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Endometrial Hyperplasia

Endometrial hyperplasia is a condition of the female reproductive system in which the lining of the uterus (endometrium) becomes unusually thick because of having too many cells (hyperplasia). While endometrial hyperplasia isn’t cancer, it can increase your risk of developing endometrial cancer and uterine cancer. Endometrial hyperplasia is rare, affecting approximately 133 out of 100,000 women.

Causes of Endometrial Hyperplasia

Women who develop endometrial hyperplasia produce too much estrogen and not enough progesterone. During ordinary ovulation, estrogen thickens the endometrium, while progesterone prepares the uterus for pregnancy. If conception doesn’t occur, progesterone levels drop, triggering the uterus to shed its lining as a menstrual period. Because women who have endometrial hyperplasia make little, if any, progesterone, the uterus doesn’t shed the endometrial lining. Instead, the lining continues to grow and thicken.

A main risk factor for endometrial hyperplasia includes women who are perimenopausal or menopausal. The condition rarely occurs in women younger than 35.

Other risk factors include:

  • Certain breast cancer treatments (tamoxifen) 
  • Diabetes
  • Obesity
  • Early age for menstruation or late onset of menopause
  • Hormone therapy
  • Family history of ovarian, uterine or colon cancer
  • Gallbladder disease
  • Never being pregnant
  • Polycystic ovary syndrome (PCOS)
  • Smoking
  • Thyroid disease
  • White race
  • Long history of irregular or absent menstruation

Symptoms of Endometrial Hyperplasia

Endometrial hyperplasia can be accompanied by the following symptoms:

  • Abnormal menstruation, such as short menstrual cycles, unusually long periods or missed periods
  • Heavy menstrual bleeding
  • Bleeding after menopause

Diagnosis for Endometrial Hyperplasia

If you’re experiencing symptoms of endometrial hyperplasia, various tests can be done to rule out other conditions and provide you with a diagnosis. These tests include:

  • Ultrasound
  • Biopsy
  • Hysteroscopy

Treatment for Endometrial Hyperplasia

Endometrial hyperplasia responds well to progestin treatments. Progestin is available in many forms, such as:

  • Oral progesterone therapy (megace, norethindrone, medroxyprogesterone)
  • Progesterone hormonal intrauterine device (IUD)
  • Injection (Depo-Provera®)

If you’re at increased risk of cancer due to atypical endometrial hyperplasia, your healthcare provider may recommend a hysterectomy to remove the uterus.