What is endometrial hyperplasia. How is it diagnosed. What are the risk factors and treatment options for this condition. Can endometrial hyperplasia lead to cancer.

Understanding Endometrial Hyperplasia: An Overview

Endometrial hyperplasia is a condition characterized by an abnormal thickening of the endometrium, which is the lining of the uterus. This condition can occur when there is an imbalance in the hormones estrogen and progesterone, leading to an overgrowth of the endometrial tissue. While endometrial hyperplasia is not cancer, it can potentially progress to endometrial cancer if left untreated.

There are four types of endometrial hyperplasia, categorized based on the presence of abnormal cells and the extent of cellular changes:

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

The severity and potential risk of progression to cancer increase from simple to complex atypical hyperplasia.

Recognizing the Symptoms of Endometrial Hyperplasia

The primary symptom of endometrial hyperplasia is abnormal uterine bleeding. Women experiencing this condition may notice:

• Heavier or longer-lasting menstrual periods than usual
• Shorter menstrual cycles (less than 21 days between periods)
• Bleeding between periods
• Absence of periods in pre-menopausal women
• Post-menopausal bleeding

Is abnormal bleeding always a sign of endometrial hyperplasia? Not necessarily. Abnormal uterine bleeding can be a symptom of various conditions, which is why it’s crucial to consult a healthcare provider for proper diagnosis and evaluation.

Hormonal Imbalance: The Root Cause of Endometrial Hyperplasia

Endometrial hyperplasia primarily results from an imbalance between estrogen and progesterone levels in the body. Estrogen stimulates the growth of endometrial cells, while progesterone regulates this growth and triggers the shedding of the endometrium during menstruation.

When there is excess estrogen or insufficient progesterone, the endometrial cells may continue to grow and accumulate, leading to hyperplasia. This hormonal imbalance can occur due to various factors, including:

• Menopause and perimenopause
• Polycystic ovary syndrome (PCOS)
• Obesity
• Certain medications containing high levels of estrogen
• Estrogen-secreting tumors

Diagnosing Endometrial Hyperplasia: A Comprehensive Approach

Accurate diagnosis of endometrial hyperplasia is crucial for appropriate treatment and management. Healthcare providers typically use a combination of methods to diagnose this condition:

Physical Examination and Medical History

The diagnostic process often begins with a thorough physical examination and a review of the patient’s medical history, including menstrual patterns and any symptoms experienced.

Transvaginal Ultrasound

This imaging technique uses sound waves to measure the thickness of the endometrium. A thickened endometrial lining may indicate hyperplasia.

Endometrial Biopsy

To confirm the diagnosis and rule out cancer, a small sample of endometrial tissue is taken for microscopic examination. This procedure helps determine the type of hyperplasia present and guides treatment decisions.

How accurate is endometrial biopsy in diagnosing hyperplasia? Endometrial biopsy is considered highly accurate, with a sensitivity of over 90% in detecting endometrial abnormalities.

Risk Factors for Endometrial Hyperplasia: Who is Most Susceptible?

While endometrial hyperplasia can affect women of all ages, certain factors increase the risk of developing this condition:

• Age: More common in women over 35, especially those who have gone through menopause
• Obesity: Excess body fat can lead to increased estrogen production
• Polycystic ovary syndrome (PCOS): This condition often causes hormonal imbalances
• Diabetes: Women with diabetes have a higher risk of developing endometrial hyperplasia
• Never having been pregnant: Pregnancy and childbirth provide natural periods of progesterone dominance
• Late menopause: Prolonged exposure to estrogen increases risk
• Family history: Genetic factors may play a role in susceptibility
• Certain medications: Long-term use of estrogen without progesterone can increase risk

Does having these risk factors guarantee the development of endometrial hyperplasia? No, having risk factors simply increases the likelihood of developing the condition. Regular check-ups and awareness of symptoms can help with early detection and management.

Treatment Options for Endometrial Hyperplasia: Tailored Approaches

The treatment of endometrial hyperplasia depends on several factors, including the type of hyperplasia, the patient’s age, overall health, and desire for future fertility. Common treatment options include:

Hormonal Therapy

Progestin therapy is often the first-line treatment for endometrial hyperplasia without atypia. It can be administered in various forms:

• Oral pills
• Intramuscular injections
• Vaginal creams
• Intrauterine devices (IUDs)

Progestin helps balance the effects of estrogen and can lead to the regression of hyperplasia in many cases.

Surgical Interventions

For more severe cases or those that don’t respond to hormonal therapy, surgical options may be considered:

• Hysteroscopy with D&C (dilation and curettage): Removes the hyperplastic tissue for further examination
• Endometrial ablation: Destroys the endometrial lining, suitable for women who don’t want future pregnancies
• Hysterectomy: Removal of the uterus, recommended for complex atypical hyperplasia or cases resistant to other treatments

How effective are these treatments in managing endometrial hyperplasia? With appropriate treatment, the success rate for resolving endometrial hyperplasia can be as high as 80-90%, depending on the type and severity of the condition.

Preventing Endometrial Hyperplasia: Proactive Measures

While it’s not always possible to prevent endometrial hyperplasia, certain lifestyle changes and preventive measures can help reduce the risk:

• Maintaining a healthy weight: Obesity is a significant risk factor for hormonal imbalances
• Regular exercise: Physical activity can help regulate hormones and maintain a healthy weight
• Balanced diet: A diet rich in fruits, vegetables, and whole grains may help reduce the risk
• Hormonal birth control: Can help regulate menstrual cycles and provide hormonal balance
• Managing underlying conditions: Proper treatment of conditions like PCOS and diabetes can reduce risk
• Regular gynecological check-ups: Allow for early detection and management of potential issues

Can lifestyle changes completely eliminate the risk of endometrial hyperplasia? While lifestyle modifications can significantly reduce the risk, they cannot guarantee prevention. Regular medical check-ups remain crucial for early detection and management.

Living with Endometrial Hyperplasia: Long-term Management and Monitoring

For women diagnosed with endometrial hyperplasia, long-term management and monitoring are essential:

Follow-up Appointments

Regular follow-up appointments with healthcare providers are crucial to monitor the condition’s progression or regression. These may include repeat biopsies or ultrasounds to assess treatment efficacy.

Lifestyle Modifications

Adopting and maintaining a healthy lifestyle can support overall well-being and potentially reduce the risk of recurrence or progression to cancer.

Emotional Support

Coping with a diagnosis of endometrial hyperplasia can be emotionally challenging. Support groups or counseling may be beneficial for some women.

Fertility Considerations

For women of reproductive age who wish to preserve fertility, discussing treatment options and potential impacts on future pregnancies with healthcare providers is crucial.

How often should follow-up appointments be scheduled? The frequency of follow-up appointments can vary based on the individual case, but typically, they are scheduled every 3-6 months initially, with less frequent visits as the condition stabilizes.

The Link Between Endometrial Hyperplasia and Cancer: Understanding the Risks

While endometrial hyperplasia itself is not cancer, it can potentially progress to endometrial cancer if left untreated. The risk of progression varies depending on the type of hyperplasia:

• Simple hyperplasia without atypia: Less than 5% risk of progressing to cancer
• Complex hyperplasia without atypia: 5-10% risk of progressing to cancer
• Simple atypical hyperplasia: 8-30% risk of progressing to cancer
• Complex atypical hyperplasia: 25-50% risk of progressing to cancer

Does the presence of endometrial hyperplasia guarantee the development of cancer? No, not all cases of endometrial hyperplasia progress to cancer. However, the risk increases with more severe types of hyperplasia, particularly those with atypical cells.

Early detection and appropriate treatment of endometrial hyperplasia are crucial in preventing its progression to cancer. Regular gynecological check-ups and prompt attention to abnormal bleeding symptoms can significantly reduce the risk of developing endometrial cancer.

Advances in Research and Future Directions

Ongoing research in the field of endometrial hyperplasia aims to improve diagnosis, treatment, and prevention strategies. Some areas of focus include:

Biomarker Identification

Researchers are working to identify specific biomarkers that could help predict which cases of hyperplasia are most likely to progress to cancer, allowing for more targeted treatment approaches.

Targeted Therapies

Development of new targeted therapies that can effectively treat hyperplasia while minimizing side effects is an active area of research.

Genetic Studies

Understanding the genetic factors that contribute to the development of endometrial hyperplasia could lead to improved risk assessment and personalized prevention strategies.

Non-invasive Diagnostic Tools

Efforts are underway to develop more accurate, non-invasive diagnostic tools to detect and monitor endometrial hyperplasia.

How might these advancements impact the management of endometrial hyperplasia in the future? These research directions hold promise for more precise, personalized approaches to diagnosing, treating, and preventing endometrial hyperplasia, potentially improving outcomes and quality of life for affected individuals.

In conclusion, endometrial hyperplasia is a complex condition that requires careful management and monitoring. With proper diagnosis, treatment, and follow-up care, most cases can be effectively managed, reducing the risk of progression to cancer. As research continues to advance our understanding of this condition, we can look forward to even more effective strategies for prevention and treatment in the future.

Endometrial Hyperplasia | familydoctor.org

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
• Complex
• Simple atypical
• Complex atypical

Symptoms 

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 of 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.

Diagnosis

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.

Prevention Tips

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

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.

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.” 

Diagnosis and treatment of uterine endometrial hyperplasia (Aleksandrov)

Endometrial hyperplasia – diagnosis and treatment in the Paracelsus clinic, Aleksandrov

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Endometrial hyperplasia is a hormonally dependent condition in which the inner layer of the uterus thickens excessively. Symptoms of the disease: heavy menstruation, non-menstrual bleeding, pulling pains in the lower abdomen.

A gynecologist deals with the diagnosis and treatment of the disease. At the consultation, the doctor examines the woman, prescribes an examination, including ultrasound of the pelvic organs, laboratory tests, and, if necessary, hysteroscopy.

What is endometrial hyperplasia

The endometrium lines the uterine cavity from the inside and is the site of attachment of the embryo during conception. Normally, it consists of mucous and glandular tissue, which is permeated with vessels. Therefore, in the first half of the menstrual cycle, the upper layer of the uterine cavity thickens under the influence of hormones – estrogen and progesterone. Hormonal imbalance leads to a violation of the concentration of hormones and causes endometrial hyperplasia. More often the disease develops in postmenopause.

Hyperplastic endometrium is the one whose thickness exceeds 4 mm in postmenopausal women; at reproductive age, the thickness of the endometrium depends on the phase of the menstrual cycle.

Types of endometrial hyperplasia

The growth of the inner layer of the uterus is divided into 2 types:

• Endometrial glandular hyperplasia : a condition in which the structure of the endometrial glands changes. The number of glands increases and the functional layer of the endometrium increases. The functional layer is the layer that appears between menstrual cycles and is removed from the body during menstruation.
• Adenomatous hyperplasia : characterized by thickening of the glands and the appearance of altered cells in them. The adenomatous type of the disease is dangerous with the risk of cell degeneration into cancerous ones.

In the Paracelsus Medical Center, a histological determination of the type of hyperplasia is carried out. According to the results of the study, the gynecologist selects a method of treatment.

Symptoms of endometrial hyperplasia

In the first stages, tissue growth is asymptomatic.

The disease becomes a diagnostic finding during a routine examination by a gynecologist, performing an ultrasound examination.

Late diagnosis is fraught with infertility, anemia due to heavy bleeding, uterine cancer.

Symptoms of hyperplasia:

• discomfort in the lower abdomen;
• occurrence of blood clots during menstruation;
• copious menses for more than a week;
• feeling unwell, lack of strength, dizziness;
• bleeding that is not related to the menstrual cycle;
• uncharacteristic pale skin, brittle hair and nails.

Causes of endometrial hyperplasia

The main reason for the growth of the inner layer of the uterus: an imbalance of estrogen and progesterone.

Unbalance can be provoked by:

• overweight;
• bad habits;
• polycystic ovaries;
• high blood pressure;
• long-term hormonal therapy;
• diseases of the endocrine organs;
• genetic predisposition;
• past abortions, curettage;
• sexually transmitted diseases;
• liver diseases – removal of estrogens from the body decreases;
• ovarian neoplasms – some tumors secrete excessive amounts of hormones.

Diagnosis of endometrial hyperplasia

WHO recommends visiting a gynecologist at least once a year and performing an ultrasound of the uterus to detect diseases at an early stage.

Diagnosis of hyperplasia includes:

• Consultation and examination by a gynecologist: the doctor will ask about complaints, collect the necessary information about the symptoms, genetic predisposition, lifestyle of the woman. Inspection in the chair will help to suspect the presence of the disease. To clarify the diagnosis, instrumental diagnostic methods are used.
• Ultrasound of the uterus and pelvic organs: performed to assess the thickness of the endometrium, the condition of neighboring organs.
• Hysteroscopy: this is an examination of the uterine cavity with an optical instrument. Hysteroscopy is the “gold standard” for diagnosing endometrial changes. During the procedure, a biopsy is taken for histological examination. Histological diagnosis establishes the type of hyperplasia and detects atypical cells.
• Laboratory studies: to determine the hormonal status and the choice of treatment tactics.

In the Paracelsus clinic, all diagnostics are performed on expert-class devices. The equipment enables doctors to see changes in the uterine cavity at an early stage and prescribe treatment.

Our own laboratory performs over 2500 types of analyzes, including histological ones.

No need to wait long for the results and go to clinics in search of the necessary examinations. You can visit a doctor, do an ultrasound scan, take tests in one place in one day without queues and wasting extra time.

Methods of treatment of endometrial hyperplasia

The type of hyperplasia depends on which method of treatment the doctor will prescribe.

• In the glandular type, conservative treatment is prescribed. After the diagnosis of the hormonal background, therapy is prescribed that stabilizes the hormonal status. At the same time, a woman regularly visits a gynecologist to monitor the disease.
• In the adenomatous type, the doctor will suggest a curettage: removal of the top layer. The procedure is performed under anesthesia and lasts up to 30 minutes. After the doctor selects hormonal therapy to prevent relapse.

In cases where a woman is at risk of developing uterine cancer, organ resection is required. Removal of the uterus is indicated for the often recurring development of hyperplasia and ineffective hormonal treatment. The operation is not performed on young women who do not have children.

Diagnosis and treatment of endometrial hyperplasia in the Paracelsus clinic, Aleksandrov

In the Paracelsus clinic in Aleksandrov, gynecologists with more than 15 years of experience are engaged in the diagnosis and treatment of uterine endometrial hyperplasia. Methods of treatment are selected taking into account age, the degree of development of the pathology, the desire to become pregnant in the future.

Diagnosis of diseases is carried out on expert-class devices, which makes it possible to see the pathology in the early stages and start treatment on time.

In our clinic we guarantee:

• complete anonymity;
• partnership with a patient;
• diagnosis and treatment without pain;
• work on the principles of evidence-based medicine;
• continuity – in one clinic you can make an appointment with an endocrinologist, gynecologist, gynecologist-mammologist, neurologist, cardiologist, etc.;
• use expert class medical equipment.

With care for your health, Paracelsus Medical Center

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Endometrial hyperplasia.

What is this? How can he manifest himself?

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Dear women!

I propose today to get acquainted with such a problem as endometrial hyperplasia .

What is it? Why does it occur and how does it proceed? What are its potential risks? And what treatment is needed?

So!

Endometrial hyperplasia is a pathology of the uterine mucosa, which is characterized by the progression of manifestations from simple hyperplasia to atypical precancerous conditions of the endometrium and develops against the background of absolute or relative hyperestrogenism.

Sounds confusing and complicated, so I’ll try to explain in more detail.

The uterus is an organ that has 3 layers – the serous membrane, the myometrium (muscle layer) and the endometrium.

Endometrium is an internal functional layer in which cyclical changes occur every month, manifested by its thickening. The thickness of the endometrium monthly increases from 1-2 mm to 15-16 mm and this cycle ends with the exfoliation of the endometrium – menstruation (if pregnancy does not occur).

Transformation and thickening of the endometrium occurs against the background of cyclic fluctuations of the hormones – estrogen and progesterone. In the first phase of the cycle, an increased level of estrogen ensures the proliferation of the endometrium. During the period of ovulation, a change in the benefits of hormones occurs – the level of progesterone rises – this causes secretory changes in the endometrium.

In the case of an absolute increase in estrogen in the blood (with a normal level of progesterone) or a relative increase (increased estrogen levels against a background of low progesterone levels) – excessive stimulation of the endometrial glands begins – they grow and, accordingly, the thickness of the endometrium also grows. The thickened endometrium no longer corresponds to the phase of the menstrual cycle.

Endometrial hyperplasia , as I mentioned, may not be atypical and with signs of atypia.

How can endometrial hyperplasia manifest itself?

Abnormal uterine bleeding occurs in most cases. Intermenstrual bleeding of varying intensity in different phases of the menstrual cycle, heavy and prolonged menstruation, or bleeding in menopause. If you have these symptoms, you should immediately consult a gynecologist. Bleeding is often accompanied by aching pains in the lower abdomen of varying intensity.

The reference point for suspicion of endometrial hyperplasia is pelvic ultrasound, but the basis for the diagnosis of definite hyperplasia is the histological examination of endometrial tissue. The sampling of material, that is, the endometrium, can be carried out by pipel biopsy, vacuum aspiration or hysteroscopy.

Treatment will depend on the type of hyperplasia found and the age of the patient. In the case of simple endometrial hyperplasia, in which there are very low risks of malignancy, as a rule, drug therapy with the use of progestogens (intrauterine system or tablet preparations is selected individually) is recommended with mandatory monitoring of endometrial biopsy during treatment and at its end.