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by Scholten A
(Hypertrophy of the Uterus)

Definition

Endometrial hyperplasia is when the inner lining of the uterus grows too thick. When the lining is too thick, it can cause heavy bleeding and irregular periods. Sometimes it can lead to uterine cancer. Early treatment can improve outcomes.

Causes

This condition is caused by an imbalance in hormones. In this case, there is too much estrogen and not enough progesterone. This leads to an overgrowth of cells in the lining of the uterus.

Risk Factors

This condition is most common in women after menopause or just before it. Other things that may raise the risk are:

  • Long-term use of estrogen or tamoxifen—in high doses
  • Having certain health problems, such as:
    • Obesity
    • Cowden disease or Lynch syndrome
    • Polycystic ovary syndrome (PCOS)
    • Diabetes, thyroid disease, or gallbladder disease
    • Breast cancer
  • Early start of menstrual periods
  • Late menopause
  • No pregnancies
  • Irregular menstrual periods
  • A family history of uterine, ovarian, or colon cancer
  • Smoking

Symptoms

Symptoms of endometrial hyperplasia are:

  • Heavy or long-lasting bleeding during periods
  • Menstrual cycles that are shorter than 21 days
  • Periods that are not regular
  • Vaginal bleeding after menopause

Diagnosis

The doctor will ask about symptoms and past health. A physical and pelvic exam will be done. Diagnosis will be based on the exam and test results. Tests may include:

  • Ultrasound—to look at the lining of the uterus
  • Biopsy—a small tissue sample is taken from the uterus
  • Dilation and curettage (D&C)—a procedure to remove samples of uterine tissue
  • Hysteroscopy—a lighted scope used to check the uterus

Treatment

Sometimes the lining of the uterus returns to normal on its own. In other cases, treatment is needed. Options may be:

Medicine

Progestin is a hormone. It may be given to correct the imbalance. It may be given by mouth, as a shot, in an intrauterine device ( IUD), or as a vaginal cream.

Surgery

The uterus can be removed by surgery. This is called a hysterectomy. This option is for women who do not want another pregnancy.

Prevention

Steps that may lower the risk of endometrial hyperplasia are:

  • Reach and keep a healthy weight.
  • Talk to the doctor about hormones, including birth control pills.
  • Do not smoke.

RESOURCES

American College of Obstetricians and Gynecologists  https://www.acog.org 

American Reproductive Society  https://www.asrm.org  

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada  https://sogc.org 

Canadian Foundation for Women’s Health  http://cfwh.org 

References

The American College of Obstetricians and Gynecologists Committee Opinion no. 631. Endometrial intraepithelial neoplasia. Obstet Gynecol. 2015 May;125(5):1272-1278. doi: 10.1097/01.AOG.0000465189.50026.20.

Endometrial cancer: risk factors. EBSCO Nursing Reference Center website. Available at: https://www.ebscohost.com/nursing/products/nursing-reference-center. Accessed March 8, 2021.

Endometrial hyperplasia. American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/womens-health. Accessed March 8, 2021.

Endometrial hyperplasia. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/endometrial-hyperplasia. Accessed March 8, 2021.

Management options and fertility-preserving therapy for premenopausal endometrial hyperplasia and early-stage endometrial cancer. Int J Gynaecol Obstet. 2015 Dec;131(3):234.

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