When a relative of mine got diagnosed with a condition
called “Endometrial Hyperplasia” and she and others among family and friends
became curious about it, I thought of providing some basic information regarding
this condition:
What is endometrial hyperplasia?
Endometrium, is the tissue that lines the UTERUS. Endometrial hyperplasia occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer of the uterus. Endometrial hyperplasia is indeed a precursor to the most common gynecologic cancer diagnosed in women, which is “endometrial cancer” of endometrioid histology. It is most often diagnosed in postmenopausal women, but women at any age with unopposed estrogen from any source are at an increased risk for developing endometrial hyperplasia.
How does the endometrium normally change throughout
the menstrual cycle?
The endometrium changes throughout the menstrual cycle in
response to hormones. During the first part of the cycle, the hormone estrogen
is made by the ovaries. Estrogen causes the lining to grow and thicken to
prepare the uterus for pregnancy. In the middle of the cycle, an egg is
released from one of the ovaries (ovulation). Following ovulation, levels of another
hormone called ‘progesterone’ begin to increase. Progesterone prepares the
endometrium to receive and nourish a fertilized egg. If pregnancy does not
occur, estrogen and progesterone levels decrease. The decrease in progesterone triggers
menstruation, or shedding of the lining. Once the lining is completely shed, a
new menstrual cycle begins.
What causes endometrial hyperplasia?
Endometrial hyperplasia most often is caused by excess
estrogen without progesterone. If ovulation does not occur, progesterone is not
made, and the lining is not shed. The endometrium may continue to grow in
response to estrogen. The cells that make up the lining may crowd together and
may become abnormal. This condition, called hyperplasia, may lead to cancer in
some women.
When does endometrial hyperplasia occur?
Endometrial hyperplasia usually occurs after menopause, when
ovulation stops and progesterone is no longer made. It also can occur during
perimenopause, when ovulation may not occur regularly. Listed as follows are
other situations in which women may have high levels of estrogen and not enough
progesterone:
•
Use of medications that act like estrogen
•
Long-term use of high doses of estrogen after
menopause (in women who have not had a hysterectomy)
•
Irregular menstrual periods, especially
associated with polycystic ovary syndrome or infertility
·
Obesity
What risk factors are
associated with endometrial hyperplasia?
Endometrial hyperplasia is more
likely to occur in women with the following risk factors:
• Age - older than 35 years
• White race
• Never having been pregnant
• Older age at menopause
• Early age when menstruation
started
• Personal history of certain
conditions, such as diabetes mellitus, polycystic ovary syndrome, gallbladder
disease, or thyroid disease
• Obesity
• Cigarette smoking
• Family history of ovarian, colon,
or uterine cancer
What are the types of
endometrial hyperplasia?
Endometrial hyperplasia is
classified as simple or complex. It also is classified by whether certain cell
changes are present or absent. If abnormal changes are present, it is called
atypical. The terms are combined to describe the exact kind of hyperplasia:
• Simple hyperplasia
• Complex hyperplasia
• Simple atypical hyperplasia
• Complex atypical hyperplasia
What are signs and symptoms
of endometrial hyperplasia?
The most common sign of hyperplasia
is abnormal uterine bleeding. If you have any of the following, you should see
your obstetrician–gynecologist:
• Bleeding during the menstrual
period that is heavier or lasts longer than usual
• Menstrual cycles that are shorter
than 21 days (counting from the first day of the menstrual period to the first
day of the next menstrual period)
• Any bleeding after menopause
How is endometrial
hyperplasia diagnosed?
There are many causes of abnormal
uterine bleeding. If you have abnormal bleeding and you are 35 years or older,
or if you are younger than 35 years and your abnormal bleeding has not been
helped by medication, your obstetrician–gynecologist may perform diagnostic
tests for endometrial hyperplasia and cancer.
Transvaginal ultrasound may be done
to measure the thickness of the endometrium. For this test, a small device is placed
in your vagina. Sound waves from the device are converted into images of the
pelvic organs. If the endometrium is thick, it may mean that endometrial
hyperplasia is present.
The only way to tell for certain
that cancer is present is to take a small sample of tissue from the endometrium
and study it under a microscope. This can be done with an endometrial biopsy,
dilation and curettage, or hysteroscopy.
What treatments options are available
for endometrial hyperplasia?
In many cases, endometrial
hyperplasia can be treated with progestin. Progestin is given orally, in a
shot, in an intrauterine device, or as a vaginal cream. How much and how long
you take it depends on your age and the type of hyperplasia.
Treatment with progestin may cause
vaginal bleeding like a menstrual period.
If you have atypical hyperplasia,
especially complex atypical hyperplasia, the risk of cancer is increased. Hysterectomy
usually is the best treatment option if you do not want to have any more
children.
For more details, please read this review article:
http://utilis.net/Morning%20Topics/Gynecology/Endometrial%20Hyperplasia.pdf
What can I do to help prevent
endometrial hyperplasia?
You can take the following steps to
reduce the risk of endometrial hyperplasia:
• If you take estrogen after
menopause, you also need to take progestin or progesterone.
• If your menstrual periods are
irregular, birth control pills (oral contraceptives) may be recommended. They
contain estrogen along with progestin. Other forms of progestin also may be
taken.
• If you are overweight, losing
weight may help. The risk of endometrial cancer increases with the degree of
obesity.
Technical
Terms:
Cells: The smallest units of a structure in the body; the
building blocks for all parts of the body.
Diabetes
Mellitus: A condition in which the
levels of sugar in the blood are too high.
Dilation
and Curettage: A procedure in which
the cervix is opened and tissue is gently scraped or suctioned from the inside
of the uterus.
Endometrial
Biopsy: A test in which a small
amount of the tissue lining the uterus is removed and examined under a microscope.
Endometrium: The lining of the uterus.
Estrogen: A female hormone produced in the ovaries that
stimulates the growth of the lining of the uterus.
Hormones: Substances produced by the body to control the
function of various organs.
Hysterectomy: Removal of the uterus.
Hysteroscopy: A procedure in which a slender, light-transmitting
device, the hysteroscope, is inserted into the uterus through the cervix to
view the inside of the uterus or perform surgery.
Intrauterine
Device: A small device that is
inserted and left inside the uterus to prevent pregnancy.
Menopause: The time in a woman’s life when the ovaries have
stopped functioning, defined as the absence of menstrual periods for 1 year.
Menstruation: The monthly discharge of blood and tissue from the
uterus that occurs in the absence of pregnancy.
Ovulation: The release of an egg from one of the ovaries.
Perimenopause: The period preceding menopause that usually extends
from age 45 years to 55 years.
Polycystic
Ovary Syndrome: A condition in which
levels of certain hormones are abnormal and small growths called cysts may be
present on the ovaries. It is associated with infertility and may increase the
risk of diabetes mellitus and heart disease.
Progesterone: A female hormone that is produced in the ovaries and
that prepares the lining of the uterus for pregnancy.
Progestin: A synthetic form of progesterone that is similar to
the hormone produced naturally by the body.
Transvaginal
Ultrasound: A type of ultrasound in
which a transducer specially designed to be placed in the vagina is used.
Uterus: A muscular organ located in the female pelvis that
contains and nourishes the developing fetus during pregnancy.
