What Is Endometrial Hyperplasia?

Endometrial hyperplasia is a precancerous condition that occurs when the lining of the uterus (endometrium) becomes too thick. The endometrium is the lining of the uterus that is shed during menstruation, and it also serves as a cushion that a fetus would grow in during pregnancy.

The underlying cause of endometrial hyperplasia is a hormonal imbalance between estrogen and progesterone. Endometrial hyperplasia may cause symptoms such as irregular or heavy bleeding during menstruation, post-menopausal bleeding, and anemia related to excessive bleeding.

The condition typically occurs during or after menopause, usually among women in their 50’s and 60’s. Less commonly, it may occur in people going through perimenopause, a transitional state before menopause, where women still have their period but on an irregular basis. If left untreated, endometrial hyperplasia may develop into endometrial cancer. There are effective treatments available that can reduce the risk of endometrial hyperplasia developing into cancer. If you are experiencing changes in your menstrual bleeding, please consult with your healthcare provider.

Signs and Symptoms

There are several symptoms of endometrial hyperplasia.

Common symptoms may include:

• Irregular menstrual bleeding, or bleeding between periods
• Heavy menstrual bleeding
• Short menstrual cycles (less than 21 days)
• Irregular bleeding after menopause
• The absence of a period (amenorrhea)

Many of these symptoms are common when the body is transitioning to menopause, which does not necessarily indicate endometrial hyperplasia. It is important to consult with your healthcare provider so they can determine whether assessing for endometrial hyperplasia is medically necessary.

Causes

The cause of endometrial hyperplasia is a hormonal imbalance between estrogen and progesterone. When the body makes very little or no progesterone and has an excess of estrogen, the uterine lining will thicken and will not shed. The lining will continue to grow and thicken, and the cells within the lining grow close together and may become abnormal.

What Are the 4 Stages of Endometrial Hyperplasia?

Endometrial hyperplasia is categorized by changes at the cellular level in the endometrial lining. Some types of endometrial hyperplasia increase the risk of developing cancer. There are four stages (or types) of endometrial hyperplasia.

The four stages of endometrial hyperplasia are:

• Simple without atypia: Cells appear normal and are not likely to become cancerous.
• Complex without atypia: Cells are abnormal but not likely to become cancerous.
• Simple with atypia: Cells appear normal but are at a higher risk of becoming cancerous.
• Complex with atypia: Cells are abnormal and at a high risk of becoming cancerous.

How Long Does It Take for Endometrial Hyperplasia to Turn into Cancer?

Endometrial hyperplasia is a precancerous condition that may develop into cancer. It usually takes several years to develop into cancer. It begins with the thickening of the endometrium and progresses to the development of glands. The glands eventually experience abnormal cellular changes. If left untreated, these changes can develop into cancer.

Risk Factors

There are several risk factors that may increase your likelihood of developing endometrial hyperplasia.

Risk factors include:

• Being over the age of 35
• People in perimenopause or menopause
• Started menstruation at an early age, or late onset of menopause
• Obesity
• Diabetes
• Polycystic ovary syndrome (PCOS)
• Certain breast cancer medications (tamoxifen)
• Family history of ovarian, uterine, or colon cancer
• Hormone therapy that uses only estrogen when you still have a uterus
• Gallbladder disease
• Never being pregnant
• Smoking
• Thyroid disease
• Long history of irregular or absent menstruation
• History of radiation on your pelvis
• Being immunocompromised

Treatment Options

Endometrial hyperplasia is a treatable condition. Treatment is dependent on what type of EH it is, how severe it is, and the age of the patient. In most cases, treatment involves taking progestin. Progestin is the synthetic version of progesterone, which is the hormone that is lacking in the body of someone who develops endometrial hyperplasia.

Treatments include:

• Oral progesterone therapy (pill)
• Intrauterine device (IUD) containing progesterone
• Vaginal cream or gel
• Injection (Depo-Provera)

If your condition worsens or does not improve with treatment, or cancerous cells develop, your healthcare provider may recommend a hysterectomy. This procedure removes the uterus and any cancerous cells within the uterus.

Learn More about Endometrial Hyperplasia

Endometrial hyperplasia is a treatable condition. However, if left untreated, it can develop into cancer. It is important to consult with your healthcare provider if you notice any changes in your menstruation so they can determine if you need to be assessed for endometrial hyperplasia.

Call to schedule an appointment today.