Endometrial hyperplasia is a condition in which the inside of the uterus (endometrium) thickens due to overgrowth of cells. The endometrium is the tissue that is shed during menstruation. It is also the tissue in which an embryo grows during pregnancy. It is usually caused by excess estrogen in the body, which can occur naturally during perimenopause and menopause or due to other factors such as obesity, polycystic ovary syndrome (PCOS) or hormone replacement therapy (HRT). In some women , endometrial hyperplasia can lead to endometrial cancer, a type of uterine cancer. Treatment with progestin can reduce symptoms. However, people at risk for cancer may choose to have their uterus removed 

What are the types of endometrial hyperplasia?

Endometrial hyperplasia is classified based on the types of cellular changes in the lining of the endometrium. Some types of endometrial hyperplasia significantly increase the risk of cancer and others do not. Η endometrial hyperplasia is classified into two categories:

• Benign endometrial hyperplasia (typical hyperplasia)
• Intraepithelial neoplasia of the endometrium (atypical hyperplasia) (a precancerous condition)

How common is endometrial hyperplasia?

Endometrial hyperplasia is rare. It tends to occur in people who are in menopause or menopause (when you stop having menstrual periods). The average age of menopause is 51 years. Women between 50 and 60 are more likely to develop endometrial hyperplasia. It occurs rarely in people under 35 years of age. 

What are the most common symptoms of endometrial hyperplasia?

The most common symptom of endometrial hyperplasia is abnormal uterine bleeding; which can manifest itself in various ways, such as:

• Heavy menstrual bleeding: Bleeding that is heavier than usual or lasts more than seven days.
• Irregular menstrual bleeding: Bleeding that occurs between periods or irregular cycles.
• Postmenopausal bleeding: Bleeding that occurs after menopause.
• Spotting or bleeding during or after sex.

In addition to abnormal uterine bleeding, other symptoms that may occur with endometrial hyperplasia include:

• Pelvic pain or discomfort
• Bloating or swelling in the abdomen
• Changes in vaginal secretion

However, it is important to note that many women with endometrial hyperplasia may not experience symptoms, especially in the early stages of the condition. In addition, many of these symptoms are common in women who are transitioning into menopause. The transition to menopause often marks unstable periods or missed periods and irregular bleeding. It is ,therefore, important to talk to your doctor about your symptoms so that he or she can determine if screening for endometrial hyperplasia is necessary.

What are the most common causes of endometrial hyperplasia?

The most common cause of endometrial hyperplasia is an imbalance of hormones in the body, particularly an excess of estrogen. This can occur naturally during perimenopause when estrogen levels are constantly changing or due to other factors such as obesity, polycystic ovary syndrome (PCOS) or hormone replacement therapy (HRT). Other factors that may contribute to the development of endometrial hyperplasia include:

• Tamoxifen use: Tamoxifen is a medicine used to treat breast cancer. It may have a stimulating effect on the endometrium and increase the risk of endometrial hyperplasia.
• Diabetes: Uncontrolled diabetes can affect hormone levels and increase the risk of endometrial hyperplasia.
• Genetic predisposition: Women with a family history of endometrial cancer or certain genetic mutations, such as Lynch syndrome, may have an increased risk of developing endometrial hyperplasia.
• Late menopause: Women who experience menopause later in life are at greater risk of developing endometrial hyperplasia.
• Anovulatory anovulation: When the ovaries do not release an egg during the menstrual cycle, this can lead to a hormonal imbalance and increase the risk of developing hyperplasia.

It is important to note that endometrial hyperplasia can also occur without a known cause and many women with the condition have no identifiable risk factors. Regular gynaecological examinations and screening for abnormal uterine bleeding can help in the early detection and treatment of endometrial hyperplasia.

How is endometrial hyperplasia diagnosed?

Endometrial hyperplasia is usually diagnosed through a combination of medical history, physical examination and diagnostic tests. The most common diagnostic test used to diagnose endometrial hyperplasia is biopsy of the endometrium. During an endometrial biopsy, a sample of tissue from inside the uterus is removed and sent to a laboratory for analysis. This procedure can be done in the doctor's office and usually takes only a few minutes. Other diagnostic tests may include transvaginal ultrasound or hysteroscopy, that allow visual examination of the uterus and its interior. If endometrial hyperplasia is diagnosed, further testing may be done to determine the type and severity of the condition. This may include additional biopsies or imaging testssuch as a pelvic MRI or CT scan. It is important for women to discuss any abnormal uterine bleeding or other symptoms with their doctor, as early detection and treatment can help prevent endometrial hyperplasia from progressing to endometrial cancer. Women who are at increased risk of developing endometrial hyperplasia or endometrial cancer, such as those with a family history or certain medical conditions, may need more frequent screening.

How is endometrial hyperplasia treated?

Treatment for endometrial hyperplasia depends on the type and severity of the condition, as well as the woman's age and fertility goals.

→ If endometrial hyperplasia is diagnosed in its early stages, can be treated with medications that help regulate hormone levels and reduce the thickness of the endometrium. These medications may include progestins, which are synthetic versions of the hormone progesterone, or oral contraceptives.

→ If the hyperplasia is more advanced or has a higher risk of progressing to cancer, a hysterectomy may be recommended. This involves surgical removal of the uterus, which can effectively treat the hyperplasia and prevent cancer from developing. Surgery for endometrial hyperplasia can be performed using traditional open surgery or minimally invasive techniques such as laparoscopic or robotic surgery. The choice of approach will depend on the severity and location of the hyperplasia, as well as the patient's overall health and medical history. In cases where a woman wants to preserve her fertility, conservative surgical options such as hysteroscopic resection (removal of the thick mucosa through a camera and a diathermy needle inserted into the uterus) may be considered. However, these procedures have a higher risk of recurrence compared to hysterectomy. Regular monitoring with imaging and biopsies may also be recommended to ensure that the hyperplasia does not progress or recur. It is important for women to discuss their treatment options with their doctor to determine the most appropriate approach for their individual case.

What does surgery for endometrial hyperplasia involve?

Surgery for endometrial hyperplasia may involve different therapeutic interventions depending on the severity of the condition and the individual's specific needs. The most common surgical procedure for the treatment of endometrial hyperplasia is hysterectomy, which involves the removal of the uterus. This procedure is recommended for women who have completed childbearing or for those who have severe endometrial hyperplasia or endometrial cancer.  In some cases, it may be recommended hysteroscopy, which involves inserting a camera called a hysteroscope through the vagina and cervix to identify the inside of the uterus. The surgeon can then remove the abnormal tissue using instruments inserted through the hysteroscope. The choice of treatment for endometrial hyperplasia will depend on a number of factors, such as the severity of the condition, the age and medical history of the individual and their personal preferences. It is important for women to discuss all treatment options with their doctor to determine the best course of action.

What are the prospects for people who have endometrial hyperplasia?

Hysterectomy is usually not usually necessary to treat endometrial hyperplasia. Most women respond well to treatment with progestin. If your risk of uterine cancer is high and you are diagnosed with atypical endometrial hyperplasia, hysterectomy may be a possible treatment option. Atypical endometrial hyperplasia can lead to endometrial cancer. Your doctor may recommend more frequent ultrasound scans, biopsies or hysterectomy to eliminate the chances of it turning into cancer. 

Does endometrial hyperplasia lead to cancer?

The risk of developing cancer ranges from 8% to 30% depending on the type of endometrial hyperplasia. Only certain types of endometrial hyperplasia lead to cancer. Your doctor can discuss the type you have and recommend the best treatment based on your health history and overall risk for cancer.