Endometrial Hyperplasia: Causes, Symptoms, and Management

Introduction:

Endometrial hyperplasia is a common disorder caused by exogenous or endogenous estrogen exposure combined with a relative progesterone deficiency. It is an early stage of endometrial carcinoma, one of the most prevalent gynecological cancers. Clinicians must watch closely for the signs and symptoms of endometrial hyperplasia to prevent the development of endometrial carcinoma. This article discusses endometrial hyperplasia's causes, symptoms, risk factors, complications, diagnosis, and treatment.

What Is Endometrial Hyperplasia?

Endometrial hyperplasia occurs when the endometrium, the uterus lining, grows too thick. The lining that sheds during menstrual cycle is called the endometrium. Additionally, it is the tissue into which a fetus develops during pregnancy. Endometrial hyperplasia, a form of uterine cancer, can cause endometrial cancer in some women and people who were assigned female at birth (AFAB).

What Are the Types of Endometrial Hyperplasia?

Medical professionals categorize endometrial hyperplasia based on the types of cell changes in the endometrial lining. Different types of endometrial hyperplasia affect the risk of developing cancer. Various endometrial hyperplasia types include:

• Simple or Complex Endometrial Hyperplasia (Without Atypia): These cells in the endometrial hyperplasia are normal-appearing and are not likely to develop into malignant tumors. The phrase "without atypia" means "less likely to develop cancer." The issue might get better on its own, or the doctor might advise hormone therapy.

• Simple or Complex Atypical Endometrial Hyperplasia (With Atypia): Endometrial hyperplasia has a higher risk of developing into cancer if it is "atypical" or "with atypia." The chance of developing uterine or endometrial cancer rises without treatment.

When describing the severity of the ailment, a doctor may use the terms simple and complex. When they look at the cells, they distinguish between simple and complicated patterns. Make sure to share any queries and worries with the physician regarding the diagnosis.

How Common Is Endometrial Hyperplasia?

Endometrial hyperplasia is uncommon. It affects roughly 133 persons out of every 100,000 in AFAB. People who have recently entered or are transitioning to menopause, when menstrual periods stop, are more likely to experience it.

What Are the Most Common Causes of Endometrial Hyperplasia?

Endometrial hyperplasia patients overproduce estrogen and underproduce progesterone. These hormones are crucial for both pregnancy and menstruation. Progesterone helps the uterus prepare for pregnancy, while estrogen thickens endometrium during ovulation. Progesterone levels fall if fertilization fails. During the menstrual cycle, the progesterone drop causes the uterus to shed its lining.

Progesterone production is minimal or nonexistent in people with endometrial hyperplasia. As a result, the endometrial lining of the uterus does not shed. Instead, the lining keeps getting thicker and growing. The lining's constituent cells can clump together and develop irregularities.

What Are the Symptoms of Endometrial Hyperplasia?

Endometrial hyperplasia patients may suffer the following symptoms: abnormal menstrual bleeding or bleeding between periods.

• Menstrual cycles that last less than 21 days.

• Heavy bleeding during the period.

• Bleed after menopause.

• Not having any period at all (amenorrhea).

Many of these signs and symptoms are typical of menopausal women. Menopause-related symptoms like irregular bleeding and irregular or skipped periods are common. Discuss the signs with the physician so they can decide whether an endometrial hyperplasia test is necessary.

What Are the Risk Factors for Endometrial Hyperplasia?

Endometrial hyperplasia is more common in women undergoing menopause or perimenopause. Rarely does it affect those under the age of 35. Other risk factors are as follows:

• Diabetes.

• Gallbladder illness.

• Gallbladder disease.

• Never being pregnant.

• Obesity.

• PCOS, or polycystic ovarian syndrome.

• Smoking tobacco.

• Thyroid condition.

• Breast cancer treatment, including tamoxifen.

• Late onset of menopause or early menstruation.

• Hormone therapy uses only estrogen when someone still have a uterus.

• Ovarian, uterine, or colon cancer runs in the family.

• Early age for menstruation or late onset of menopause.

• Family history of ovarian, uterine, or colon cancer.

• The protracted absence of or irregularity in menstruation.

• History of pelvic irradiation (radiation exposure).

• The compromised immune system is due to medication or autoimmune illness.

What Are the Complications of Endometrial Hyperplasia?

All forms of hyperplasia can result in irregular, severe bleeding that can deplete mineral stores. When the amount of iron-rich red blood cells in the body is insufficient, anemia can develop. Atypical endometrial hyperplasia can progress to cancer if left untreated. Approximately 8 % of AFAB patients with untreated simple atypical endometrial hyperplasia develop endometrial or uterine cancer. About 30 % of AFAB patients with complex atypical endometrial hyperplasia develop cancer if they are not treated.

How to Diagnose Endometrial Hyperplasia?

The causes of irregular uterine bleeding are numerous. Healthcare professionals might request one or more of the following tests to determine what is causing the symptoms:

• Ultrasound: During a transvaginal ultrasound, sound waves create images of the uterus. The photos can reveal if the lining of the uterus is overly thick.

• Biopsy: The uterine lining is sampled during an endometrial biopsy. Pathologists examine the cells under a microscope to see whether cancer is present.

• Hysteroscopy: A healthcare professional will inspect the cervix and the interior of the uterus using a hysteroscope, a thin, illuminated instrument. This operation could be carried out with a biopsy, dilation, and curettage (D&C). A doctor can use hysteroscopy to examine the endometrial cavity for abnormalities and obtain a biopsy of any suspect regions.

What Is the Treatment for Endometrial Hyperplasia?

The majority of endometrial hyperplasia patients are treated with progestin. Progestin is a synthetic form of the hormone progesterone, which body lacks. Progestin can take a variety of forms:

• Oral progesterone treatment (a pill).

• An intrauterine device (IUD) that contains progesterone.

• Depo-Provera injection.

• Vaginal gel or cream.

A doctor may prescribe a hysterectomy to remove the uterus if the condition worsens, cancerous cells develop, or the condition does not improve with progestin treatment.

How to Prevent Endometrial Hyperplasia?

Taking the following actions may lower the chance of getting endometrial hyperplasia:

• Using a progestin-containing medication (synthetic progesterone) while taking estrogen for menopause.

• If periods are irregular, consider using a birth control pill containing estrogen and progestin.

• Give up smoking.

• Losing weight.

What Is the Outlook for People Who Have Endometrial Hyperplasia?

Progestin therapy works well for treating endometrial hyperplasia. Endometrial or uterine cancer may result from atypical endometrial hyperplasia. To lower the likelihood of it developing into cancer, doctor may advise more frequent ultrasound exams, biopsies, or a hysterectomy. This advice will be given based on the diagnosis and medical background.

Conclusion:

Endometrial hyperplasia is a condition that results in abnormal uterine bleeding. These signs and symptoms may be unpleasant and bothersome. Treatments with progestin hormones provide comfort for many people. Atypical endometrial hyperplasia increases the risk of uterine cancer in a person. A hysterectomy ends the symptoms and lowers the risk of cancer. Consult the healthcare provider to determine the best course of action. Endometrial hyperplasia risk factors like obesity and a high body mass index can be discussed with women. They can be pushed to make lifestyle changes and lose weight, which can reduce the endogenous production of estrogen.