Endometrial hyperplasia is a condition characterised by the excessive growth and thickening of the endometrium, which is the lining of the uterus. It occurs due to an imbalance between the hormones estrogen and progesterone, with estrogen stimulation outweighing progesterone's inhibitory effects.
The endometrium normally undergoes cyclic changes during a woman's menstrual cycle. It thickens in response to estrogen and prepares for potential implantation of a fertilized egg. If fertilisation does not occur, the endometrium sheds during menstruation. However, if there is an excess of estrogen or insufficient progesterone, the endometrium may continue to grow, resulting in hyperplasia.
There are two main types of endometrial hyperplasia:
Simple hyperplasia: In this type, the glandular structures in the endometrium become enlarged but maintain their normal architectural pattern. Simple hyperplasia has a low risk of developing into endometrial cancer.
Complex hyperplasia with or without atypia: This type involves abnormal growth of the glandular structures, and they may appear crowded and distorted. Complex hyperplasia with atypia has a higher risk of progressing to endometrial cancer.
Endometrial hyperplasia can be caused by various factors, such as hormonal imbalances, obesity, polycystic ovary syndrome (PCOS), estrogen therapy without progesterone, certain medications, and certain genetic conditions.
Symptoms of endometrial hyperplasia may include abnormal uterine bleeding, such as heavy or prolonged menstrual periods, bleeding between periods, or postmenopausal bleeding. However, some women with endometrial hyperplasia may not experience any symptoms.
Diagnosis is typically made through a combination of medical history evaluation, physical examination, imaging tests (such as ultrasound), and endometrial biopsy to examine the tissue and determine if there are any cellular abnormalities.
Treatment options for endometrial hyperplasia depend on the type and severity of the condition, as well as the woman's desire for future fertility. Treatment may involve hormonal therapy with progestins to help shed the excess endometrial tissue, or in some cases, a hysterectomy (removal of the uterus) may be recommended, especially if the hyperplasia is complex and atypical or if other treatments have been ineffective.
It's important for women with endometrial hyperplasia to receive regular follow-up care and monitoring to ensure that the condition is properly managed and to detect any potential progression to endometrial cancer.