About Endometrial Hyperplasia

Endometrial Hyperplasia is a condition where the uterine lining (endometrium) becomes abnormally thick due to hormonal imbalance most often when estrogen acts without the balancing effect of progesterone.

It occurs more commonly in perimenopausal and postmenopausal women, as well as those with PCOS, obesity, or prolonged irregular cycles.

The hallmark symptom is abnormal uterine bleeding (AUB), which can present as heavy, prolonged periods, bleeding between cycles, or postmenopausal bleeding.

Diagnosis usually involves:

• Ultrasound to assess endometrial thickness
• Endometrial biopsy to confirm the diagnosis
• Hysteroscopy for direct visualization and targeted sampling

What is Endometrial Hyperplasia?

It is the excessive proliferation of endometrial cells that causes thickening of the uterine lining.

• In many cases, it is benign.
• In some cases, especially with atypia (abnormal cells), it may be precancerous and increase the risk of endometrial (uterine) cancer.

Types of Endometrial Hyperplasia (WHO Classification)

1. Without Atypia

• Cells appear normal but are more numerous.
• Risk of progression to cancer: ~1–3%.

2. With Atypia (Atypical Endometrial Hyperplasia)

• Cells show abnormal features (nuclear atypia, irregular architecture).
• Risk of progression to cancer: ~22–30%.

Signs & Symptoms of Endometrial Hyperplasia

• Heavy or prolonged periods (lasting >7 days or >80 ml blood loss)
• Short cycles or irregular spotting between periods
• Postmenopausal bleeding (always considered abnormal)
• Anemia symptoms (fatigue, weakness, pale skin, shortness of breath)
• Asymptomatic cases, often detected during fertility or health evaluations
   

Endometrial Hyperplasia Causes

Hormonal imbalance (estrogen dominance):

• PCOS, chronic anovulation
• Perimenopause
• Obesity (fat tissue converts hormones into estrogen)
• Estrogen-producing ovarian tumors

External estrogen exposure:

• Hormone therapy without progesterone
• Tamoxifen use

Risk factors include for Endometrial Hyperplasia

• Family history of uterine/ovarian/colon cancer
• Early onset of menstruation or late menopause
• Never having been pregnant
• Diabetes, thyroid disease, or gallbladder disease
• Smoking, obesity, or metabolic syndrome
• Prior pelvic radiation or weakened immunity

Complications of Endometrial Hyperplasia

• Persistent heavy bleeding → Anemia
• Atypical hyperplasia → Progression to cancer

Around 8% of untreated simple atypical hyperplasia and up to 30% of complex atypical hyperplasia progress to cancer if not treated.

Endometrial Hyperplasia Diagnosis at MASSH Group of Hospitals

Our specialists use a combination of non-invasive imaging and advanced minimally invasive tools to ensure accurate diagnosis:

• Transvaginal Ultrasound (TVUS): Measures endometrial thickness.
• Endometrial Biopsy: Tissue sampling for microscopic evaluation.
• Hysteroscopy: Gold-standard for visualizing uterine cavity abnormalities, often combined with biopsy for targeted precision.

Endometrial Hyperplasia Treatment & Management

Medical Management

• Progestin therapy (oral pills, injections, vaginal gels, or IUDs like LNG-IUS) to balance hormones.
• Treatment tailored to whether hyperplasia is with or without atypia, fertility goals, and overall health.

(Medications only under expert supervision.)

Minimally Invasive Surgical Management

• Hysteroscopic Guided Endometrial Biopsy
  
  • Direct visualization of the uterus with precise tissue sampling.
  • Outpatient, quick, minimal discomfort.
• Laparoscopic Surgery (2D/3D)
  
  • For severe or recurrent cases, or when atypia suggests risk of cancer.

Includes hysteroscopic resection or laparoscopic hysterectomy if fertility is not a concern.