Endometrial Hyperplasia

Endometrial hyperplasia is a condition where the lining of the uterus (womb) becomes thicker than normal. It is not 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.
3. Lab analysis: Determines if cells are non-atypical or atypical.

Treatment Options

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

1. Non-atypical hyperplasia:
   1. Progesterone therapy:
      1. Tablets (e.g., medroxyprogesterone) for 3–6 months.
      1. Hormonal IUD (e.g., Mirena®): Releases progesterone locally.
   1. Lifestyle changes: Weight loss (if overweight) to reduce oestrogen.
2. Atypical hyperplasia:
   1. High-dose progesterone (longer course, with regular biopsies).
   1. 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 doctor 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 consult your gynaecologist.