Endometrial Hyperplasia: Symptoms, Causes, Treatment

What are the symptoms of endometrial hyperplasia?

Endometrial hyperplasia is a condition characterized by the abnormal thickening of the lining of the uterus (endometrium). In some cases, it may not cause any symptoms, especially in its early stages. However, when symptoms do occur, they may include:

1. Abnormal uterine bleeding: This is the most common symptom of endometrial hyperplasia. It can manifest as irregular menstrual periods, heavy menstrual bleeding (menorrhagia), or bleeding between periods (metrorrhagia).
2. Postmenopausal bleeding: Bleeding after menopause, when menstrual periods have stopped, is a concerning symptom and should always be evaluated by a healthcare provider.
3. Pelvic pain: Some individuals with endometrial hyperplasia may experience pelvic pain or discomfort, although this is less common than abnormal uterine bleeding.
4. Changes in menstrual patterns: This can include shorter or longer menstrual cycles, as well as changes in the duration or intensity of menstrual bleeding.
5. Symptoms related to hormonal imbalances: In some cases, endometrial hyperplasia may be associated with hormonal imbalances, leading to symptoms such as hot flashes, night sweats, or mood changes.

It’s important to note that these symptoms can also be caused by other conditions, so a proper evaluation by a healthcare provider is necessary to determine the underlying cause. If you experience any of these symptoms, particularly postmenopausal bleeding or persistent abnormal uterine bleeding, it’s essential to seek medical attention promptly for proper diagnosis and management.

What are the causes of endometrial hyperplasia?

Endometrial hyperplasia is often caused by an imbalance of hormones, particularly estrogen and progesterone, which regulate the menstrual cycle and the growth of the endometrium. Several factors can contribute to this hormonal imbalance and increase the risk of developing endometrial hyperplasia, including:

1. Excess estrogen: High levels of estrogen, without enough progesterone to balance its effects, can lead to the excessive growth of the endometrium. This can occur due to various factors, such as obesity, estrogen therapy without progesterone (used in menopausal hormone therapy), or conditions like polycystic ovary syndrome (PCOS).
2. Low progesterone: Progesterone plays a crucial role in regulating the growth of the endometrium and balancing the effects of estrogen. A decrease in progesterone levels, which can occur during perimenopause or due to conditions like anovulation (lack of ovulation), can lead to endometrial hyperplasia.
3. Menstrual irregularities: Conditions that cause irregular menstrual cycles or anovulation, such as PCOS, obesity, or thyroid disorders, can increase the risk of endometrial hyperplasia.
4. Obesity: Excess body weight is associated with higher estrogen levels, which can promote the growth of the endometrium and increase the risk of hyperplasia.
5. Estrogen-producing tumors: Certain types of ovarian tumors, such as granulosa cell tumors, can produce estrogen and lead to endometrial hyperplasia.
6. Tamoxifen: This medication, used in the treatment of breast cancer, has estrogen-like effects on the uterus and can increase the risk of endometrial hyperplasia and cancer.
7. Family history: A history of endometrial hyperplasia or cancer in close relatives may increase the risk of developing the condition.

It’s important to note that while these factors can increase the risk of endometrial hyperplasia, not everyone with these risk factors will develop the condition. Regular gynecologic check-ups and monitoring can help detect and manage endometrial hyperplasia early.

How is the diagnosis of endometrial hyperplasia made?

The diagnosis of endometrial hyperplasia is typically made through a combination of medical history, physical examination, and diagnostic tests. Here’s how it’s usually done:

1. Medical history: Your healthcare provider will ask about your menstrual history, including the regularity of your periods, any changes in bleeding patterns, and other symptoms you may be experiencing.
2. Physical examination: This may include a pelvic examination to check for any abnormalities, such as an enlarged uterus or signs of other conditions that could be causing your symptoms.
3. Transvaginal ultrasound: This imaging test uses sound waves to create a picture of the uterus. It can help evaluate the thickness of the endometrium and detect any abnormalities, such as thickening or polyps.
4. Endometrial biopsy: This is the most definitive test for diagnosing endometrial hyperplasia. It involves taking a small sample of tissue from the lining of the uterus and examining it under a microscope to look for abnormal cell growth.
5. Hysteroscopy: In some cases, a hysteroscopy may be performed to directly visualize the inside of the uterus. During this procedure, a thin, lighted tube (hysteroscope) is inserted through the cervix into the uterus, allowing the doctor to examine the lining of the uterus and take a biopsy if necessary.
6. Dilation and curettage (D&C): In this procedure, the cervix is dilated, and a thin instrument is used to scrape tissue from the lining of the uterus. This tissue is then examined under a microscope to look for signs of hyperplasia or other abnormalities.

The specific tests recommended may vary depending on your symptoms, age, and other factors. It’s important to follow up with your healthcare provider for a proper diagnosis and appropriate management if you are experiencing symptoms of endometrial hyperplasia.

What is the treatment for endometrial hyperplasia?

The treatment for endometrial hyperplasia depends on several factors, including the type of hyperplasia, the severity of symptoms, and whether you plan to have children in the future. Treatment options may include:

1. Progestin therapy: This is often the first-line treatment for endometrial hyperplasia. Progestin, a synthetic form of progesterone, helps regulate the growth of the endometrium and can help reduce the thickness of the lining. It can be taken orally, as an injection, or as a hormonal intrauterine device (IUD).
2. Dilation and curettage (D&C): In some cases, a D&C may be performed to remove the thickened endometrial tissue. This procedure can also help determine the type and severity of hyperplasia.
3. Hysterectomy: In severe cases or when other treatments have not been effective, a hysterectomy may be recommended. This involves surgical removal of the uterus and is considered a definitive treatment for endometrial hyperplasia.
4. Lifestyle changes: Maintaining a healthy weight, exercising regularly, and eating a balanced diet may help reduce the risk of endometrial hyperplasia, especially in cases where obesity is a contributing factor.
5. Monitoring: For some women, especially those with mild or asymptomatic hyperplasia, regular monitoring with ultrasound and endometrial biopsies may be recommended to watch for any changes in the condition.

The choice of treatment depends on your individual circumstances and should be discussed with your healthcare provider. It’s important to follow up as recommended and adhere to your treatment plan to manage endometrial hyperplasia effectively.