Endometrial hyperplasia is a condition in which cells of the endometrium, the lining of the uterus, grow at a more rapid pace than is normal. Two forms of endometrial hyperplasia exist: typical and atypical. In the typical form, the cells of the uterus have not undergone any changes as a result of the endometrial condition. In the atypical form of hyperplasia, the cells have undergone changes that might develop into uterine cancer if left untreated.
During the course of the menstrual cycle, the endometrium becomes thicker in preparation for pregnancy, becoming a nutrient-rich layer of cells and blood. If pregnancy does not occur during this cycle, the endometrium is shed as a menstrual period. The thickening of the endometrium is controlled by estrogen and progesterone. If estrogen production is abnormally high or progesterone production is abnormally low, the endometrium overgrows in response to the altered ratio of estrogen to progesterone. This overgrowth is called hyperplasia.
Any condition that alters the ratio of estrogen to progesterone can increase the risk of hyperplasia. Endometrial hyperplasia is therefore more likely to occur in women who are at or near menopause or who have menstrual cycle disturbances such as irregular periods. Diseases such as diabetes or polycystic ovary syndrome also can increase the risk of hyperplasia of the endometrium. In addition, menopausal women taking estrogen-only hormone replacement therapy are at a greater risk of endometrium hyperplasia.
The main symptom of endometrial hyperplasia is abnormal menstruation. A woman with this condition often has heavy or irregular periods and might also bleed at other times during her menstrual cycle. Menstruation might also be unusually painful. Diagnosis of hyperplasia of the endometrium is generally made on the basis of these symptoms and the results of tests such as ultrasound or hysteroscopy, which allow a doctor to view the interior of the uterus and take samples of endometrial tissue.
For women with typical hyperplasia, endometrial hyperplasia treatment can include hormonal therapy to provide extra progesterone. This helps normalize the ratio of estrogen to progesterone, preventing overgrowth of the endometrium. Women with atypical hyperplasia have a greatly increased risk of uterine cancer and therefore must consider more radical treatment. The most common option is hysterectomy, but women who wish to have children in the future might prefer other options. A common alternative to hysterectomy is a stronger version of the hormonal therapy used for women with typical hyperplasia.