysteroscopy.

Prevention of endometrial hyperplasia

To reduce the risk of this pathology, it is necessary: ​​

• in the perimenopausal period, prescribe estrogens to women only in combination with progestin preparations;
• in case of irregular menstruation, as prescribed by a doctor, use oral contraceptives that normalize the cycle;
• maintain normal weight.

Treatment in the clinic at Barclay

Therapy of endometrial hyperplasia is quite complex and depends on the age of the patient, the severity of the disease, the severity of its symptoms, the ability to take drugs, their tolerance and many other factors. Such a woman needs regular observation and treatment by a gynecologist.

The Barclay Clinic offers:

• consultations and treatment by qualified doctors;
• thorough diagnostic examination;
• dynamic observation and evaluation of the effectiveness of treatment;
• selection of the most modern and effective hormonal preparation;
• psychological comfort for patients, attentive attitude of all staff;
• affordable prices for services.