Endometrial hyperplasia

Endometrial hyperplasia is a condition where the lining of the uterus (endometrium) is abnormally thick.

There are 2 main types:

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

Symptoms of endometrial hyperplasia can include:

• heavy periods
• bleeding between periods or irregular bleeding
• bleeding after menopause
• bleeding while using hormone medicines.

Some women don’t have any symptoms.

Endometrial hyperplasia is caused by an imbalance in oestrogen and progesterone hormones.

During a normal menstrual cycle, oestrogen helps thicken the lining of the uterus. After ovulation, progesterone helps control this growth. If the body doesn’t produce enough progesterone, the lining may continue to grow and become too thick. This increases the risk of developing endometrial cancer.

Other factors may contribute to this condition, such as:

• inflammation
• immune system issues
• hormonal changes due to other medical conditions.

You can’t change some risk factors for endometrial hyperplasia, but it’s good to be aware of them.

The risk of endometrial hyperplasia is higher in people who don’t ovulate regularly. This might happen with polycystic ovary syndrome (PCOS) and perimenopause (the time just before menopause).

Other risk factors include:

• being overweight
• having an oestrogen or androgen-producing tumour
• using tamoxifen therapy after breast cancer.

If you think you might have endometrial hyperplasia, see your doctor.

Diagnosis usually involves:

• a review of symptoms and medical history, including changes to your periods
• a pelvic exam
• an ultrasound (via the vagina) to measure the thickness of the uterus lining
• blood tests to check for iron deficiency or anaemia due to the bleeding
• a sample (biopsy) or procedures to collect tissue samples for analysis.

Treatments for typical endometrial hyperplasia

Typical endometrial hyperplasia is unlikely to progress to cancer and may not need treatment. It progresses slowly and often goes away on its own, especially in women without symptoms.

Weight management may help to reduce the risk of cancer from hyperplasia.

If you are using hormone medicines, your doctor may recommend changing the dose.

Progestogen treatment, for example, IUD or tablets, can help control bleeding and reduce cancer risk.

Treatments for atypical endometrial hyperplasia

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

The recommended treatment is removal of the uterus, fallopian tubes and cervix (total hysterectomy) to avoid cancer developing. This operation is usually performed via keyhole surgery (laparoscopy).

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

If you choose not to have a hysterectomy and plan to get pregnant in the future, your doctor may recommend hormone medicines with progesterone and regular check-ups for signs of cancer.

When deciding on treatment, it’s important to understand the benefits and risks of hysterectomy and consider how it could impact you in the future.

See your doctor straight away if you have abnormal vaginal bleeding.

It’s important to rule out other causes and, if diagnosed with endometrial hyperplasia, treat it as early as possible.