Endometrial hyperplasia is the abnormal thickening of the lining of the uterus due to an increase in the number of endometrial glands. This disorder most often affects young women who are just beginning to menstruate and older women approaching menopause. In most cases endometrial hyperplasia is not a serious health risk.
In some women, microscopic examination of endometrial tissue may reveal abnormalities in cellular nuclei, a precancerous disorder sometimes referred to as atypical adenomatous hyperplasia, which may lead to endometrial (uterine) cancer. However, most cases of endometrial hyperplasia are benign and respond well to treatment with hormones or minor surgery. Symptoms of abnormal vaginal bleeding may cease with menopause.
What Causes Endometrial Hyperplasia?
- An overproduction of estrogen causes endometrial hyperplasia in young women.
- Unopposed estrogen replacement therapy (taking estrogen without progesterone) in postmenopausal women is associated with a higher incidence of endometrial hyperplasia.
- Young women who have just begun to menstruate, and women who have (or who have had) irregular menstrual cycles, are at greater risk for endometrial hyperplasia.
Symptoms of Endometrial Hyperplasia
- Vaginal bleeding between menstrual periods or after menopause
- Heavy menstrual bleeding
- Periods that last longer than usual
- Pain during sexual intercourse
- Amenorrhea (absence of menstrual periods)
- Anovulatory periods (menstrual cycles without ovulation)
Prevention of Endometrial Hyperplasia
- Although endometrial hyperplasia cannot be prevented, women should have regular pelvic examinations once they reach age 18 or become sexually active, to aid in early detection and treatment of any abnormalities.
- Postmenopausal estrogen replacement should be accompanied by a progestational agent, frequent endometrial biopsies or intrasound assessments of the endometrium.
- Losing weight may be helpful for women who are overweight.
- Daily exercise can reduce the risk of endometrial hyperplasia.
- Eat a healthy diet and avoid fatty foods.
Diagnosis of Endometrial Hyperplasia
- Although a Pap smear is performed (a small sample of cells is scraped from the cervix and examined under the microscope), it is done mostly to rule out other abnormalities. The Pap smear has a low detection rate for endometrial abnormalities.
- A biopsy of endometrial tissue may be taken during a pelvic examination.
- A dilatation and curettage (D&C) may be performed. In this procedure the cervix is widened, and tissue samples are obtained from the uterine lining.
- An ultrasound assessment of the thickness of the lining of the uterus may be used as a screening tool.
- Hysteroscopy may be performed to detect abnormal areas in the endometrial lining and remove cells for examination in a laboratory. In this test, the doctor inserts a slender, telescope-like device (hysteroscope) into the uterus.
How to Treat Endometrial Hyperplasia
- In most cases removal of excessive uterine tissue during the diagnostic D&C is all that is needed to treat endometrial hyperplasia.
- Postmenopausal women on unopposed estrogen therapy who have recurrent endometrial hyperplasia should discuss with a gynecologist the options of either stopping the therapy or supplementing it with a progestational agent.
- In premenopausal women who have recurrent endometrial hyperplasia, oral contraceptives or a progestational agent such as Depo-Provera may be prescribed for a few months to thin the endometrial lining.
- A hysterectomy, the surgical removal of the uterus (and perhaps other reproductive organs), may be advised for postmenopausal women (or premenopausal women who no longer wish to have children) to reduce the risk of cancer when adenomatous hyperplasia does not respond to progestational agents.
When to Call a Doctor
Call a doctor if you develop heavy vaginal bleeding or if you experience vaginal bleeding between periods or after menopause.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media