Endometrial Hyperplasia

Definition - What does Endometrial Hyperplasia mean?

Endometrial hyperplasia is a non-cancerous condition where the inner lining of the uterus, called the endometrium becomes abnormally thicker. It is caused by increased amounts of estrogen that, when unopposed by the hormone progesterone, stimulates the endometrium to proliferate and grow.

Endometrial hyperplasia usually occurs in women above the age of 40 years or after the onset of menopause; however, women of any age can be at risk. Endometrial thickening can be caused by taking estrogen pills without progesterone, obesity (androgens are converted to estrogens in the fat cells), and polycystic ovary syndrome (PCOS). Although a benign (non-cancerous) condition by itself, it poses an enhanced risk for endometrial cancer.

FertilitySmarts explains Endometrial Hyperplasia

When estrogen levels peak, they prevent the release of a hormone called follicle-stimulating hormone (FSH). FSH stimulates the maturation of ovarian follicles into eggs. Reduced FSH implies that there is a reduced maturation of ovarian follicles. Since it is the mature ovarian follicle that bursts and releases an egg (the process of ovulation), its absence results in anovulation - an absence of ovulation. When ovulation does not occur, the endometrium is shed, resulting in prolonged and heavy vaginal bleeding. Endometrial hyperplasia may also present with abnormal vaginal discharge. Sometimes pap smear findings prompt further workup.

Fluid-filled sacs form within the follicles of the ovaries called as follicular cysts. These cysts fail to burst and release an egg. The absence of ovulation contributes to infertility.

A transvaginal ultrasound is done to evaluate the thickness of the endometrium. Endometrial hyperplasia is diagnosed by taking a sample of endometrial tissue and examining it under a microscope - a procedure called endometrial biopsy.

Several factors influence the kind of treatment used. These include the severity of symptoms, the extent of hyperplasia, and the desire for future conception. In many cases, hormonal therapy with progestin is sufficient for the treatment of endometrial hyperplasia.

In some cases, the patient might require surgical removal of the uterus known as a hysterectomy, which strongly interferes with the ability to conceive. This surgery is therefore reserved for patients who are past the childbearing age or who show predominant signs of cancer on a biopsy.

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