Endometrial Hyperplasia

What it is

Endometrial hyperplasia is the excessive thickening of the endometrium, the layer lining the inside of the uterus, usually caused by excess estrogen without the balancing action of progesterone. It is more frequent in perimenopause and postmenopause, in women with obesity, PMOS, diabetes, anovulatory cycles or those using estrogen without progesterone. The main symptom is abnormal uterine bleeding — heavy, prolonged or irregular periods, or bleeding after menopause. Diagnosis begins with transvaginal ultrasound and is confirmed by endometrial biopsy, performed in the office or by hysteroscopy. There are types without atypia, which are low risk, and types with atypia, which can progress to endometrial cancer and require stricter treatment. Treatment may include progestins, a hormonal IUD, control of risk factors and, in selected cases, hysterectomy, always with periodic follow-up.

Most common symptoms

• Heavy or prolonged periods
• Bleeding between periods
• Irregular cycles, with short or very long intervals
• Bleeding after menopause
• Anemia, fatigue and weakness
• No symptoms, with thickening seen on ultrasound

Causes and risk factors

• Excess estrogen without the balancing action of progesterone
• Anovulatory cycles, as in PMOS and perimenopause
• Obesity and diabetes
• Estrogen therapy without progesterone and use of tamoxifen
• Late menopause and never having been pregnant
• Estrogen-producing ovarian tumors, more rarely

How it is diagnosed

The investigation begins with a report of the bleeding and the risk factors, such as weight, diabetes, PMOS and hormone use. Transvaginal ultrasound measures the thickness of the endometrium and guides the need for biopsy. Confirmation is made by endometrial biopsy, taken in the office or by hysteroscopy, which allows the uterine cavity to be seen and targeted samples to be taken. Pathological analysis classifies the hyperplasia as without atypia or with atypia, which determines the risk and the type of treatment.

How we treat it at Femi Saúde

Treatment depends on the type of hyperplasia, age and the desire for pregnancy. In hyperplasia without atypia, the Femi Saúde gynecology team usually recommends progestins, taken orally or through the hormonal IUD, which acts directly on the endometrium, together with control of risk factors such as weight and diabetes; the response is checked with a repeat biopsy after a few months. In hyperplasia with atypia, hysterectomy is generally the recommended option for those who no longer wish to become pregnant; women who wish to become pregnant may receive hormonal treatment with close follow-up through hysteroscopy and biopsies. The plan is individualized and follow-up is periodic.

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