Endometrial hyperplasia is relatively rare, affecting just over one in one thousand women. It is a condition in which the lining of the womb, the endometrium, becomes too thick. This can be harmless in some cases, but in others it can cause problems with fertility or even be a precursor to cancer of the womb. It is therefore important for any woman showing endometrial hyperplasia symptoms to seek medical advice.
In this article, we review some of the major concerns about the condition: what causes the condition, what are the symptoms, what is likely to be recommended for endometrial hyperplasia treatment, and what are the prospects for your fertility? We also deal with some common questions which arise, such as whether endometrial hyperplasia causes weight gain and whether it can go away on its own.
What is endometrial hyperplasia?
During a normal menstrual cycle, the lining of the womb thickens in readiness to receive a fertilised egg. If this does not happen, the lining is shed during menstruation, in a cycle which is regulated mainly by the hormones oestrogen and progesterone. In cases of endometrial hyperplasia, the hormonal balance is disrupted. When there is too much oestrogen and not enough progesterone, the uterus lining is not shed during menstruation but continues to thicken in the presence of excess oestrogen. This abnormal thickening is endometrial hyperplasia. There are two types, depending on whether the accumulated cells become irregular.
- Hyperplasia without atypia: This is when the lining of the womb is thicker due to a build-up of endometrial cells, but they are normal and unlikely to undergo any changes. In this version of the condition, it is possible that the thickening will stop of its own accord, or may need to be treated.
- Atypical hyperplasia: In this variation of endometrial hyperplasia, the cells show signs of abnormality (e.g. they are atypical). This version of the condition is more dangerous: these abnormal cells can lead over time to cancer of the womb.
Endometrial hyperplasia symptoms
The main symptom is heavy or unusual bleeding from the uterus. This can take different forms such as:
- Periods that last longer than usual or in which the bleeding is heavier
- Periods come close together, for example when there are fewer than 21 days from the start of one period to the start of the next
- You have vaginal bleeding even though you have passed the menopause.
However, abnormal vaginal bleeding can have many different causes. This is why it’s essential to follow up with a doctor if you have symptoms.
What are the risk factors?
According to the NHS guidance, you may be more at risk of developing endometrial hyperplasia if you:
- Are over 35 years old
- Have never had children or been pregnant
- Smoke cigarettes
- Have a family history of ovarian, bowl or womb cancer.
You are also considered to be at a higher risk of developing endometrial hyperplasia if you started your periods at an early age.
What are the causes of endometrial hyperplasia?
There are several reasons you could develop a hormonal imbalance which could lead to hyperplasia. These include:
- Reaching the menopause, which means you no longer ovulate and the body produces less oestrogen.
- You are post-menopausal and taking HRT in the form of oestrogen.
- You have polycystic ovary syndrome (PCOS).
- Being overweight to the extent of being considered obese. Being overweight does not directly ‘cause’ hyperplasia, nor does hyperplasia cause you to become overweight. Rather, obesity causes a hormonal imbalance which could trigger hyperplasia.
Endometrial hyperplasia treatment
In some cases, endometrial hyperplasia can go away on its own and no treatment would be needed. However, your doctor will need to carry out some diagnostic tests, such as an ultrasound scan or an endometrial biopsy, in which some cells are removed from the endometrium for analysis. You may also require a hysteroscopy, which involves a thin tube-like telescope and allows the doctor to see inside the womb. The diagnostic tests will be able to confirm whether there is endometrial hyperplasia is present, and if so which type. Whether or not treatment is required and which option will be most effective depends on which type you have.
Hyperplasia without atypia
Since this type of hyperplasia very rarely develops into cancer, no treatment may be needed. Your doctor could recommend monitoring your symptoms and possibly a repeat biopsy after a few months to see whether the endometrium thickening has stopped. Where treatment is required, this could be in the form of hormonal treatment with progesterone, delivered either by means of an intrauterine device (IUD) or by oral medication.
Atypical endometrial hyperplasia
If you have this type of hyperplasia, the most commonly recommended treatment is a hysterectomy – complete removal of the womb. This prevents any possibility of womb cancer developing. However having a hysterectomy will lead to infertility. If you want to have children and you have not yet started or completed your family, what are your options?
Endometrial hyperplasia and fertility
Women with atypical hyperplasia, where the recommended treatment is hysterectomy, should discuss their options with a fertility specialist. In many cases, it is possible to proceed with hormone treatment for a period of six months and if tests show that the treatment is working, hysterectomy could be delayed until after you have completed your family. In such cases, it is likely that the more radical treatment will be delayed rather than cancelled, because of the likelihood of the hyperplasia returning.
A study published in the American National Library of Medicine demonstrated that a combination of progesterone therapy and in vitro fertilisation (IVF) gave women the best chance of achieving pregnancy. The study also found that using IVF for such patients not only increased the chances of conception but could also shortened the time taken to conceive.
Contacting us at IVI
It is essential that you take appropriate medical advice if you are diagnosed with endometrial hyperplasia. But if this is the case for you, you don’t necessarily need to give up hope of starting or completing your family. If you would prefer to speak to a fertility specialist about your situation, you are welcome to get in touch with us at IVI using our online contact form. You can also attend one of our Virtual Open Evenings where our consultants will be live answering your questions. Book your place at our next event.