Endometrial hyperplasia is an overgrowth or thickening of part or all of the lining of the uterus. This diagnosis can only be made by a pathologist who examines a sample of tissue removed from the thickened lining by a sampling procedure such as endometrial biopsy or dilatation and curettage (D&C).
Hyperplasia usually develops in the presence of continuous estrogen stimulation unopposed by progesterone. During adolescence and in the years before menopause women may have numerous cycles without ovulation during which there is continuous unopposed estrogen activity. Similarly, hormone replacement therapy consisting of estrogen without progesterone may lead to endometrial hyperplasia.
By microscopic exam it can be determined if hyperplasia with or without atypical cells is present. Hyperplasia without atypia may resolve spontaneously or following a D&C. On the other hand, hyperplasia with atypia tends to persist (in 75% of cases) even after multiple D&Cs and hormone treatment. Hyperplasia without atypia rarely progresses to endometrial cancer while hyperplasia with atypia is a precancerous condition that may progress to overt malignancy. Endometrial hyperplasia is currently the reason for 5% of all hysterectomies performed in the U.S.
Conventional medicine uses progestins such as Provera, given continuously, either by mouth or long acting injections. A D&C is repeated after 3-4 months of treatment to demonstrate resolution of the hyperplasia. Failure of hyperplasia without atypia to resolve in a repeat D&C is cause for alarm.
Conditions that suggest Endometrial Hyperplasia
Endometrial Hyperplasia can lead to
Recommendations for Endometrial Hyperplasia
Progesterone
The addition of progesterone or resumption of ovulation (which produces progesterone) can eliminate the hyperplasia.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Highly recommended |
Glossary
Biopsy
Excision of tissue from a living being for diagnosis.
Dilatation
Normal increase in the size of a body opening, blood vessel, or tube.
D&C
Dilation and curettage or D&C, is the scraping of the lining of the uterus (the endometrium). There are two main reasons for performing a D&C: in recently pregnant woman in order to remove tissue remaining in the womb, and as part of the investigation of heavy or irregular periods or vaginal bleeding after menopause.
Estrogen
One of the female sex hormones produced by the ovaries.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Hysterectomy
Surgical removal of the uterus, by way of either an abdominal or vaginal incision. Removal might include removal of the cervix (total hysterectomy) or not (subtotal / partial hysterectomy). A radical hysterectomy involves surgical removal of the uterus, upper vagina, tissues adjacent to the uterus and possibly the ovaries; usually undertaken for carcinoma of the uterus. A hysterectomy with oophorectomy involves the removal of the uterus and one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).