Women Specific Issues
Updated on 8 November 2023
Medically Reviewed by
Dr. Shruti Tanwar
C-section & gynae problems - MBBS| MS (OBS & Gynae)
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Ritu had been experiencing irregular menstrual cycles and occasional bouts of heavy bleeding for some time. At first, she brushed it off as just one of those pesky hormonal imbalances but as the symptoms persisted, she knew she must visit a doctor. Dr. Niharika uttered two words that sent shivers down her spine: "Endometrial Hyperplasia."
At that moment, her world seemed to stand still as she grappled with the unfamiliar term. What on earth was Endometrial Hyperplasia, and how would it affect my life? And thus, began her journey exploring the causes, types, complications of this condition and more importantly, endometrial hyperplasia treatment. So, let’s join Ritu and Dr. Niharika and understand in detail about this condition.
Endometrial hyperplasia is a condition where the lining of your uterus thickens, leading to heavy or irregular bleeding. This condition often manifests during or after menopause and is often attributed to unopposed estrogen exposure, leading to an imbalance in hormone levels. As a result, the endometrium undergoes increased cell growth, potentially leading to complications if left untreated.
According to the previous World Health Organization (WHO) classification in 1994, endometrial hyperplasia can be categorized as follows:
"Simple hyperplasia"
Characterized by an increased number of glands, but the glandular architecture remains regular. This type is also called cystic endometrial hyperplasia.
Atypical endometrial hyperplasia involves crowded and irregular glands with abnormal cellular features.
"Complex hyperplasia"
This type of hyperplasia is similar to simple hyperplasia, it has normal-looking cells that are unlikely to become cancerous. .
Exhibits complex hyperplasia with cytologic atypia, representing a more advanced stage of the condition.
In simple endometrial hyperplasia (EH), there is a uniform thickening of both gland cells and stroma in the uterine lining, but the gland cells do not show excessive prominence and maintain rounded shapes, unlike those observed in a normal uterine cycle.
In contrast, complex endometrial hyperplasia involves a higher proliferation of gland cells with less involvement of stroma, resulting in the crowding of glands. The glands exhibit varying shapes and sizes, displaying marked and irregular branching and formation of buds.
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The causes of endometrial hyperplasia are often related to hormonal imbalances, particularly an excess of estrogen in relation to progesterone. Some common factors contributing to the development of endometrial hyperplasia include:
Medicine named Tamoxifen
Family history
It's important to note that the causes can be multifactorial, and individual cases may have unique contributing factors.
Common symptoms of endometrial hyperplasia may include:
Abnormal uterine bleeding
Pelvic pain or discomfort
Changes in menstrual patterns
Anemia
The treatment for endometrial hyperplasia depends on several factors, including the type of hyperplasia, the severity of symptoms, and whether there are atypical (abnormal) cells present. The main approaches to treatment are:
This is often the first-line treatment for simple and complex hyperplasia without atypia. Progestin helps balance the estrogen-progesterone levels and reduces the excessive growth of the endometrial lining.
In cases of atypical hyperplasia or when other treatments are not effective or suitable, a hysterectomy (removal of the uterus) may be recommended to eliminate the risk of cancer.
D&C may be performed to remove the abnormal endometrial tissue for diagnostic and therapeutic purposes.
In certain cases, hormone therapy with combined estrogen and progestin may be prescribed to manage symptoms and prevent further hyperplasia.
Regular follow-up visits and monitoring are essential to assess the response to treatment and ensure there are no signs of progression or recurrence.
The choice of treatment is individualized, and the decision is made in consultation with a healthcare professional based on the patient's age, desire for fertility, severity of hyperplasia, and overall health status.
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The most common age range for developing endometrial hyperplasia is between 40 and 60 years old. This is because hormonal changes, particularly perimenopause and menopause, can lead to an imbalance in estrogen and progesterone levels, increasing the risk of endometrial hyperplasia.
Endometrial hyperplasia can be a serious condition, particularly if left untreated or if it progresses to atypical hyperplasia. While simple hyperplasia without atypia has a lower risk of developing into cancer, atypical hyperplasia carries a higher likelihood of becoming endometrial cancer.
Reducing endometrial thickness naturally can be challenging, as it is often related to hormonal imbalances. However, maintaining a healthy lifestyle with regular exercise, a balanced diet, and stress management can promote hormonal balance and overall well-being.
In conclusion, endometrial hyperplasia is a condition characterized by the excessive growth and thickening of the endometrial lining in the uterus. It is often linked to hormonal imbalances, particularly an excess of estrogen in relation to progesterone. While simple hyperplasia without atypia carries a lower risk, atypical hyperplasia has a higher likelihood of progressing to endometrial cancer. Early detection of endometrial hyperplasia symptoms and appropriate treatment are essential in managing the condition and preventing potential complications.
1. Montgomery, B. E., Daum, G. S., & Dunton, C. J. (2004). Endometrial Hyperplasia: A Review. Obstetrical & Gynecological Survey
2. Singh, G., & Puckett, Y. (2020). Endometrial Hyperplasia. PubMed; StatPearls Publishing.
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Medically Reviewed by
Dr. Shruti Tanwar
C-section & gynae problems - MBBS| MS (OBS & Gynae)
View Profile
Written by
Madhavi Gupta
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