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DESCRIPTION
Endometrial hyperplasia is an overgrowth of tissue in the endometrium (inner lining of the uterus). The uterine lining becomes too thick which results in abnormal bleeding. It affects about one out of 1,000 women in the United States. This is not cancerous, but some hyperplasia (hyperplasia with atypia - precancerous changes in the cells), even though reversible, is considered pre-malignant. Terms used to describe the hyperplasia (simple, complex, adenomatous and atypical) helps to explain its pre-malignant potential.
FREQUENT SIGNS AND SYMPTOMS
Bleeding between normal menstrual periods.
Heavy menstrual flow (saturating a tampon or pad once every hour).
Bleeding after menopause.
Vaginal discharge, especially after menopause.
Lower abdominal cramps occur in some patients.
CAUSES
Endometrial hyperplasia is caused by excessive estrogen (a female hormone) as compared with the amount of progesterone (another female hormone) that may not be produced in enough quantities to rein in the effects of the estrogen. This excess is caused internally, or from the use of hormone-containing medications. Endometrial hyperplasia rarely occurs in women who have a normal menstrual cycle. The excessive estrogen spurs cells of the uterine lining (endometrium) to divide. Hyperplasia is most common during adolescence and as a woman approaches menopause. Women with polycystic ovary syndrome and those on estrogen therapy, without progesterone, also have an elevated risk of endometrial hyperplasia. Obesity and late menopause (after 55) are other known risk factors.
RISK INCREASES WITH
Use of estrogen replacement therapy (a therapy often considered after menopause) without the addition of a progesterone drug.
History of chronic anovulation such as with polycystic ovary disease.
Obesity in postmenopausal women.
Late menopause (over age 55).
PREVENTIVE MEASURES
No special preventive measures for endometrial hyperplasia other than regular exposure to progesterone for at least three months.
EXPECTED OUTCOME
Hyperplasia without atypia may need no treatment since it often disappears on its own. In most cases, hormonal treatment with a progesterone (progestin) will reverse the hyperplasia caused by the excess estrogen.
In other cases, it is often curable with D&C (dilation & curettage), hysteroscopy, or hysterectomy (removal of the uterus).
Because hyperplasia with atypia persists in about 75 percent of cases after multiple D&Cs and progestin treatment, and up to 15 percent of women with atypia will develop endometrial cancer, hysterectomy is usually recommended. If you are planning a pregnancy, high-dose progestin may first be recommended.
If a woman chooses not to have surgery, hormone therapy usually controls symptoms.
POSSIBLE COMPLICATIONS
Perforation of the uterus and abdominal pelvic infection as a complication of surgery (endometrial biopsy, D&C or hysteroscopy).
Excessive, uncontrollable bleeding.
Confirmation that the hyperplasia is precancerous.
TREATMENT
GENERAL MEASURES
Diagnostic tests may include laboratory studies, such as blood tests of hormone levels and Pap smear. An endometrial biopsy and a D&C (dilation and curettage) is a treatment and to obtain tissue for microscopic examination (biopsy) to rule out any malignancy (cancer) may be necessary.
Treatment will be individualized based on the medical tests findings, your age, and your reproductive desires.
Occasionally a hysterectomy (surgery to remove the uterus) is performed, particularly when hormone therapy has failed and precancerous cells are discovered.
Try to reduce psychological stress that can complicate your illness and delay your recovery. If you cannot resolve the stress, ask for help from family, friends or competent counselors.
Use heat to relieve pain. Place a heating pad or hot-water bottle on your abdomen or back.
Take frequent hot baths to relax muscles and relieve discomfort. Sit in a tub of water for 10 to 15 minutes.
MEDICATION
Hormone treatment with birth control pills or progesterone (progestin), a female hormone, is often prescribed. (According to an ObGyn health care practitioner resource, "there are no estrogen only birth control pills, they either contain both estrogen and progesterone or just progesterone. In either case, the progesterone interacts with the cells of the endometrium and causes them to be unresponsive to the estrogen. The endometrial lining shrinks as a result. This is one of the 3 mechanisms by which birth control pills work, the other two are preventing ovulation and causing the mucous in the cervix to get very thick, thus creating a barrier to sperm.")
Avoid aspirin; it may increase bleeding.
ACTIVITY
No restrictions unless you have surgery. Then resume your activities gradually.
You may resume sexual relations once medical clearance is given.
DIET
Usually, no special diet is required. If you are overweight, a weight reduction plan might help regulate cycles and decrease estrogen in the body.
MoonDragon's ObGyn Information: Obesity
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of endometrial hyperplasia.
The following symptoms occur during hormone treatment or after surgery or D&C:
- Excessive bleeding (saturating more than 1 pad or tampon every hour).
- Signs of infection, such as fever, pain, a general ill feeling, headache, dizziness or muscle aches.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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