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Moronacity Health Journal » Women's Health


Endometrial Hyperplasia

By Diane Ursu
Endometrial hyperplasia is the abnormal thickening of the endometrium, which is the inner lining of the uterus to which the embryo attaches during pregnancy, and the part that sheds during the menstrual period.  Photo:  United States Federal GovernmentThe endometrium is the inner lining of the uterus that is shed every month during menstruation, or the period. It thickens throughout the menstrual cycle in preparation for pregnancy. In some cases, the endometrium may thicken significantly and abnormally—a condition called endometrial hyperplasia.

Endometrial hyperplasia is usually benign and can be treated with hormones or simple surgical procedures, but it can develop into cancer. For that reason, it is best to obtain a diagnosis as soon as something is suspected. In the event of abnormal cells or cancer, an early diagnosis can mean that treatment will be very successful. Some women may be able to prevent endometrial hyperplasia by learning the risk factors and discussing important lifestyle or medication changes with their doctors.

Endometrial Hyperplasia Risk Factors

Several factors may contribute to endometrial hyperplasia, especially hormonal fluctuations. Perimenopausal women are at a greater risk, but postmenopausal women should be wary of unusual bleeding or spotting, as well. Abnormal menstrual cycles, such as skipped periods or amenorrhea, are a sign that the body’s hormone levels are abnormal, such as with polycystic ovarian syndrome (PCOS), obesity, and diabetes, all of which can cause endometrial hyperplasia.


Estrogen is the hormone that triggers growth of the endometrium, so estrogen therapy may contribute to hyperplasia and even cancer. Women who have taken Tamoxifen for breast cancer are at a greater risk for endometrial hyperplasia and cancer.

Abnormal spotting or bleeding is a sign of endometrial hyperplasia. Women who are still menstruating may have spotting between periods, but this can also be a sign of other gynecological problems. Postmenopausal women who have any spotting should immediately see a doctor.

Endometrial Hyperplasia Treatment

In addition to standard testing, such as a pap test, ultrasound is often done to examine and measure the thickness of the endometrium. It may be followed up with a biopsy to remove some of the endometrial tissue and test it for abnormal, or cancerous, cells. Dilation and Curettage (D&C) or hysteroscopy are alternative tests for visualizing and sampling the endometrium.

Progesterone may be prescribed to cause the endometrial lining to shed, resulting in a period that may be quite heavy depending on the endometrial thickness. If abnormal or cancerous cells are present, a hysterectomy—the surgical removal of the uterus—may be done. According to Endometrial Hyperplasia, by the American Congress of Obstetricians and Gynecologists, “If you take estrogen after menopause, you need to take a form of progesterone to reduce the risk of endometrial hyperplasia and cancer of the uterus.”

Women of child-bearing age may consider other treatment options. Those with conditions such as polycystic ovarian syndrome may take birth control pills to regulate the menstrual cycle. Since obesity can contribute to PCOS, working with a physician and a nutritionist to lose weight may be all that is necessary to normalize the cycle.

Endometrial hyperplasia may indicate more serious problems, so anyone who experiences abnormal bleeding should be examined by a doctor. Early detection is important in fighting and beating cancer, so do not put off examinations.



Comments

16 Responses to "Endometrial Hyperplasia"

  1. alinda moses says:

    I’m a medical radiographer by profession.Received a young girl 16 years old by age with a history of heavy and long lasting menstrual periods for about a year.She was referred for gynecological ultrasound scan.
    Findings: thickened and echogenic endometrium but intact with nothing in the cavity, normal myometrium and a dnexal regions, nil in the recto-uterine recess.
    Question: What is the most appropriate diagnosis?

  2. Diane Ursu says:

    Endometrial hyperplasia would be my first guess, and that is what it is if the endometrium is abnormally thickened, but one has to question the cause.

  3. AJW says:

    I am a 41 yo female just diagnosed with Endometrial Hyperplasia. I am scheduled for a biopsy next week. I have been researching the symptoms and causes of this and I’ve found that I’m not very typical: I don’t have excessive bleeding, I am like clockwork with my cycle, I am not overweight (although I’ve found that I have gained some weight in the past few months despite a very solid and regular exercise and eating regimen), I don’t spot in between my cycles, I’m not going through menopause (that I know of) and I’m not currently taking any hormones. The only reason I went to see a doctor was the more intense-than-usual abdominal pain (sometimes debilitating) and major bloating I was experiencing 10 days prior to the beginning of my cycles within the last few months. I had been diagnosed several years ago (4 years I believe) with an ovarian cyst (through a physical vaginal examination, no ultrasound) and was thinking this was the reason for my current symptoms. I had an ultrasound performed and there was only one small cyst on my ovary; I was told that it was nothing that should cause the pain and discomfort and that my uterine wall was approximately 18mm thick (resulting in the diagnosis of EH.) So my question is this: can Endometrial Hyperplasia cause this much discomfort, bloating and weight gain without the other usual symptoms and, because of the higher risk of uterine cancer and me not planning any children anymore, should I opt for a partial hysterectomy?

  4. Diane Ursu says:

    AJW, gynecology, unfortunately, is very complex. I wouldn’t think that the EH would be the cause of the bloating, pain, and weight gain. If it were, I would think it would be cancer-related (metastasis).

    I am leaning more towards something else. You might want to speak with a gastroenterologist and discuss different possibilities from food allergies, food intolerances (food allergies and food intolerance are not the same thing), and irritable bowel syndrome. It is possible that PMS can cause some bowel difficulties, or even worsen an existing condition, because progesterone is more prevalent in the body before one’s period, and progesterone can cause some bowel issues such as bloating, loose bowels, and gas.

    You may wish to seek out a holistic doctor. If you don’t, search for one that will consider the body as a whole. In other words, a gynecologist is not going to consider bowel problems, and a dermatologist is not going to look at the heart. Start with a good general practitioner who can steer you through the specialist maze and bring all of that information together to find out what you need.

  5. Caroline Caudill says:

    I an 62 years old and overweight. I had a pap in November that was normal. I am dieting and have lost 14 pounds so far. I had abnormal vaginal bleeding and so had an ultrasound which showed uterine hyperplasia. My doctor reccomends a DNC. I want to know if this is something I can postpone for several months.

  6. Diane Ursu says:

    Caroline, absolutely not! Have the D&C done as soon as possible. They will test the tissue for cancer, as well. If it is cancer, it is best getting it done, NOW. Catching and treating it early is the easiest and best way.

    My mother had the exact same problem, last year. They biopsied, found it was very early stage cancer, and decided to treat it aggressively by doing a hysterectomy. She had three very small dose radiation treatments that didn’t even affect her (no illness, no hair loss, just radiation straight to that area). She is now fine.

    If she had waited, she could have later stage, metastasized cancer requiring more aggressive chemotherapy or radiation, and all of the well-known effects associated with these treatments.

    Do yourself a favor. Treat it, NOW! Best to you. At 62, and with your new healthy lifestyle changes, you still have a long life ahead of you. Take care of yourself. You’re worth it.

  7. Caroline says:

    Like AJW, I was also diagnosed with Endometrial Hyperplasia. I am 45 yrs old with 3 children. I am not overweight, get my period every 21-28 days and do not bleed between periods. I have an appointment with the doctor in two days, I am sure we will discuss the biopsy or DNC that is the next step. My symptoms have included extreme abdominal swelling (this past month, in between menstrual cycles, there was no relief at all), and HEAVY bleeding during menstruation (hemmoraging), which keeps me from leaving my house for 2 days. I am 45 yrs old and have 3 children. I am a little nervous (prematurely) because of the constant bloating and tenderness in my lower abdominal area. I am just so uncomfortable. More info: My mom passed away from colon cancer when she was 62. I am also scheduled for a colonoscopy later this month. Do you have any advice?

  8. Diane Ursu says:

    Caroline, I wouldn’t be surprised if your doctor ordered a pelvic ultrasound including transvaginal sonography in addition to the endometrial biopsy. The colonoscopy is also a good idea. My only advice would be to make sure you do the prep as instructed, call your doctor with any questions (ask your doctor who to call if you have any problems or questions the night of the prep), and keep your appointments at all costs. If cancer is the culprit, early detection is key.

  9. LisaMK says:

    Hi, I am a 47 year old who has been without a period for over two years. I have been having terrible hot flashes and menopausal symptoms during this time. My family doctor was not concerned about my symptoms so I paid to see another doctor who specializes in bio-identical hormones. She ran some bloodwork and did a pre medication baseline ultrasound of my pelvis. I have since been diagnosed with Endometrial Hyperplasia. I guess I am not typical for this as I have not had any bleeding at all for years, only bloating and a sudden increase in size of my abdomen with fullness and constipation. She has started me on progesterone to see if she can bring about a period to shed the lining of my uterus. If not I have to go for a biopsy. It seems to be abnormal not to be bleeding like most women with this condition. Should I be concerned?

  10. Diane Ursu says:

    LisaMK, hormonal complications are just that: complicated. Everything is out of balance as you go through menopause. It could simply be that your body wasn’t reducing the progesterone levels to signal menstruation, so the lining never shed. Since you are periomenopausal, you aren’t going to have textbook cycles.
     
    My advice is to continue working with your doctor. When hormones are involved, diagnosis is trial-and-error. The good news is that she is ruling out cancer with the biopsy.

  11. lot says:

    My endometrium measures 1.54 cm. due to tamoxifen is there any options or treatment aside from D & C.

  12. I am 45 years old. For the last year I have had heavy periods for a few months followed by a couple months of a brown stringy discharge, only when wiping for a period. I have currently gone 2 months without a period. I feel very bloated, I look like I am 5 months pregnant. I eat but fill up very fast and I have frequent urination. I went to my GYN. She did an exam and said that my uterous was large. She orgered an ultrasound. My ultrasound showed a large cyst on my right overy and endometrial hyperplasia. My GYN scheduled me a biopsy 3 weeks from now. I am scared. Should I request a hysterectomy to be certain I have nothing to worry about? I appreciate any input…..Thank you, Angie

  13. lisa oxley says:

    im 25 years old havent had a period for 5 years since i had my son been in alot of pain down below iv been under my consultant for 8 months now and found out iv got low estrogen and no lining of the womb which he says he has never come across this before so he doesnt know what to do because he already tryed me on hrt tablets before but they didnt work i go bk in 6 weeks to discuss what he has found out and what to do next im really in shock and upset as im wanting another baby :(

  14. Nicole says:

    Hi I am 39 and have given birth to 7 children and had 3 miscarriages. I have not had a period for 9months. I have had blood test etc all come back normal. I asked for an u/s and it showed endometrial hyperplasia my endometrium is 18mm thick. See a specialist soon. Any help and advice appreciated.

  15. joanne boyd says:

    I have been without periods for a little over a year and in the last 2 months developed intense though intermittent pelvic pain. I am overweight. The ultrasound showed endometrial thickening, and a small cyst that has been on one ovary for at least a couple of years. I haven’t had any bleeding at all though. Is that very unusual? I am being scheduled for a biopsy.

  16. Gayathri says:

    I am 35 years old. I’m the mother of 2. I have been diagnoised for hypothyrodism. I have pcod also. I am putting in my best of efforts to lose weight. I am on 100 mcg of thyronorm for the past 3 months. Before that there was a trial and error on my dosage and they kept altering the dose. Should the medication be a lifelong one? Even now when i checked my tsh is 8.8. What can be done with my wieight and medication

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