ENDOMETRIAL HYPERPLASIA

(Adenomatous Hyperplasia of the Uterus)

 Basic information

description

• Endometrial hyperplasia is an excess growth of tissue in the endometrium (inner lining of the uterus). It is not cancerous, but some hyperplasia is known to be precancerous (called atypia). Types of hyperplasia include:
  • Simple or complex (adenomatous) hyperplasia without atypia.
  • Simple or complex (adenomatous) hyperplasia with atypia.

FREQUENT SIGNS & SYMPTOMS

• Bleeding after menopause.
• Vaginal discharge, especially after menopause.
• Lower abdominal cramps (sometimes).
• Bleeding between normal menstrual periods.
• Heavy menstrual flow.

causes

Excess estrogen (a female hormone) as compared with the amount of progesterone (another female hormone). This excess is caused internally, or from the use of hormone-containing drugs. Tamoxifen, a drug used for breast cancer, is a risk factor for hyperplasia.

risk increases with

• Estrogen replacement therapy without progestin use.
• Diabetes.
• Obesity (25 or more pounds over normal weight).
• Women in the years around menopause.
• Polycystic ovary syndrome.
• Women who skip menstrual periods, or have none.

PREVENTIVE MEASURES

• If taking estrogen, balance it with progesterone.
• Weight loss, if obesity is a problem.
• Birth control pills (oral contraceptives) contain estrogen, along with a form of progesterone. They may help protect against endometrial hyperplasia in women who do not have regular periods.

expected outcomes

• In most cases, hormonal treatment with progesterone (progestin) will reverse the hyperplasia caused by the excess estrogen.
• In other cases, it is often curable with D & C (dilatation and curettage) or a hysterectomy. If a woman chooses not to have surgery, hormone therapy usually controls symptoms.

possible complications

• Without treatment, women who have hyperplasia with atypia have a higher risk for endometrial cancer.
• Excessive, uncontrolled bleeding.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam and a pelvic exam. Medical tests may include blood tests of hormone levels and Pap smear. A vaginal ultrasound, an endometrial biopsy, a D & C (dilatation and curettage) procedure, or a hysteroscopy (use of a telescopic instrument inserted through the vagina to look inside the uterus) may be done. They are used to diagnose the type of hyperplasia and to rule out cancer.
• Treatment will be based on findings from the medical tests, your age, and desires about future pregnancy.
• Drugs are normally the first step in treatment. They will cause the lining to shed and prevent it from building up again. This will show up as vaginal bleeding or a menstrual period.
• Long-term follow-up with your health care provider will be required to help avoid a recurrence. Periodic endometrial biopsies, and possibly other tests, will be used to watch for complications of this condition.
• For some women, a hysterectomy (surgery to remove the uterus) is recommended. It may help when hormone therapy has failed and precancerous cells are discovered.

medications

Progesterone (progestin), a female hormone, may be prescribed. It may be given by mouth or a skin patch.

activity

No limits unless you have surgery. Then resume your activities gradually. You may resume sexual relations once medical approval is given.

diet

Usually, no special diet is required. If you are overweight, losing weight might help decrease estrogen in the body.

 notify our office if

• You or a family member has symptoms of endometrial hyperplasia.
• The following symptoms occur during treatment: excessive bleeding, signs of infection, or new, unexplained symptoms develop.

Special Notes: