Endometrial Hyperplasia (EH) is a gynecological disease that makes women experience mood swings, irregularities in periods or severe fatigue. Read on to find out all about this condition – its causes, symptoms, diagnosis, treatment and more.
It is a condition characterized by abnormal or excessive thickening of the inner lining of the uterus. This inner lining, which is also known as Endometrium, goes through a thickening process every month as a preparation for pregnancy. The lining sheds automatically in case there is no pregnancy, a process which is known as menstruation or a menstrual period. Most women have their normal menstrual period nearly every 28 days. The entire process is monitored by two hormones, namely progesterone and estrogen. If these hormones are not available or do not function properly, then the cellular lining of the uterus experience excessive growth, which may lead to Endometrial Hyperplasia.
Most instances of Endometrial Hyperplasia occur due to the presence of excess levels of estrogens that combines with inadequate levels of progesterone-like hormones that generally counteract the proliferative influence of estrogen on this tissue. Various factors such as polycystic ovary syndrome, obesity, estrogen producing tumors like granulosa cell tumor and some formulations of the estrogen replacement therapy may give rise to the conditions that lead to endometrial hyperplasia.
Picture 1 - Endometrial Hyperplasia
EH is also a major risk factor for the development or coexistence of endometrial cancer. It is thus necessary to carefully monitor and treat women who have this disorder.
The ICD-9 code for this disorder is 621.3.
In women, the hormone progesterone controls and manages the buildup of the sex hormone estrogen in the lining of the uterus. An excess of estrogen and insufficiency of progesterone can lead to the cellular overgrowth of the uterus lining as well as excessive thickening of endometrium. Women who are undergoing estrogen hormone therapy (but not taking any progesterone to negate the side effects of estrogen) can develop EH and endometrial cancer.
Chronic diseases like polycystic ovary syndrome, diabetes and obesity may also lead to the development of the disorder. Polycystic ovary syndrome is a condition in which cysts develop over or inside the uterus.
Having an endocrine-disrupting diet can also stimulate production of surplus amounts of estrogen, which may lead to endometrial hyperplasia.
Like any other hyperplastic disorder, EH is characterized by the physiological response of the endometrial tissue to growth-enhancing actions of the estrogen hormone. The cells of hyperplastic endometrium which are responsible for forming glands may also undergo many changes over time, and this might make them vulnerable to cancerous transformation. Numerous histopathology subtypes of this disorder are identified by pathologists; all of them having differing therapeutic and prognostic aspects. The condition is, however, broadly classified into:
Simple EH is characterized by irregularity as well as cystic expansion of the glands. In complex EH, budding and crowding of the glands is observed without significant change in the appearance of an individual gland. In certain cases, patients having complex Endometrial Hyperplasia are eventually found to develop the symptoms of endometrial cancer.
In these cases, simple or complex changes in the architecture of the glands are accompanied by atypical or serious changes in the cells of the glands. These changes include tufting, cell stratification, enlarged nuclei, loss of the nuclear polarity, as well as increase in the mitotic activity. The changes are very similar to the ones seen in true cancer cells. However, no signs of connective tissue invasion are seen in atypical hyperplasia, which is a major characteristic of cancer. Nearly 22% of patients suffering from atypical hyperplasia are known to develop cancer.
This condition is characterized by formation of cyst in the uterine lining of a woman. This hampers circulation and leads to an abnormal increase in endometrium. The gland becomes swollen and takes an asymmetrical shape due to atypical cells. Bleeding may also occur in this condition, even though EH is not a malignant disease itself.
The general signs of EH are changes in the menstrual periods of a woman. In many cases, patients also experience symptoms external to the reproductive system, such as hot flashes or hot flushes. These hot flashes are accompanied by a feeling of intense heat with excessive sweating as well as rapid heartbeat.
The symptoms of the disease can be experienced by a patient in varying degrees, either daily or every now and then. The most common symptoms of this disorder include the following:
In certain cases, the syndrome can occur along with some other symptoms which might point towards a serious condition. These involve:
Immediate medical care should be sought in such cases.
The comdition is generally diagnosed by first conducting an endometrial biopsy. An endometrial biopsy is normally done by using a thin, straw-like pipelle made of glass to cut through the uterine cavity for obtaining a small portion of endometrial tissue. This endometrial tissue then goes through histopathologic analysis. Abnormal uterine bleeding or presence of several atypical glandular cells over a pap smear may indicate the presence of endometrial disease. A transvaginal and pelvic ultrasound allows in evaluating the thickness of endometrium. Ultrasound should be performed within one or two days after menstruation stops. If the transvaginal and pelvic ultrasound shows that the endometrium of the patient is unusually thickened, a repeat ultrasound should be conducted the following month. This repeat ultrasound must also be conducted within one or two days after menstruation stops.
The differential diagnosis of the disease involves distinguishing it from other conditions that are characterized by abnormal uterine bleeding. A patient suffering from abnormal uterine bleeding has to be evaluated to make sure that the blood is coming from her uterus instead of any other part of genital tract, rectum or anus. The problems arising due to EH also has to be differentiated from the symptoms of Endometrioid adenocarcinoma.
The treatment options used for this disease depend on the stage of life of a patient as well as the severity of her symptoms. Young menstruating women tend to derive benefits from medications that can regulate their periods.
Picture 2 - Endometrial Hyperplasia Image
For women having EH, Hormone replacement therapy or HRT may be advocated. This method of treatment provides the affected female body with necessary hormones so that it is no more able to produce them naturally. Long term hormone replacement therapy is however not advisable as it may increase the chances of breast cancer, stroke and heart disease. An EH patient should thoroughly discuss the benefits and risks of hormone replacement therapy with her health care provider.
The disease is treated with hysterectomy if a patient is not found to respond to medical therapy and there is a high potentiality of endometrial cancer. It is a procedure in which the uterus of a woman is surgically removed.
Certain hormone-releasing contraceptives like birth control pill, birth control patch, IUD or intrauterine device and birth control vaginal ring can help younger women in regulating their hormonal balance and maintain the health of the uterus.
Menopausal or premenopausal women may benefit from HRT or hormone replacement therapy that includes a synthetic progesterone or estrogen combined with progestin.
Although EH is not cancerous itself, the condition can eventually lead to uterine cancer. Menstruating women having Endometrial Hyperplasia are highly prone to suffer from anemia.
The complications of poorly controlled or untreated EH are known to be severe. It is hence necessary to strictly follow the treatment plan for this disorder, as prescribed by the doctor.
The various complications of this disease include the following:
The disease can be completely cured with a dilation and curettage test. When EH develops without atypical cells, it does not become cancerous. Naturally, it is not much dangerous. But leaving it untreated can lead to serious health effects which may interfere with the normal day to day functioning of a woman. With proper medical attention, it is possible to manage this disorder before it gets seriously threatening.