Endometrial hyperplasia

What is endometrial hyperplasia?

Endometrial hyperplasia is a condition in which the cells in the lining of the uterus grow faster than normal. There are two types of endometrial hyperplasia:

• typical – a condition that is less likely to progress to endometrial cancer
• atypical – a precancerous condition that has a high risk of developing into endometrial cancer.

Symptoms

Symptoms of endometrial hyperplasia can include:

• abnormal bleeding during or in between periods
• heavier periods with longer or shorter menstrual cycles
• bleeding, spotting or staining after menopause.

Causes

Endometrial hyperplasia is caused by abnormal production of oestrogen and progesterone hormones during your menstrual cycle.

In the first part of your menstrual cycle, oestrogen hormones stimulate the lining of your uterus to thicken. After ovulation (mid cycle), your ovary produces oestrogen and progesterone. The progesterone stops the lining of your uterus from getting thicker. If progesterone is not produced, the lining can become abnormally thick, increasing the risk of developing endometrial cancer.

Risks

If you don’t ovulate consistently during your menstrual cycles, it can increase the risk of endometrial hyperplasia. This might happen with:

• polycystic ovarian syndrome (PCOS)
• perimenopause (before menopause)
• obesity.

After menopause, your risk can increase if you don’t have enough progesterone in your menopausal hormone therapy (MHT) treatment.

There are other risks for endometrial hyperplasia. For example, if you:

• have an oestrogen- or androgen-producing tumour
• use tamoxifen therapy after breast cancer
• have Lynch Syndrome with the hereditary non-polyposis colon cancer gene (HNPCC)
• started your periods early or had a late menopause
• have diabetes
• have a family history of bowel, ovarian or uterine cancer.

Diagnosis

Your doctor will ask questions about your periods and any abnormal bleeding. They will also ask about pre-existing conditions and possible causes of the bleeding.

They might ask to do a vaginal examination to try to see or feel anything that may be causing the abnormal bleeding.

You may also need to get blood tests to see if you have an iron deficiency or anaemia due to the bleeding.

Your doctor will usually ask to do a vaginal ultrasound to assess the size of your uterus and the thickness of the uterus lining. They will also look for endometrial polyps, fibroids and adenomyosis to exclude them as possible causes of the bleeding.

If the lining is thick, your doctor may refer you to a gynaecologist. The gynaecologist will check the uterus lining by getting a sample (biopsy) or organising for you to have a hysteroscopy and dilatation and curettage (D and C). The samples from either of these procedures will be sent to pathology to see if you have endometrial hyperplasia.

Treatment

If you are diagnosed with endometrial hyperplasia, your doctor will talk to you about different treatment options.

Typical endometrial hyperplasia

Typical endometrial hyperplasia has a slow rate of progressing to endometrial cancer, but it’s important to get treatment and reduce risk factors.

Your doctor may recommend progestogen treatment. For example:

• the levonorgestrel-releasing IUD (Mirena™) – an effective treatment with few side effects
• progestogen tablets.

You will need to have progestogen treatment for a minimum of six months, until at least two biopsies (six months apart) have been reviewed by your doctor.

Atypical endometrial hyperplasia

Atypical endometrial hyperplasia has a high risk of developing into endometrial cancer.

Your doctor or gynaecologist will usually recommend the removal of your uterus and cervix (total hysterectomy). This operation is usually performed via keyhole surgery (laparoscopy).

Depending on your stage of life, your doctor may also recommend removal of your fallopian tubes and ovaries to reduce the risk of ovarian cancer.

When to see your doctor

See your doctor straight away if you have abnormal bleeding. It’s important to rule out all other causes of the bleeding and, if diagnosed with endometrial hyperplasia, treat it as early as possible.