Endometrial hyperplasia is a condition that occurs when the lining of the uterus (endometrium) grows too much. It is a benign (not cancer) condition. In some cases, however, it can lead to cancer of the uterus. Some women are at higher risk of hyperplasia but it can be treated and women at risk can take steps to protect against it.
Who is at Risk?
Endometrial hyperplasia is more likely to occur in certain women. Those most at risk are women who:
- Are in the years around menopause
- Skip menstrual periods or have no periods at all
- Are overweight
- Have diabetes
- Have polycystic ovary syndrome
- Take estrogen without progesterone to replace the estrogen their body is no longer making and to relieve symptoms of menopause
The most common symptom of hyperplasia is abnormal uterine bleeding.
Tests
If you have abnormal bleeding along with any of the other risk factors, you may need to be tested for endometrial hyperplasia. One or more tests may be required.
Ultrasound
Your doctor may suggest you have a vaginal ultrasound exam. For this test, a small device is placed in vagina. Fluid may be placed in your uterus. Ultrasound uses sound waves to make a picture of the uterine lining.
Biopsy
Endometrial hyperplasia also may be found with a biopsy of the endometrium. Endometrial biopsy can be done in a doctor’s office. Your doctor puts a narrow tube inside the uterus to take a sample of cells. You may feel some cramping during the test. The cells will be sent to a lab and checked under a microscope. Endometrial biopsy results may detect cancer of the uterus.
Dilation and Curettage
For dilation and curettage (D&C), the opening of the uterus is stretched. A special device called a curette is used to gently loosen and remove a sample of the uterine lining. This tissue is then studied in the lab to check for cancer.
You may be given anesthesia during the procedure. It may be done in an outpatient clinic, doctor’s office or hospital. The D&C may be done with other procedures such as hysteroscopy.
Hysteroscopy
For hysteroscopy, your doctor inserts a slender, telescope-like device into the uterus to look for areas in the lining that maybe abnormal. He or she then removes cells from these areas and sends the sample to a lab for testing.
Treatment
In most cases endometrial hyperplasia can be treated with medication that is a form of the hormone progesterone. Taking progesterone will cause the lining to shed and prevent it from building up again. It often will cause vaginal bleeding.
You and your doctor will find a form of progesterone and a dose that is right for you. How much and how long you take progesterone depends on your condition. After you have been taking progesterone, the lining of the uterus maybe tested again by endometrial biopsy.
If the problem persists, more treatment options such as other medication or surgery may be used. Hysterectomy (surgery to remove the uterus) may be an option if you are done having children or your biopsy showed cells that could become cancer (atypical hyperplasia). If you wish to have children, other options can be discussed.
Protecting Against Endometrial Hyperplasia
Women can take steps to reduce the risk of endometrial hyperplasia. This can protect women with certain risk factors as well as help keep it from recurring.
If you take estrogen after menopause, you need to take a form of progesterone to reduce the risk of endometrial hyperplasia and cancer of the uterus.
If you don’t have monthly periods, you may need to take a form of progesterone to help prevent the lining of the uterus from growing too much. Birth control pills (oral contraceptives) contain estrogen along with a form of progesterone. They may help protect against endometrial hyperplasia in women who don’t have regular periods.
If you are overweight, losing weight may help.
Finally . . .
In most cases, endometrial hyperplasia can be treated. Work with our doctor during treatment to prevent further problems. Women at risk can take steps to protect against endometrial hyperplasia.
