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Endometrial Hyperplasia: Causes, Symptoms, Diagnosis And Treatment

Abnormal uterine bleeding is not uncommon and it is quite likely that you might have approached your doctor at some point of time complaining about such abnormal bleeding. Heavier than normal menstrual bleeding, post-menopausal bleeding or bleeding in between your periods could all be signs of endometrial hyperplasia [1] .

Abnormality of the lining of the uterus or endometrium indicates a condition known as endometrial hyperplasia [2] . Although this condition does not hint at the arrival of cancer, it might lead to uterine cancer in some women, especially if left untreated.

Read on to know more about endometrial hyperplasia and how it can be treated.

What Is Endometrial Hyperplasia?

It is a condition wherein the endometrium (lining of the uterus) turns abnormally thick. This condition occurs when there is an excess of estrogen, but no progesterone [3] .

Your endometrium is what builds up and sheds each month in the form of your regular monthly periods. When there is an imbalance in the hormonal stimulation of the endometrium, an abnormality arises. In women with endometrial hyperplasia, progesterone is not made and the lining of the uterus does not shed itself as a result of missed ovulation [4] . The endometrium continues to grow in response to the rise in production of estrogen. When the cells of the endometrium get crowded abnormally (causing hyperplasia), it may lead to uterine cancer [5] .

The following are some of the conditions that can cause excess production of estrogen, in turn, leading to endometrial hyperplasia:

  • Anovulation: In case you do not ovulate (there can be a variety of reasons), there won't be an increase in the production of progesterone. If this happens, you will not get your periods, in other words, the lining of your uterus will not shed [6] .
  • Obesity: Presence of fat tissues can make other hormones convert to estrogen [7] . This result in extra estrogen that stimulates the lining of the uterus in addition to the normal estrogen that is produced by the ovaries.
  • Exogenous hormones: Hormonal medication can cause abnormal thickening of the endometrium [8] . For people using hormone replacement therapy, this condition is quite common.
  • Estrogen producing ovarian tumours: Benign ovarian tumours can produce excess estrogen [9] .

Symptoms Of Endometrial Hyperplasia

The major symptoms of this condition are abnormal menstrual bleeding. You should consult your doctor immediately whenever you face any of the following [10] :

  • Menstrual cycles shorter than 21 days
  • Menstrual bleeding between menstrual period cycles
  • Menstrual bleeding that is heavier and lasts longer than usual
  • Pre-menopause (not having a period at all)
  • Post-menopause uterine bleeding

Causes Of Endometrial Hyperplasia

The two main causes of this condition are as follows:

1. Too much estrogen: This is a hormone that plays an important role in the menstrual cycle. Estrogen makes the cells grow [11] . When an abnormal scenario occurs, there can be a production of too many cells.

2. Not enough progesterone: This is also another important hormone for the normal functioning of the menstrual cycle. Progesterone signals the shedding of the cells [12] . When there is an imbalance, it can produce abnormal cells.

Diagnosis Of Endometrial Hyperplasia

When you approach your doctor with complaints of abnormal uterine bleeding, you are most likely to be advised to undergo a biopsy of the lining of the uterus. Either of the following two procedures could be tried out :

1. Endometrial biopsy: This is a very common gynecologic procedure. However, to minimize the cramping during or after the procedure, you can carry a small warm pack with you. Also, you can choose to have a little snack about an hour before the procedure. The procedure is almost like a routine pap smear. Your cervix is held using a grasper and a small aspirator device is inserted [13] . The discomfort experienced might be like mild period cramps. The procedure will last less than a minute.

2. Hysteroscopy: At times, your doctor might suggest that you get a hysterectomy done instead of an endometrial biopsy. The benefit of this procedure is that the doctor can get a direct view of the lining of the uterus [14] . This procedure ensures that all areas of the endometrium are adequately sampled.

Note that endometrial hyperplasia cannot be diagnosed by a blood test or an ultrasound. However, your doctor might suggest certain blood tests to rule out other causes of abnormal uterine bleeding.

Treatment For Endometrial Hyperplasia

The most common treatment approach is through the use of progestin [15] . This can be taken in the form of a pill, as a shot, vaginal cream or in the form of an intrauterine device.

Complex endometrial hyperplasia increases your risk of getting cancer. In case, one has the atypical type of endometrial hyperplasia (there could be a presence of tumours in the uterus), then she should consider a hysterectomy (a surgical process of getting the uterus removed). This is recommended if you no longer wish to conceive [16] .

For the younger women who wish to have babies in the future, progesterone therapy works best.

Risk Factors And Prevention Of Endometrial Hyperplasia

Women who have gone through menopause are more likely to have this condition. This is because the menstrual cycle changes along with the bodily hormones.

The following are some of the risk factors associated with this condition [17] :

  • Obesity
  • First menstrual cycle at an early age
  • Long-term use of medicines containing high levels of estrogen
  • Use of tobacco
  • Not being pregnant ever
  • Going through menopause at an older age
  • Irregular menstrual cycles
  • Family history of uterine or ovarian cancer.

Although endometrial hyperplasia cannot be prevented, the risks of it occurring can be lowered by

  • taking birth control [18] to regulate hormonal changes,
  • losing weight, if obese and
  • taking medicine with progestin, if you are already taking estrogen medicines.
View Article References
  1. [1] Sobczuk, K., & Sobczuk, A. (2017). New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Przeglad menopauzalny = Menopause review,16(3), 107–111.
  2. [2] Emons, G., Beckmann, M. W., Schmidt, D., Mallmann, P., & Uterus commission of the Gynecological Oncology Working Group (AGO) (2015). New WHO Classification of Endometrial Hyperplasias.Geburtshilfe und Frauenheilkunde,75(2), 135–136.
  3. [3] Carlson, M. J., Thiel, K. W., Yang, S., & Leslie, K. K. (2012). Catch it before it kills: progesterone, obesity, and the prevention of endometrial cancer.Discovery medicine,14(76), 215–222.
  4. [4] Reed, S. D., Newton, K. M., Clinton, W. L., Epplein, M., Garcia, R., Allison, K., … Weiss, N. S. (2009). Incidence of endometrial hyperplasia.American journal of obstetrics and gynecology,200(6), 678.e1–678.e6786.
  5. [5] Leslie, K. K., Thiel, K. W., Goodheart, M. J., De Geest, K., Jia, Y., & Yang, S. (2012). Endometrial cancer.Obstetrics and gynecology clinics of North America,39(2), 255–268.
  6. [6] Rebar, R. (2018). Evaluation of amenorrhea, anovulation, and abnormal bleeding. InEndotext [Internet]. MDText. com, Inc..
  7. [7] Nelson, L. R., & Bulun, S. E. (2001). Estrogen production and action.Journal of the American Academy of Dermatology,45(3), S116-S124.
  8. [8] Neven, P., & Vernaeve, H. (2000). Guidelines for monitoring patients taking tamoxifen treatment.Drug safety,22(1), 1-11.
  9. [9] Stephens, J. W., Katz, J. R., McDermott, N., MacLean, A. B., & Bouloux, P. G. (2002). An unusual steroid-producing ovarian tumour: case report.Human Reproduction,17(6), 1468-1471.
  10. [10] Montgomery, B. E., Daum, G. S., & Dunton, C. J. (2004). Endometrial hyperplasia: a review.Obstetrical & gynecological survey,59(5), 368-378.
  11. [11] MacDonald, P. C., Grodin, J. M., Edman, C. D., Vellios, F., & Siiteri, P. K. (1976). Origin of estrogen in a postmenopausal woman with a nonendocrine tumor of the ovary and endometrial hyperplasia.Obstetrics and gynecology,47(6), 644-650.
  12. [12] Faivre, E. J., & Lange, C. A. (2007). Progesterone receptors upregulate Wnt-1 to induce epidermal growth factor receptor transactivation and c-Src-dependent sustained activation of Erk1/2 mitogen-activated protein kinase in breast cancer cells.Molecular and cellular biology,27(2), 466-480.
  13. [13] Langer, R. D., Pierce, J. J., O'hanlan, K. A., Johnson, S. R., Espeland, M. A., Trabal, J. F., ... & Scully, R. E. (1997). Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease.New England Journal of Medicine,337(25), 1792-1798.
  14. [14] O'connell, L. P., Fries, M. H., Zeringue, E., & Brehm, W. (1998). Triage of abnormal postmenopausal bleeding: a comparison of endometrial biopsy and transvaginal sonohysterography versus fractional curettage with hysteroscopy.American journal of obstetrics and gynecology,178(5), 956-961.
  15. [15] Wentz, W. B. (1974). Progestin therapy in endometrial hyperplasia.Gynecologic oncology,2(2-3), 362-367.
  16. [16] Randall, T. C., & Kurman, R. J. (1997). Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40.Obstetrics & Gynecology,90(3), 434-440.
  17. [17] Savelli, L., De Iaco, P., Santini, D., Rosati, F., Ghi, T., Pignotti, E., & Bovicelli, L. (2003). Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps.American journal of obstetrics and gynecology,188(4), 927-931.
  18. [18] Gambrell, J. R. (1986). The role of hormones in the etiology and prevention of endometrial cancer.Clinics in obstetrics and gynaecology,13(4), 695-723.
Read more about: uterus periods bleeding
Story first published: Tuesday, May 14, 2019, 15:45 [IST]
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