Table of ContentsView AllTable of ContentsTypesSymptomsCausesRisk FactorsDiagnosisTreatmentOutlook
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Risk Factors
Diagnosis
Treatment
Outlook
Endometrialhyperplasiais a thickening of the lining of the uterus due to a hormonal imbalance. Endometrial hyperplasia may lead to various symptoms, such as heavy menstrual periods, spotting, and post-menopausal bleeding.
While risk factors vary, some conditions that cause too much of the hormone estrogen can lead to endometrial hyperplasia. Depending on the severity of the condition, treatment may involve observation, managing certain risk factors, medication, and surgery.
This article discusses the symptoms, causes, and risk factors of endometrial hyperplasia. It also covers how it’s diagnosed and treated.
ericsphotography / Getty Images
Types of Endometrial Hyperplasia
There are two types of endometrial hyperplasia:
While both increase the chance of developing endometrial cancer, the risk increases if your endometrium cells are abnormal.
All About the Endometrial Lining
What Are the Symptoms of Endometrial Hyperplasia?
Endometrial hyperplasia can causeabnormal uterine bleeding. This can include:
When to Call Your Healthcare Provider
Reach out to your healthcare provider if you:
*Endometrial hyperplasia is not associated with back pain, but endometrial cancer is.
Pelvic Pain
What Causes Endometrial Hyperplasia?
When balanced with the right amount of progesterone, your endometrium builds up, but then thins out. When there is too much estrogen, the lining is overstimulated and continues to thicken. Over time, that thickened lining begins to develop abnormal changes.
Is Endometrial Hyperplasia Hereditary?Studies suggest that certain types of endometrial hyperplasia and endometrial cancer are genetically similar.Because endometrial cancer can run in families, this suggests that there may be a hereditary component to endometrial hyperplasia as well.
Is Endometrial Hyperplasia Hereditary?
Studies suggest that certain types of endometrial hyperplasia and endometrial cancer are genetically similar.Because endometrial cancer can run in families, this suggests that there may be a hereditary component to endometrial hyperplasia as well.
What Are the Risk Factors of Endometrial Hyperplasia?
Conditions that cause excess estrogen that can lead to endometrial hyperplasia include:
Obesity
Anovulation
Anovulation happens when you don’t ovulate, meaning an egg doesn’t release from your ovaries. If you don’t ovulate, your ovary won’t increase its production of progesterone. This increase in progesterone is necessary for the lining of your uterus to shed. In other words, you won’t get your period.
In some types of anovulatory cycles, this leads to too much estrogen compared to progesterone. This unbalanced estrogen results in abnormal thickening of the endometrium. Eventually, you will have some type ofabnormal uterine bleeding.
This may cause irregular and heavy periods or bleeding between your periods. Common causes of this type of hormonal imbalance include:
Taking Hormones
Hormones that are taken as medications or hormone therapy can increase your estrogen levels relative to your progesterone. One example is estrogen replacement. If you’re taking estrogen replacement and still have a uterus, you need to take some form of progestin (progesterone). This helps prevent your endometrium from being overstimulated when taking estrogen.
Another hormonal medication that can cause abnormal thickening of the endometrium is tamoxifen. Tamoxifen is a drug that is called a selective estrogen receptor modulator or SERM. SERMs are drugs that affect the estrogen-sensitive parts of your body in different ways.
Tamoxifen is often used in the treatment of hormone-sensitive breast cancers. That’s because it opposes the effects of estrogen in the breast tissue. However, tamoxifen stimulates the estrogen receptors in the lining of the uterus. It acts like an estrogen and can cause endometrial hyperplasia.
See your healthcare provider if you are using hormone replacement therapy or tamoxifen and develop abnormal uterine bleeding.
Estrogen-Producing Ovarian Tumors
Hormone-producing tumors are not a common cause of endometrial hyperplasia. However, there are certain (usually benign) ovarian tumors that produce excess estrogen.
An Overview of Metrorrhagia
How Is Endometrial Hyperplasia Diagnosed?
Your healthcare provider may order several tests to diagnose endometrial hyperplasia and rule out other conditions that may be causing abnormal uterine bleeding. These tests may include:
Determining the Type of Endometrial Hyperplasia
When thepathologistlooks at the sample of your endometrium under the microscope, they look specifically at changes in the two components of your endometrium: the glands and the supportive tissue called stroma.
Endometrial hyperplasia is diagnosed when there are more glands relative to stroma than you would find in normal proliferative or cycling endometrium.
The pathologist will then comment on whether there are abnormal looking cells in the thickened endometrium. If the cells are normal, the condition is classified as hyperplasia without atypia. If they are abnormal, the condition is classified as atypical hyperplasia. The abnormal cells seen in atypical hyperplasia are considered precancerous.
Endometrial hyperplasia is notendometrial cancer. However, in some cases of significant atypical hyperplasia, a very early stage endometrial cancer may already be present.
What Is Endometrial Cancer?
How Is Endometrial Hyperplasia Treated?
It is very important that all endometrial hyperplasia be closely followed or treated. The course of treatment will depend on whether or not there is atypia, or abnormal cells.
Endometrial Hyperplasia Without Atypia
When there are no atypical cells present, the chance of endometrial hyperplasia eventually becoming endometrial cancer is very unlikely. The evidence suggests that only about 5% of individuals with endometrial hyperplasia without atypia will develop endometrial cancer.It is also likely that this type of endometrial hyperplasia will resolve on its own over time.
Modifying Risk Factors
If you’re taking hormone replacement therapy, your healthcare provider may need to adjust your dose or recommend that you discontinue using it.
Progesterone
Your healthcare provider may recommend using progestin treatments to counteract the thickening effect of the excess estrogen on your endometrium. Your healthcare provider may suggest treating you with progestin if:
An oral progesterone or a progesterone-containing IUD may be suggested for the treatment of endometrial hyperplasia without atypia. This can include the levonorgestrel IUD (Mirena).
If your BMI is over 35, the progesterone treatment may not work well unless you also lose weight. You should discuss with your healthcare provider which type of progesterone treatment is best for you.
Whether you chose observation or treatment with progesterone, you will have to be followed closely with interval endometrial sampling. This helps to assure that the endometrial hyperplasia is gone and doesn’t come back.
Hysterectomy
Experts say that ahysterectomyshould not be offered as a first-line treatment option for endometrial hyperplasia without atypia. That’s because of the overall effectiveness of progesterone treatment and the lowrisk of developing endometrial cancer.
However, there are certain situations where a hysterectomy may be an appropriate treatment option for individuals who are done having children. Your healthcare provider may recommend a hysterectomy if:
Hysterectomy: What to Expect on the Day of Surgery
Endometrial Hyperplasia With Atypia
If you have hyperplasia with atypia, there is a much more significant risk of developing endometrial cancer. Treatment is a bit more aggressive because of that increased risk. In fact, experts recommendhysterectomyas the first-line treatment for atypical hyperplasia in individuals who are done having children.
If you are diagnosed with atypical hyperplasia and are planning on trying to get pregnant, you will likely be treated withprogesterone. Preferably, this would be with the levonorgestrel IUD.
You will have more frequent endometrial sampling to assure that the atypical hyperplasia has been treated adequately. Your healthcare provider may suggest you see a fertility specialist to complete your childbearing as soon as you possibly can.
Your healthcare provider will likely suggest having a hysterectomy after you are done having children. That’s because atypical endometrial hyperplasia has a high likelihood of recurrence.
The outlook for most individuals with endometrial hyperplasia is good, with many cases resolving on their own or responding well to progestin treatment.
If you have hyperplasia with atypia, your healthcare provider may recommend more aggressive treatment options to reduce or eliminate your risk of developing endometrial cancer.
Summary
Endometrial hyperplasia can be classified as one of two types. Hyperplasia without atypia has normal-looking cells, and atypical hyperplasia has abnormal cells considered precancerous.
In hyperplasia without atypia, treatment may include risk factor management, such as losing weight or discontinuing hormone therapy. You may also take progesterone treatments. If you have atypical hyperplasia, a precancerous condition, your healthcare provider may recommend a hysterectomy.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sobczuk K, Sobczuk A.New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Prz Menopauzalny. 2017;16(3):107-111. doi:10.5114/pm.2017.70589Mount Sinai.Vaginal or uterine bleeding-overview.American Cancer Society.Signs and symptoms of endometrial cancer.Rafique S, Decherney AH.Medical management of endometriosis.Clin Obstet Gynecol. 2017;60(3):485-496. doi:10.1097/GRF.0000000000000292Russo M, Newell JM, Budurlean L, et al.Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma.Cancer. 2020;126(12):2775-2783. doi:10.1002/cncr.32822American Cancer Society.Endometrial cancer risk factors.Nees LK, Heublein S, Steinmacher S, et al.Endometrial hyperplasia as a risk factor of endometrial cancer.Arch Gynecol Obstet. 2022;306(2):407-421. doi:10.1007/s00404-021-06380-5Spaczynski RZ, Duleba AJ.Diagnosis of endometriosis.Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326Royal College of Obstetricians and Gynaecologists.Management of endometrial hyperplasia.Byun JM, Jeong DH, Kim YN, et al.Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge.Obstet Gynecol Sci. 2015;58(6):468-474. doi:10.5468/ogs.2015.58.6.468Yale Medicine.Endometrial hyperplasia.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sobczuk K, Sobczuk A.New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Prz Menopauzalny. 2017;16(3):107-111. doi:10.5114/pm.2017.70589Mount Sinai.Vaginal or uterine bleeding-overview.American Cancer Society.Signs and symptoms of endometrial cancer.Rafique S, Decherney AH.Medical management of endometriosis.Clin Obstet Gynecol. 2017;60(3):485-496. doi:10.1097/GRF.0000000000000292Russo M, Newell JM, Budurlean L, et al.Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma.Cancer. 2020;126(12):2775-2783. doi:10.1002/cncr.32822American Cancer Society.Endometrial cancer risk factors.Nees LK, Heublein S, Steinmacher S, et al.Endometrial hyperplasia as a risk factor of endometrial cancer.Arch Gynecol Obstet. 2022;306(2):407-421. doi:10.1007/s00404-021-06380-5Spaczynski RZ, Duleba AJ.Diagnosis of endometriosis.Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326Royal College of Obstetricians and Gynaecologists.Management of endometrial hyperplasia.Byun JM, Jeong DH, Kim YN, et al.Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge.Obstet Gynecol Sci. 2015;58(6):468-474. doi:10.5468/ogs.2015.58.6.468Yale Medicine.Endometrial hyperplasia.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sobczuk K, Sobczuk A.New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Prz Menopauzalny. 2017;16(3):107-111. doi:10.5114/pm.2017.70589Mount Sinai.Vaginal or uterine bleeding-overview.American Cancer Society.Signs and symptoms of endometrial cancer.Rafique S, Decherney AH.Medical management of endometriosis.Clin Obstet Gynecol. 2017;60(3):485-496. doi:10.1097/GRF.0000000000000292Russo M, Newell JM, Budurlean L, et al.Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma.Cancer. 2020;126(12):2775-2783. doi:10.1002/cncr.32822American Cancer Society.Endometrial cancer risk factors.Nees LK, Heublein S, Steinmacher S, et al.Endometrial hyperplasia as a risk factor of endometrial cancer.Arch Gynecol Obstet. 2022;306(2):407-421. doi:10.1007/s00404-021-06380-5Spaczynski RZ, Duleba AJ.Diagnosis of endometriosis.Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326Royal College of Obstetricians and Gynaecologists.Management of endometrial hyperplasia.Byun JM, Jeong DH, Kim YN, et al.Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge.Obstet Gynecol Sci. 2015;58(6):468-474. doi:10.5468/ogs.2015.58.6.468Yale Medicine.Endometrial hyperplasia.
Sobczuk K, Sobczuk A.New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.Prz Menopauzalny. 2017;16(3):107-111. doi:10.5114/pm.2017.70589
Mount Sinai.Vaginal or uterine bleeding-overview.
American Cancer Society.Signs and symptoms of endometrial cancer.
Rafique S, Decherney AH.Medical management of endometriosis.Clin Obstet Gynecol. 2017;60(3):485-496. doi:10.1097/GRF.0000000000000292
Russo M, Newell JM, Budurlean L, et al.Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma.Cancer. 2020;126(12):2775-2783. doi:10.1002/cncr.32822
American Cancer Society.Endometrial cancer risk factors.
Nees LK, Heublein S, Steinmacher S, et al.Endometrial hyperplasia as a risk factor of endometrial cancer.Arch Gynecol Obstet. 2022;306(2):407-421. doi:10.1007/s00404-021-06380-5
Spaczynski RZ, Duleba AJ.Diagnosis of endometriosis.Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326
Royal College of Obstetricians and Gynaecologists.Management of endometrial hyperplasia.
Byun JM, Jeong DH, Kim YN, et al.Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge.Obstet Gynecol Sci. 2015;58(6):468-474. doi:10.5468/ogs.2015.58.6.468
Yale Medicine.Endometrial hyperplasia.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
