Has your menstrual cycle become very irregular? Some days it is very heavy, sometimes it is delayed for several days, or do you see drops of blood again after your period has stopped? Although these things seem normal to many women, sometimes this can be a sign of a condition that needs attention. That is the condition we are talking about today, 'Endometrial Hyperplasia'.
Simply put, what is Endometrial Hyperplasia?
It's very simple. The lining of your uterus, we medically call it the endometrium , becomes thicker than it should be, which is called Endometrial Hyperplasia.
Think about it, every month during menstruation, it is this endometrial lining that comes out of your body. Also, when a baby is conceived, that baby grows safely inside this lining. So what happens in this situation is that it becomes thicker than it should be. For some women, if this condition is not controlled, it can even develop into endometrial cancer . Therefore, it is very important to be aware of this.
Are there types of this? Is the risk of cancer the same for everyone?
Yes, there are two main types of this. Doctors classify it based on the type of cells in the thickened uterine lining. Some types are more likely to cause cancer, while others are less likely.
| Quality type | Simple explanation |
|---|---|
| Hyperplasia without atypia | In this case, the cells in the uterine wall are normal in appearance. This means that they are less likely to become cancerous. Sometimes this condition can get better without any treatment. Or it can be cured with hormone therapy. |
| Atypical Hyperplasia | This is the type we need to be most concerned about . Here the cells look abnormal. That means they have a significantly higher chance of becoming cancerous. This definitely needs to be treated. |
Therefore, it is very important for your doctor to accurately diagnose whether you have atypia or not. This will determine your future treatment and risk.
What are the symptoms of this condition?
The main and most common symptom of this is abnormal bleeding.
- Irregular menstruation: Spotting or bleeding between menstrual cycles.
- Short menstrual cycles: Menstruation occurring less than 21 days apart.
- Heavy bleeding: Bleeding that is more than normal during menstruation.
- Postmenopausal bleeding: Vaginal bleeding that occurs after menopause has completely stopped. This should never be taken lightly.
- Absence of menstruation: Some people may not have their period at all.
Many people ignore these symptoms as they approach menopause. However, it's best to talk to your doctor to find out the exact cause.
Why is this happening? What is the main reason?
Simply put, the main cause is an imbalance between the two hormones estrogen and progesterone in our body. That is, the level of estrogen in the body increases more than necessary, and the corresponding amount of progesterone is lost.
Think about it, the hormone estrogen thickens the uterine lining. The hormone progesterone prepares that thickened lining for pregnancy. If pregnancy doesn't occur, progesterone levels drop, and that's when the uterine lining sheds and comes out as menstruation.
So, when there's not enough progesterone, the uterine lining doesn't get the signal to shed. Instead, it continues to thicken under the influence of estrogen. That's what's happening here.
Who may be at increased risk for this?
Although this condition can occur in women of any age, some people are at a slightly higher risk.
- Age: It is very rare for people under 35 years of age. Women who are approaching menopause (perimenopause) and have gone through menopause (menopause) are at higher risk.
- Never having been pregnant.
- Obesity: As body fat increases, estrogen production also increases.
- PCOS condition: People with Polycystic Ovary Syndrome (PCOS) experience hormonal imbalances.
- Diabetes.
- Some cancer treatments: Drugs such as Tamoxifen, which is used for breast cancer.
- Hormone therapy: Women who do not have their uterus removed and take estrogen hormone alone as treatment.
- Family history: If anyone in your family has had uterine, ovarian, or colon cancer.
- Smoking.
How does a doctor find this?
If you have unusual bleeding, your doctor may run several tests to find the cause.
1. Transvaginal Ultrasound: This involves inserting a small instrument through the vagina to take clear images of the uterus. This can accurately measure the thickness of the uterine wall.
2. Endometrial Biopsy: This is the most important test. A very small piece of tissue is taken from the uterine wall and examined under a microscope. There is nothing to be afraid of, this is what exactly looks at the nature of the cells and confirms whether there is atypia or cancer cells.
3. Hysteroscopy: A thin, lighted tube with a camera is inserted through the cervix to look directly at the inside of the uterus. A biopsy may also be taken at this time.
What are you doing as treatment?
The treatment for this depends on what type of hypoplasia you have, your age, and whether you want to have more children.
- Progestin hormone therapy: This is the main treatment for most people. Progestin is a synthetic form of the hormone progesterone that we talked about. It works by reducing the effects of estrogen and allowing the thickened uterine lining to shed.
- Swallowed pills
- An intrauterine device (IUD)
- Injection (e.g. Depo-Provera®)
- Types of vaginal creams
- Hysterectomy: This is usually recommended for women with hyperplasia with atypia , who are at high risk of cancer, and who no longer wish to have children. This surgery removes the uterus, which can completely relieve symptoms and reduce the risk of cancer.
What are the situations when you should see a doctor?
If you have any of the following symptoms, definitely see a doctor.
| Symptom | Description |
|---|---|
| Excessive or unusual bleeding | If you have heavy bleeding during or after your menstrual cycle. |
| Bleeding after menopause | This is definitely a must-check. |
| Severe lower abdominal pain | Unbearable pain that occurs with menstruation. |
| Pain during sex | If you experience pain that wasn't there before. |
Take-Home Message
- Endometrial hyperplasia is a condition caused by a hormonal imbalance.
- The main symptom is irregular and heavy bleeding. Never ignore it, especially if it occurs after menopause.
- The type with 'atypia' has a risk of developing into uterine cancer. Therefore, an accurate diagnosis is very important.
- Don't worry, there are very effective hormone treatments and, if necessary, surgery for this.
- The risk of this condition can be reduced by things like maintaining a healthy weight and avoiding smoking.
- If you notice a change in your body, never be afraid or delay talking to your doctor about it.
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