Endometrial hyperplasia: What are the causes?

In his latest online article, renowned consultant gynaecologist Mr Mahantesh Karoshi delves into the possible causes behind endometrial hyperplasia, its diagnostic process, and the available treatments.

What constitutes endometrial hyperplasia and what are the treatment options?

If you've received a diagnosis of endometrial hyperplasia, you might be experiencing concern or uncertainty regarding its implications for your well-being. Endometrial hyperplasia is characterised by an abnormal thickening of the uterine lining (endometrium). This condition can manifest in irregular bleeding, such as heavy menstruation, intermenstrual spotting, or postmenopausal bleeding.

While endometrial hyperplasia is not a malignancy, neglecting its treatment may, in some instances, pave the way for cancerous development. Fortunately, the majority of endometrial hyperplasia cases can be effectively and safely managed through pharmaceutical interventions or surgical procedures.

What triggers endometrial hyperplasia?

The primary cause of endometrial hyperplasia is a hormonal imbalance within the body. Hormones, acting as chemical messengers, regulate various bodily functions, including the menstrual cycle.

Oestrogen and progesterone are the key hormones influencing the endometrium. Oestrogen stimulates endometrial growth, while progesterone maintains its balance. Ordinarily, fluctuating levels of these hormones throughout the menstrual cycle result in the regular shedding of the endometrium during menstruation.

However, an imbalance, characterized by elevated oestrogen and insufficient progesterone, can cause abnormal thickening of the endometrium, hindering proper shedding.

Several factors that heighten the risk of developing endometrial hyperplasia include:

• Excessive body weight or obesity
• Polycystic ovary syndrome (PCOS)
• Unbalanced hormone replacement therapy (e.g., Sequential HRT)
• Irregular or absent menstrual periods
• Proximity to menopause or postmenopausal stage

How is it diagnosed?

Typically, when a woman with abnormal bleeding undergoes an ultrasound scan that raises suspicion of endometrial hyperplasia, the standard diagnostic approach involves a hysteroscopy and endometrial biopsy. This procedure entails inspecting the uterine cavity with a hysteroscope and extracting a small tissue sample from the uterine lining for microscopic examination. This dual assessment serves two purposes:

1. A hysteroscopic evaluation of the uterine cavity provides a comprehensive examination of the endometrial lining, enabling targeted biopsies and ruling out the presence of other pathologies, such as polyps or sinister conditions, which may be overlooked on ultrasound.
2. The biopsy involves either a random sampling of the uterine lining or a directed biopsy from the area identified by the specialist as most suitable for sampling.

This process helps identify any abnormalities in the endometrial cell structure.

Are there different types of endometrial hyperplasia?

Endometrial hyperplasia comprises different types based on the degree of abnormality in cell appearance and the likelihood of progression to cancer. These types are:

• Simple hyperplasia without atypia: The most common and least severe form, where cells are slightly enlarged and irregular but not markedly distinct from normal cells. The risk of cancer development from this type is less than 5% over 20 years. • Complex hyperplasia without atypia: Involving more cells than usual, they are more densely packed and irregular. The risk of cancer from this type is approximately 10% over 20 years.
• Simple hyperplasia with atypia: This type entails enlarged and irregular cells displaying abnormal features known as atypia, making them resemble cancer cells more than normal cells. The risk of cancer development from this type is about 25% over 20 years.
• Complex hyperplasia with atypia: The most severe form, featuring numerous abnormal cells that are densely packed, irregular, and exhibit atypia. The risk of cancer development from this type is around 50% over 20 years.

If you would like to book a consultation with Mr Karoshi, you can do so today via his Top Doctors profile.