Endometrial hyperplasia is the excessive proliferation of the cells that make up the endometrium. In general, this endometrial alteration is caused by a hormonal imbalance between estrogen and progesterone values.
The most prominent sign that raises suspicion of possible endometrial hyperplasia is abnormal vaginal bleeding, although it is not a specific clinical manifestation of this disorder.
On the other hand, endometrial hyperplasia is classified into 4 different types: simple, complex, atypical simple, and atypical complex. In any case, the most important thing is to diagnose, control and treat this endometrial thickening to prevent it from progressing to endometrial cancer.
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What is endometrial hyperplasia?
Endometrial hyperplasia consists of an exaggerated growth of the cells that make up the superficial layer surrounding the uterus, i.e. the endometrium. This condition usually appears in women over 45 years of age.
Generally, excessive proliferation of endometrial cells is associated with elevated estrogen levels in women in combination with decreased progesterone values.
These hormones (estrogen and progesterone) act on the woman's menstrual cycle. The purpose of estrogens is to provoke cell growth of the endometrium, while progesterone indicates the moment of endometrial detachment.
For this reason, an imbalance in estrogen and progesterone values may be the cause of excessive and abnormal proliferation of endometrial cells.
As in any other medical pathology, there are risk factors that increase the probability of endometrial hyperplasia in women. Some of these risk factors are listed below:
- Follicular persistence and as a result the appearance of cysts within the ovary.
- Cirrhosis of the liver, i.e., the last stage of liver disease.
- Adrenal tumors.
- Polyps in the cervix.
- Presence of myomas in the uterus
On the other hand, scientific studies have found evidence that obesity and a family history of colon carcinoma are also associated as risk factors for endometrial hyperplasia.
However, it should be noted that having any of these risk factors does not mean that there is a 100% chance that a woman will develop endometrial hyperplasia.
Types of endometrial hyperplasia
The World Health Organization (WHO) established a classification of endometrial hyperplasia into three groups: cystic, adenomatous, and atypical. At present, this classification is not taken into account, but the types of endometrial hyperplasia are as follows:
- Simple atypical endometrial hyperplasia
- its risk of progression to endometrial carcinoma is 8% if not adequately treated.
- Complex atypical endometrial hyperplasia
- is the precursor form of endometrial carcinoma. This type of hyperplasia usually progresses to endometrial cancer in 29% of cases.
- Simple non-atypical endometrial hyperplasia
- it is a benign proliferation with an increase in the number of endometrial glands, but without cytologic atypia.
- Complex non-atypical endometrial hyperplasia
- the risk of progression to endometrial cancer is 3% in approximately 10 years. In this case, the endometrial glands have irregular contours and are agglomerated.
In any case, each form of endometrial hyperplasia has certain morphologic features that aid in diagnosis. Despite being a benign alteration, it is essential to diagnose endometrial thickening to avoid progression over time to cancer.
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The main symptom that makes a specialist suspect possible endometrial hyperplasia is an altered menstruation. Other manifestations in women that may be indicative of endometrial hyperplasia include the following:
- Abundant menstrual bleeding, both in quantity and duration.
- Short menstrual cycles, less than 21 days.
- Bleeding between periods.
- Uterine bleeding after menopause.
However, many women with endometrial hyperplasia do not show any symptoms. Therefore, there are cases of endometrial hyperplasia that are totally asymptomatic.
As we have already mentioned, the detection of endometrial hyperplasia in women is important, as it can progress to cancer. In addition, endometrial hyperplasia causes uterine bleeding and is indicative of possible polycystic ovarian syndrome (PCOS).
Mainly, the diagnosis of endometrial hyperplasia in a woman is basically histological and will be made through 3 medical tests:
- is performed through the vagina and the gynecologist will measure the thickness of the endometrium. If the endometrium is too thick, it is an indication of possible endometrial hyperplasia.
- Endometrial biopsy
- to obtain a sample of the endometrium to be analyzed in the laboratory cell histology.
- a test that allows visualization of the uterine cavity and mucous membranes, in addition to helping if combined with endometrial biopsy.
Diagnostic studies can also be completed with the observation of abnormal glandular cells by means of a pap smear.
Treatment of endometrial hyperplasia
The best treatment for endometrial hyperplasia will depend on the type of hyperplasia diagnosed and the woman's desire for future pregnancy. In addition, it is also important to take into account the patient's age and the existence of other associated pathologies.
In the case of women diagnosed with endometrial hyperplasia and who want to have offspring, treatment will consist of administering contraceptive pills or progesterone. These women should visit their gynecologist periodically for ultrasound examinations.
For women diagnosed with atypical endometrial hyperplasia and women who do not desire a future pregnancy, most specialists propose the removal of the uterus. Hysterectomy in these cases prevents endometrial hyperplasia from progressing to cancer.
Another therapeutic alternative for endometrial hyperplasia is to perform curettage followed by pharmacological treatment with progestogens.
FAQs from users
Does endometrial hyperplasia affect fertility?
Endometrial hyperplasia is a condition of the endometrium characterized by exaggerated proliferation. This condition can affect the endometrium as a whole or in a focal form constituting the so-called endometrial polyps.
In any case, abnormal proliferations of the endometrial tissue should be observed and sometimes a biopsy is recommended to rule out complex pathologies.
The endometrium is the biological tissue where the embryo will nest. For this reason, an abnormal development of the endometrium will generate an extremely hostile and inadequate terrain for gestation to take place.
Are there other symptoms associated with endometrial hyperplasia besides abnormal bleeding?
The main clinical manifestation of endometrial hyperplasia is abnormal uterine bleeding, and in approximately 15% of patients with a history of abnormal uterine bleeding, a diagnosis of some form of hyperplasia is made.
In some cases, endometrial hyperplasia may present with fever, severe abdominal pain or abdominal swelling, but may also be asymptomatic. If endometrial thickening occurs in young patients, it may cause infertility due to a non-functioning endometrium.
What is endometrial hyperplasia?
Endometrial hyperplasia is an uncontrolled growth of the endometrium, without this implying malignancy in its cells. Most of the time (although not always) it occurs due to excessive hormonal stimulation, for example, prolonged estrogen secretion or administration.
Endometrial hyperplasia, therefore, is nothing more than the situation in which the endometrium produces, as always in the first part of the cycle, before ovulation, cellular proliferation and growth of endometrial thickness, but in an excessive and disordered manner.
Can endometrial hyperplasia be prevented?
No. Excessive proliferation of endometrial cells cannot be prevented, although the risk can be reduced. There are certain risk factors that could be avoided and, therefore, reduce the probability of developing endometrial hyperplasia. This is mainly the case with obesity and smoking.
As discussed in the article, endometrial hyperplasia may be indicative of PCOS. If you want to learn more about this syndrome, we recommend you to visit the following article: Polycystic ovary syndrome (PCOS): causes, symptoms, and treatment.
On the other hand, one way to diagnose this endometrial condition is by biopsy. If you are interested in this diagnostic test and want more in-depth information, do not forget to access this link: What is endometrial scratching - Indications and procedure.
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FAQs from users: 'Does endometrial hyperplasia affect fertility?', 'Are there other symptoms associated with endometrial hyperplasia besides abnormal bleeding?', 'What is endometrial hyperplasia?' and 'Can endometrial hyperplasia be prevented?'.
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