Endometrial Hyperplasia

Endometrial hyperplasia is a condition where the lining of the uterus (womb) becomes thicker than normal. It is not a cancer, but in some cases, it can develop into cancer if left untreated. There are two main types:

• Non-atypical hyperplasia (no cell abnormalities): Lower cancer risk.
• Atypical hyperplasia (abnormal cell changes): Higher cancer risk.

Causes

Endometrial hyperplasia is often caused by excess oestrogen without enough progesterone (a hormone that balances oestrogen). Common triggers include:

• Obesity (fat tissue increases oestrogen).
• Polycystic ovary syndrome (PCOS).
• Hormone replacement therapy (HRT) without progesterone.
• Irregular ovulation (common in perimenopause).
• Tamoxifen (a breast cancer medication).

Symptoms

• Abnormal uterine bleeding:
  • Heavy or prolonged periods.
  • Bleeding between periods or after menopause.
• No symptoms: Sometimes found during tests for other issues.

Diagnosis

1. Transvaginal ultrasound: Measures the thickness of the uterine lining.
2. Biopsy:
   1. Pipelle biopsy: A thin tube collects a tissue sample through the cervix.
   1. Hysteroscopy: A camera-guided procedure to view and sample the lining, which can be performed as outpatient office hysteroscopy or under anaesthetic.
3. Lab analysis: Determines if cells are non-atypical or atypical.

Treatment options

Treatment depends on the type of hyperplasia and your health goals:

• Non-atypical hyperplasia:
  Progesterone therapy: Tablets (e.g., medroxyprogesterone) for 3–6 months.
  Hormonal IUD (e.g., Mirena): Releases progesterone locally.
  Lifestyle changes: Weight loss (if overweight) to reduce oestrogen.
  
• Atypical hyperplasia:
  High-dose progesterone (longer course, with regular biopsies).
  Hysterectomy (removal of the uterus): Recommended if cancer risk is high or if you’ve completed childbearing.

Risks of untreated hyperplasia

• Non-atypical: Up to 5% risk of progressing to cancer.
• Atypical: Up to 30% risk of cancer if untreated.

Prevention

• Maintain a healthy weight.
• Use progesterone with oestrogen during HRT.
• Treat conditions like PCOS or diabetes.

Frequently Asked Questions

Q: Is this cancer?
A: No, but atypical hyperplasia requires prompt treatment to prevent cancer.

Q: Can I still get pregnant?
A: Yes – progesterone therapy preserves fertility in non-atypical cases. Discuss risks with your gynaecologist if you have atypical changes.

Q: Will the hyperplasia come back?
A: Possible, especially without lifestyle changes. Regular check-ups are key.

Q: Does a hysterectomy cure it?
A: Yes – removing the uterus eliminates the risk of uterine cancer.

eGynaecologist Advice

• Ongoing monitoring after successful treatment for endometrial hyperplasia is essential and you must consult your gynaecologist for regular review.
• You must seek gynaecological consultation if you report heavy bleeding or develop new symptoms after treatment
• You must consider hysterectomy procedure when you have completed your family after hormonal treatment for endometrial hyperplasia and discuss its timing with your gynaecologist.