What is Endometrium?
Endometrium is the inner lining of the uterus. This layer is shed regularly during menstruation of women if they don’t get pregnant. In some women, the endometrium layer becomes thick (thickens) and causes unusual bleeding. This condition is called ‘Endometrial Hyperplasia’. Endometrial Hyperplasia can be cancerous or benign depending on the presence of cells on the layer. It can sometimes be a precursor to uterine cancer / endometrial cancer.
Types of Endometrial Hyperplasia
The thickened endometrial layer may or may not have abnormal growth of cells on it. These abnormal cells are called ‘atypia’.
- Endometrial hyperplasia without atypia – As the name says it all, this is the case when there is no usual cell growth on the endometrium.
- Atypical endometrial hyperplasia – This refers to the condition where there is growth of abnormal cells that are precancerous. Growth of abnormal cells indicates that they can lead to Uterine cancer if left untreated.
It is important for you to know the type of endometrial hyperplasia because, you can save yourself from cancer.
Symptoms of Endometrial Hyperplasia
Unusual uterine bleeding is one first obvious sign but that is not conclusive to determine or diagnose endometrial hyperplasia. Other symptoms include:
- Periods going beyond 5 days combined with heavy bleeding.
- When the periods run beyond 5 days, the interval between the periods gets shortened. It may go below 21 days.
- Women who have reached menopause stage will also see vaginal bleeding.
Unusual bleeding surely indicates some problem inside your uterus or other reproductive organs. You should not neglect this symptom and contact your gynaecologist as soon as possible for diagnosis.
Causes of Endometrial Hyperplasia
Estrogen and Progesterone are two hormones that run the menstrual cycle in every woman. Estrogen causes the formation of inner lining of the uterus. (endometrium). If the egg that is released during the middle of the menstrual cycle doesn’t meet with any sperm, at the end of the cycle, the levels of progesterone hormones drop and that results in shedding the inner lining of the uterus. This is how the cycle runs every period month for a woman. When the amount of estrogen increases in the body but not enough progesterone is present, that can lead to the over growth of endometrium. Now, the question changes from ‘What causes endometrial hyperplasia’ to ‘what causes hormonal imbalance in women?’. Some possible reasons include:
- You have reached menopause stage and your body doesn’t produce progesterone as it thinks that it is not needed anymore.
- During perimenopause stage(typically a year before menopause), ovulation doesn’t happen regularly.
- Hormone Replacement Therapy to combat symptoms of menopause. (This is one reason why HRT will involve combination of estrogen and progesterone in women with uterus).
- PCOS, irregular cycles or infertility problems can also cause imbalance of hormones.
- Medications that you may be taking can disturb hormone levels.
- Over weight to obese women can also acquire endometrial hyperplasia condition.
Risk factors for endometrial hyperplasia:
- Women, after the age of 35 will be at higher risk
- Young girls whose periods start at an early age
- Women who reach menopause after 55 years of age (a little late)
- Other health conditions such as diabetes, thyroid issues or gallbladder problem
- If diseases such as Uterine cancer or Ovarian cancer or colon cancer run in the family.
Diagnosis of Endometrial Hyperplasia
A good gynaecologist will start with a list of questions regarding your menstrual cycle, bleeding, family history, your medical history, current medication, menopause state etc. Then he/she may proceed with
- Transvaginal Ultrasound – A small device will be placed inside the vagina. This releases ultrasound waves and paints a picture of internal organs on the screen. Your gynaecologist should be able to measure the thickness of the endometrium and view cervix and ovaries using this device.
- Hysteroscopy – This device has a light and camera at the end. This tiny tube will be inserted into the vagina to view the status of internal organs.
- Endometrial biopsy – A tiny sample of uterus lining will be removed and will be observed under a microscope for the presence of cancerous cells. The tissue may be sent to a lab for further analysis.
Treating endometrial hyperplasia
Treatment of endometrial hyperplasia depends on certain factors such as:
- Presence of cells on the endometrium.
- Your menopause stage
- Plans for your future pregnancy
- Family history of the disease.
If cancerous cells are not found, your gynaecologist may just keep you under observation and let the symptoms subside. Or another test may be performed few months later to check for cancerous cells, if the symptoms don’t go away.
Hormone therapy will be an option if you have reached menopause stage or if you have plans to get pregnant in future. Hysterectomy can be an ultimate option wherein the uterus will be removed. If you are sure that you don’t have plans to get pregnant in future or if you have reached menopause or if your doctor infers that you are at higher risk of cancer, hysterectomy will be the chosen option.