Know Everything About Endometrial Hyperplasia

Endometrial Hyperplasia is an abnormal proliferation of endometrium or endometrial glands. The abnormality arises due to estrogenic stimulation and progesterone deficiency. Endometrial Hyperplasia eventually leads to endometrial carcinoma. To prevent the development of endometrial malignancy in women, signs or symptoms must be observed for Endometrial Hyperplasia.  

What is EH (Endometrial Hyperplasia)?

Endometrial Hyperplasia occurs as a result of excessive exposure to hormone estrogens along with progesterone deficiency.  

Types of EH (endometrial hyperplasia) 

In the case of normal menstruation, the hormone estrogen is responsible for the proliferation of the endometrial lining. 

In the luteal phase, ovulation occurs, and there are changes in the endometrial lining as a result of the hormone progesterone. Furthermore, there are the follicular phase and secretory phase. In all these phases, the endometrium glands remain organized, and there is no evidence of mitosis ( a type of cell division)in the endometrial cells.

Endometrial hyperplasia that is without atypia

This is simple Endometrial hyperplasia, wherein the endometrial cells look normal, and there is no indication of cancer development.  

Endometrial hyperplasia that is with atypia

This is a complicated version of Endometrial hyperplasia, wherein the uterus lining thickens abnormally, leading to heavy vaginal bleeding. This complicated condition poses more risk of causing endometrial cancer.

Classification systems of endometrial hyperplasia on the basis of variable degrees of hyperplasia: 

How common is EH (endometrial hyperplasia)?

Endometrial hyperplasia is a common gynecologic malignancy estimated in women. According to statistics from India s well as worldwide, it is one of the most common cancers affecting women. It has led to endometrial cancer in many women and can only be prevented if diagnosed at early stages. 

According to large case studies conducted across different age groups, endometrial hyperplasia was rare in women below 30 years of age and mostly found in women between 50-60 years of age. 

Treatment of EH (endometrial hyperplasia)

There are certain management measures for endometrial hyperplasia

• 1. Preventing the progression of the disease 
• 2. Proper diagnosis to look for endometrial malignancy 
• 3. Look for all the health issues and customize the medication to treat the patient
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Causes of endometrial hyperplasia

 Main causes are:

• 1. Estrogen predominance
• 2. Progesterone insufficiency
•  

Endogenous causes

• 1. Perimenopause
• 2. PCOS ( polycystic ovarian syndrome)
• 3. Obesity
• 4. Estrogen secreting tumors of ovaries
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Exogenous causes

• 1. Estrogen therapy
• 2. HRT (Hormone replacement therapy) 
• 3. Tamoxifen (for treatment of breast cancer)
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Symptoms of EH (endometrial hyperplasia)

• 1. Abnormal bleeding from uterine 
• 2. Altered pattern of the menstrual cycle
• 3. Passage of blood clots
• 4. The foul smell of the vaginal discharge
• 5. Blood stains with the vaginal discharge 

Risk factors 

• 1. Age
• 2. Obesity
• 3. Genetic
• 4. Diabetes Mellitus
• 5. Anovulatory cycles
• 6. PCOS
• 7. Ovarian cancer or tumor
• 8. HRT (Hormone replacement therapy)
• 9. Immunosuppression (in the case of individuals who get renal graft )
• 10. Infection
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How to diagnose EH (endometrial hyperplasia)?

The PAP smear test – To observe abnormal cells of endometrial glands or cells of atypical endometrial hyperplasia

Histological examination of endometrial tissue – endometrial sampling, blood test

Transvaginal ultrasound – To overlap normal and abnormal thickness of endometrial lining.

Hysteroscopy 

NOTE 

According to a research study conducted on women suffering from PCOS, there was no indication of endometrial hyperplasia in women with less than 7mm endometrial thickness.  

Complications of EH (endometrial hyperplasia) 

• 1. Endometrial adenocarcinoma is the most clinically significant complication arising from untreated endometrial hyperplasia. 
• 2. Atypia endometrial hyperplasia has a greater risk of tumor development that is highly invasive if not treated properly.
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How to prevent EH (endometrial hyperplasia)? 

Women must get counseling about various risk factors that exaggerate the development of endometrial hyperplasia like:

• 1. Obesity 
• 2. Increased BMI (body mass index)
•  

Women must be encouraged to alter certain lifestyle

Work towards weight loss

Women must have knowledge of potential causes of endometrial hyperplasia. 

Frequently Asked Questions 

What are the treatment options for EH (endometrial hyperplasia)?

Low-dose progestin is given for the treatment of Simple and complex Hyperplasia.

A higher progestin dose is recommended when there is no response to a low dose of progestin in complex hyperplasia. A biopsy examination must be done regularly if there is a positive response. 

Hysterectomy is recommended in case of no response to progestin therapy in postmenopausal women. 

Common therapies to treat EH (endometrial hyperplasia)

Progestin therapy 

• 1. Medroxy progesterone acetate
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(Steroidal progestin to treat absent or irregular menstrual periods and abnormal uterine bleeding). 

• 2. Megestrol acetate
•  

(The therapy has antigonadotropic and progestational effects and has the ability to inhibit abnormal uterine proliferation) 

• 3. Levonorgestrel
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(A component of hormonal contraceptives) 

• 4. Norethisterone acetate
•  

(The medication has antiestrogen and antiandrogenic effects) 

• 5. Megestrol acetate+metformin
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Other therapies besides progestin therapy

• 1. Danazol
• 2. Genistein
• 3. Metformin
•  

GnRH therapy

• 1. Histrelin (Subcutaneous implant)
• 2. Nafarelin (Nasal spray)
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What are the signs and symptoms of endometrial hyperplasia?

Abnormal uterine bleeding in the form of the following conditions:

• 1. Menorrhagia (heavy menstrual bleeding)
• 2. Metrorrhagia (irregular bleeding)
• 3. Unscheduled bleeding (patients on HRT) 
• 4. Postmenopausal bleeding
•  

Abnormal discharge – foul-smelling or blood-stained 

How often endometrial hyperplasia turns into cancer?

It has been estimated that women with atypical hyperplasia have the most chances of developing endometrial abnormality into cancer. This may happen over the course of 10 -20 years. 

What is the estimated age of getting EH (endometrial hyperplasia)?

According to a prospective study conducted on women, it was seen that endometrial hyperplasia was commonly occurring in women 50-55 years of age. 

How serious is EH (endometrial hyperplasia)?

Endometrial hyperplasia becomes serious when it is categorized as atypical. Ignorant behavior or inappropriate treatment to prevent disease progression may cause endometrial cancer.  

What is the most frequent symptom of endometrial hyperplasia?

Abnormal bleeding from the uterus is the most frequent symptom indicating endometrial hyperplasia.

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