What is Endometrial Hyperplasia
Endometrial hyperplasia is a condition in which the endometrium, the inner lining of the uterus, becomes unusually thick. This pathological increase in endometrial thickness is due to excessive growth of the cells that comprise this tissue.
The endometrium normally increases in thickness during the menstrual cycle, preparing for potential pregnancy. When fertilization does not occur, the endometrium is shed during menstruation. In endometrial hyperplasia, this normal process is disrupted.
Types of Endometrial Hyperplasia
- Simple Hyperplasia without Atypia
Simple hyperplasia is characterized by an increase in the number of cells without significant morphological changes in the cells.
- Hyperplasia with Atypia
Hyperplasia with atypia is the most serious type, where cells show abnormal characteristics. This type has the highest likelihood of progressing to endometrial cancer.
Causes and Risk Factors
Hormonal Imbalance
The main cause of endometrial hyperplasia is hormonal imbalance, particularly prolonged exposure to estrogen without counteracting progesterone effect. This condition can be a result from:
- Polycystic ovary syndrome (PCOS)
- Estrogen-producing ovarian tumors
- Obesity (fat cells produce estrogen)
Age Factors
Age plays a significant role, with most cases appearing:
- In the perimenopausal period (40-50 years)
- After menopause
- Rarely in women of reproductive age
Other Risk Factors
- Type 2 diabetes: Associated with increased risk
- Family history: Heredity of endometrial or ovarian cancer
- Hypertension: May be associated with hormonal disorders
- Drug therapies: Certain medications such as Tamoxifen
Symptoms of Endometrial Hyperplasia
Main Symptoms
The most common symptom of endometrial hyperplasia is abnormal uterine bleeding. This can manifest as:
- Menorrhagia: Very heavy menstrual periods
- Metrorrhagia: Bleeding between menstrual periods
- Prolonged bleeding: Menstruation lasting more than 7 days
- Postmenopausal bleeding: Bleeding after menopause
Secondary Symptoms
- Pelvic pain: May be mild to moderate
- Anemia: Due to chronic blood loss
Diagnosis of Endometrial Hyperplasia
Clinical Examination
The diagnostic process begins with detailed medical history and physical examination. The doctor will record:
- Symptoms and their duration
- Menstrual history
- Family history
- Medication intake
Diagnostic Tests
- Transvaginal Ultrasound
Transvaginal ultrasound is the first line imaging examination. This non-invasive test can measure endometrial thickness and assess the overall uterine structure.
- Endometrial Biopsy
Endometrial biopsy is the most important test for confirming diagnosis. During the procedure:
- A small tissue sample is taken from the endometrium
- The sample is examined microscopically by a pathologist
- The type of hyperplasia is determined
- Hysteroscopy
Hysteroscopy allows direct visual examination of the uterine interior through a thin telescope. This examination:
- Provides direct visualization of the endometrium
- Allows targeted biopsy
- Can reveal polyps or other abnormalities
Treatment Options
Pharmacological Treatment
- Progestin
Progestin is first-line treatment for endometrial hyperplasia:
- Medroxyprogesterone: Administered orally or intramuscularly
- Progestin intrauterine device: Provides local action with fewer systemic side effects
- Other forms: Various options exist depending on patient needs
- GnRH Antagonists
Gonadotropin-releasing hormone antagonists can be used in special cases:
- Significantly reduce estrogen levels
- Usually used for short periods
- May cause menopausal symptoms
Surgical Treatment
- Total Hysterectomy
In severe cases, particularly with atypical hyperplasia, total hysterectomy may be recommended:
- Completely removes the risk of endometrial cancer
- Is a definitive solution
- Recommended mainly for women who do not desire to preserve fertility
Prognosis and Monitoring
- Prognosis by Type
- Simple hyperplasia without atypia: Excellent prognosis with appropriate treatment
- Hyperplasia with atypia: Requires close monitoring due to cancer risk
- Monitoring
Long-term monitoring includes:
- Regular endometrial biopsies
- Ultrasound checks
- Clinical examinations
- Symptom monitoring
Prevention of Endometrial Hyperplasia
- Weight Management
Maintaining healthy weight is critical for prevention:
- Reduces estrogen production from fat cells
- Improves overall hormonal balance
- Reduces diabetes risk
- Medical Monitoring
Women with risk factors should have regular gynecological examinations and discuss any concerns with their doctor.
Complications and Risks
- Endometrial Cancer
The most serious risk is progression to endometrial cancer:
- Risk varies depending on hyperplasia type
- Atypical hyperplasia has the highest risk
- Timely treatment significantly reduces this risk
- Anemia
Chronic bleeding can lead to:
- Iron-deficiency anemia
- Fatigue and weakness
- Reduced quality of life
New Developments in Treatment
Medical research continues to develop new therapeutic approaches:
- New hormonal preparations: With fewer side effects
- Minimalist surgical techniques: With faster recovery
Importance of Timely Diagnosis
Endometrial hyperplasia is a condition that can be effectively treated with timely diagnosis and appropriate therapy. Women experiencing abnormal uterine bleeding should not hesitate to seek medical advice.
Appropriate monitoring and treatment can prevent disease progression and maintain women's health. With proper medical care, most women with endometrial hyperplasia can have excellent quality of life and prognosis.
Get informed by Kostis Nikolopoulos about modern treatment options.
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