Endometrial hyperplasia occurs when the lining of the uterus becomes too thick. Although it is not cancerous, it is known to signal that endometrial cancer may be coming. Endometrial hyperplasia is a dangerous condition characterized by the excessive proliferation (a rapid increase or production) of cells of your endometrium (the inner lining of your uterus). Endometrial hyperplasia predisposes your uterus to harbor the most common gynecologic cancer in the United States: endometrial carcinoma or cancer of the uterine wall.
Endometrial hyperplasia is a hyperplastic disorder, which is a branch of disorders characterized by the overproduction of organic tissue that results from cell proliferation. Hyperplastic disorders like endometrial hyperplasia represent the physiological response of your endometrial tissue to your growth-producing hormone, estrogen. Most cases of endometrial hyperplasia occur when you have high levels of estrogens mixed with small or insufficient levels of the progesterone-type hormone that usually counteract’s estrogen’s proliferative effect on tissues in your body.
Types of Endometrial Hyperplasia
Endometrial hyperplasia can be classified as either simple or complex. It can also be classified by whether certain cell changes are happening or not. If abnormal cell changes are happening, it is referred to as atypical. The terms are combined to describe the exact type of hyperplasia:
- Complex Atypical Hyperplasia
- Complex Hyperplasia
- Simple Atypical Hyperplasia
- Simple Hyperplasia
Knowing the numbers about the incidence of endometrial hyperplasia is difficult to do because endometrial hyperplasia frequently goes unreported and unnoticed.
Symptoms of Endometrial Hyperplasia
The symptom consistent with all patients struggling with endometrial hyperplasia is abnormal uterine bleeding. Because women’s periods aren’t the same every month, usually endometrial hyperplasia goes unnoticed or is dismissed as a natural change that happens, unless of course you are experiencing vaginal bleeding after menopause. It is critical that you get tested for endometrial hyperplasia as often as you can, and if you have a menstrual cycle lasting less than 21 days, check with your doctor.
Risks for Developing Endometrial Hyperplasia
If you are a woman with the following risk factors, you are more likely to experience endometrial hyperplasia:
- Age: 35 years or older
- Cigarette Smoking
- Diagnosed with Diabetes Mellitus, Polycystic Ovary Syndrome, Thyroid Disease
- Race: White
- Menstruation Began Early
- Never Been Pregnant
- Older Age at Menopause
Diagnosing Endometrial Hyperplasia
There are many causes of abnormal bleeding from the uterus. If you have abnormal bleeding and are over 35, or if you are under 35, and no medication is helping your abnormal bleeding, your doctor will likely choose to run diagnostic tests for endometrial hyperplasia and cancer. Your doctor will administer a transvaginal ultrasound to measure the thickness of your endometrium. If the endometrium is very thick it could indicate that hyperplasia is present.
The only way for your doctor to know for certain whether cancer is present is to take a small tissue sample from your endometrium and then study it under a microscope. This is accomplished by any of these three procedures:
- Dilation and Curettage: Your surgeon will dilate your cervix with a special instrument, and then they will use a curette (a medical tool that looks like a metal stick with loops on both ends) to collect a bit of your uterus.
- Endometrial Biopsy: Your doctor will use a speculum to open your vaginal canal enough for him or her to visualize your cervix. Then they will insert a thin plastic or metal tube through your cervix into your uterus to remove a tiny piece of your inner lining tissue.
- Hysteroscopy: This procedure lets your doctor look inside your uterus to treat and diagnose the cause of your abnormal bleeding. A hysteroscopy is done with a special device called a hysteroscope, which is a thin, lighted tube that is inserted into your vagina. The hysteroscope is used to examine your cervix and the inside of your uterus.
Endometrial Hyperplasia Prevention
There are some steps you can take to reduce your risk of developing endometrial hyperplasia. These steps include:
- Birth Control: If your periods are irregular, oral contraceptives are recommended. These pills contain estrogen as well as progesterone.
- Estrogen and Progesterone Balance: If you take estrogen after menopause, make sure you are also taking progestin or progesterone.
- Losing Weight: If you are overweight or obese, losing weight will hep you. As your degree of obesity increases so does your risk of developing endometrial cancer.
Treating Endometrial Hyperplasia
In most cases, endometrial hyperplasia can be treated with progestin, a substance that has a progesterone-like function. Progestin can be administered in up to four ways:
- Intrauterine Device
- Vaginal Cream
How much progestin you take and how long you will take it depends on your age and type of hyperplasia. Treatment with progestin may cause vaginal bleeding that will feel like a menstrual period, but don’t panic, this bleeding is a normal side effect.
If you have an atypical version of hyperplasia, especially complex atypical hyperplasia, your chances of getting cancer increase. In these cases, a hysterectomy (removal of the uterus) is the best treatment option if you don’t want to have any more children.
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