What do you need to know about Endometrial Hyperplasia?

Endometrial hyperplasia is an excessive growth of the endometrium, which is the lining of the uterus. Normally the lining of the uterus thickens and sheds during the menstruation. It is caused by longstanding exposure to Oestrogens. Endometrial Hyperplasia is rare in women under 30 years of age and occurs more frequently from the ages 45-50. It is estimated that 10% of women with abnormal uterine bleeding may have endometrial thickening.

How is it diagnosed? 

The affected women commonly present with abnormal uterine bleeding.

Commonly women with this issue present as:

• Heavy menstrual periods: Experiencing unusually heavy or prolonged periods.
• Irregular menstrual bleeding: Having irregular periods or bleeding between periods.
• Postmenopausal bleeding: Experiencing vaginal bleeding after menopause, which is considered abnormal.

Ultrasound can detect this issue when the endometrium is excessively thick (greater than 15 mm in women of reproductive age group with periods and greater than 5mm in postmenopausal women). Confirmatory diagnosis is always histological. This can be achieved by endometrial biopsy (obtained by hysteroscopy and Pipelle biopsy or curette).

What are the types of endometrial Hyperplasia?

• Simple or complex endometrial hyperplasia (without atypia):This type of endometrial hyperplasia has normal-looking cells that aren’t likely to become cancerous (“without atypia” means less likely to become cancer). This condition may improve without treatment or treatment with hormones.
• Simple or complex atypical endometrial hyperplasia (with atypia): If the type of endometrial hyperplasia is “atypical” or is “with atypia,” it has a higher chance of becoming cancer. Without treatment, your risk of endometrial or uterine cancer increases.

 What are the risk factors for Endometrial Hyperplasia?

• Postmenopausal women
• Obesity and diabetes -leading to higher oestrogen levels increasing the risk.
• Hormone Replacement Therapy-Long-term use of oestrogen without progesterone in hormone replacement therapy.
• Polycystic Ovarian Syndrome (PCOS) -leading to hormonal imbalance elevating oestrogen levels leading to a thick uterine lining.
• Family history of ovarian, bowel, or uterine cancer.

What are the dangers if left untreated?

• Due to abnormal bleeding women can become anaemic.
• Untreated atypical endometrial hyperplasia can become cancerous.
• Risk of endometrial cancer is as high as 8% in women with simple atypical hyperplasia.
• 30% of women with complex atypical hyperplasia who don’t get treatment develop cancer.

What is the treatment for endometrial hyperplasia?

• In most cases of endometrial hyperplasia without atypia, progesterone therapy alone (either oral or Mirena coil) will reverse the condition within 3-6 months. A repeat biopsy is required to confirm the disappearance of the lesion. This is suited for women under the age of 45 and who wish to preserve childbearing.
• In cases with atypical hyperplasia, total hysterectomy with the removal of tubes is recommended for premenopausal women and the removal of ovaries is offered for post-menopausal women.
• For women who wish to preserve fertility in cases with atypical hyperplasia, they should be counselled about the risks of underlying cancer and progression to endometrial cancer.
• They can be offered oral progesterone or Mirena IUD, ensuring that frequent and comprehensive checks are undertaken to evaluate if the lesion improves.

If you experience abnormal uterine bleeding, seek medical attention promptly.

please contact Rockingham Women’s Health Centre on 0895918943 or www.rockinghamwomenshealth.com.au to book an appointment to discuss our gynaecological care.