A comprehensive overview of endometrial hyperplasia

Here, highly regarded consultant gynaecologist, Mr Osama Naji, takes us through the causes, symptoms, diagnosis, and treatment options with regards to endometrial hyperplasia.

What is endometrial hyperplasia?

Endometrial hyperplasia is a medical condition characterised by the abnormal thickening of the lining of the uterus, called the endometrium. It occurs when the cells that make up the endometrium grow and multiply in an uncontrolled way, causing the lining to become thicker than usual.

What causes endometrial hyperplasia?

Endometrial hyperplasia is often caused by an imbalance of hormones, such as an excess of oestrogen, which if left to continue for a long time, may lead to endometrial hyperplasia. Certain conditions make endometrial hyperplasia more likely due to increased oestrogen. These include:

• increased body weight, particularly a body mass index (BMI) over 30
• taking oestrogen-only HRT
• if you have never been pregnant
• untreated polycystic ovary syndrome (PCOS)
• you have a type of tumour of the ovary that secretes oestrogen, such as a granulosa cell tumour
• you take a medicine called tamoxifen (a hormone therapy used to treat breast cancer).
• diabetes
• a family history of ovarian, bowel or womb cancer.

What are the types of endometrial hyperplasia?

There are several types of endometrial hyperplasia. These vary in their degree of abnormal cell growth and the risk of developing into endometrial cancer. The most common type is called simple hyperplasia without atypia, which has a low risk of developing into cancer. In this type, more normal cells are being produced and accumulate, making the lining of the womb thicker.

Complex endometrial hyperplasia with atypia (also known as typical hyperplasia) has a higher risk of progressing to endometrial cancer, and it is important to identify and treat this condition promptly. In this type, abnormal (atypical) cells are being produced. This type of hyperplasia is more likely to become cancerous over time, if not treated.

What are the symptoms?

Symptoms of endometrial hyperplasia usually occur in the form of abnormal uterine bleeding. This condition may also be incidentally discovered during pelvic imaging.

Common symptoms include:

• heavy/irregular periods
• bleeding in between periods
• unscheduled or irregular bleeding while you are on HRT
• vaginal bleeding after the menopause
• increasing brown/red vaginal discharge

How is endometrial hyperplasia diagnosed?

An ultrasound scan is usually arranged if your doctor thinks you may have endometrial hyperplasia. It is performed to measure the thickness/appearance of the lining of the womb and look for other causes of abnormal uterine bleeding at the same time, such as polyps, fibroids, or presence of any cysts on the ovaries. 

An endometrial biopsy is when we take a sample of tissue from the lining of the womb. It is often an outpatient procedure and usually does not require an anaesthetic. A thin lighted tube and a camera (hysteroscope) is inserted through the cervix (the neck of the womb) to visualise the lining and obtain some cells. Alternatively, a sample can be taken though a small plastic tube without a camera (pipelle endometrial sampling).

A hysteroscopy allows your doctor to see inside your womb using a thin tube-like camera. It can identify any abnormalities inside the womb and take a biopsy from it. This procedure can be carried out in the outpatient clinic with or without a local anaesthetic. It can also be done under a short general anaesthetic in the operating theatres, and you will be allowed home on the same day. The tissue studied under a microscope to confirm if endometrial hyperplasia is present. 

How is endometrial hyperplasia treated?

Treatment options for endometrial hyperplasia depends on which type you have.

How can I prevent endometrial hyperplasia?

You can lower the risk of endometrial hyperplasia by:

• treating endometrial hyperplasia without atypia with progesterone
• maintaining a healthy body weight.
• taking progesterone in combination with estrogen as part of HRT
• taking the oral contraceptive pill or progesterone to regulate your menstrual cycle if you have PCOS
• seeking early advice for abnormal bleeding if you are taking medications such as Tamoxifen.

Make sure to book an appointment with Mr Osama Naji. You can do just that via his Top Doctors profile today.