Endometrial Hyperplasia

An overgrowth of tissue in the endometrium (inner lining of the uterus). This is not cancerous, but some hyperplasia, even though reversible, is considered premalignant. Terms used to describe the hyperplasia (simple, complex, adenomatous and typical) helps explain its premalignant 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

Excessive estrogen (a female hormone) as compared with the amount of progesterone (another female hormone). This excess is caused internally, or from the use of hormones-containing medications. Endometrial hyperlapsia rarely occurs in women who have a normal menstrual cycle.

RISK INCREASES WITH

  • Use of oral contraceptives or estrogen replacement therapy (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).

POSSIBLE MEASURES
No specific preventive measures.

POSSIBLE COMPLICATIONS

  • Perforation of the uterus and abdominal pelvic infection as a rare complication of surgery (endometrial biopsy, D & C hysteroscopy).
  • Excessive, uncontrollable bleeding.
  • Confirmation that the hyperplasia is precancerous.

EXPECTED OUTCOME

  • 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 (dilatation and curettage) or hysterectomy. If a woman chooses not to have surgery, hormone therapy usually controls symptoms.

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 (dilatation and curettage) as a treatment and to obtain tissue for microscopic examination (biopsy) to rule out any malignancy 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 can’t 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 hot water for 10 to 15 minutes.