Endometrial Hyperplasia
Endometrial hyperplasia is a condition in which the lining of the uterus (the endometrium) becomes abnormally thick. This usually occurs when there is an imbalance between estrogen and progesterone, causing the endometrium to grow more than normal. Some forms of hyperplasia carry a higher risk of progressing to endometrial cancer, while others are benign. Many cases are discovered because of abnormal bleeding or on imaging performed for pelvic concerns.
What is it?
Endometrial hyperplasia occurs when the uterine lining grows thicker than normal due to excess estrogen without enough progesterone to balance it. This imbalance can occur around menopause, with obesity, polycystic ovary syndrome (PCOS), certain medications, or prolonged hormone exposure. Hyperplasia may be classified as simple or complex, with or without atypia (abnormal cells), which helps guide treatment and determine cancer risk.
Ultrasound is typically the first imaging method used to measure endometrial thickness and identify whether the lining appears unusually thick or irregular. MRI can offer additional detail when needed. However, biopsy is required to confirm the diagnosis and determine whether atypia is present.
Important to Know
Not all endometrial hyperplasia carries the same risk. Hyperplasia with atypia has a higher chance of progressing to cancer and usually requires closer monitoring or treatment. Hyperplasia without atypia is often managed with medication and follow-up imaging.
Red flag symptoms include heavy or prolonged bleeding, bleeding between periods, or any bleeding after menopause. These should be evaluated promptly. Follow-up imaging and biopsy may be recommended to monitor treatment response and ensure the condition does not progress.