Endometrial Hyperplasia Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Endometrial hyperplasia is a condition when the endometrial wall is too thick. The endometrium itself is the innermost lining of the uterus (uterus).
Under normal circumstances, the thickness of the endometrium varies according to the menstrual cycle. Towards the fertile period, due to the influence of the hormone estrogen, the endometrial lining begins to grow and thicken.
After the egg is released during the fertile period, under the influence of the hormone progesterone, the endometrium is prepared to become a place for the fetus to attach.
If pregnancy does not occur, the endometrium sheds and menstruation occurs. And so on this cycle repeats every 21-35 days.
Now, in endometrial hyperplasia, the innermost layer of the uterus is too thick. This condition can potentially become endometrial cancer in the future.
There are two types of endometrial hyperplasia, namely simple endometrial hyperplasia (without atypia) and atypical endometrial hyperplasia.
1. Simple endometrial hyperplasia (without atypia)
This type of endometrial hyperplasia has cells that appear normal and are less likely to become cancerous.
This condition can improve without treatment. Hormone therapy helps in some cases.
2. Simple or complex atypical endometrial hyperplasia
The overgrowth of abnormal cells causes this precancerous condition. Without treatment, the risk of endometrial or uterine cancer increases.
Symptom
Some of the symptoms of endometrial hyperplasia include:
- Menstrual bleeding that is heavier than usual
- Shorter menstrual cycle (under 21 days)
- Bleeding after menopause
Reason
Endometrial hyperplasia is often caused by excessive estrogen without progesterone.
If ovulation does not occur, progesterone will not be formed so that the endometrial lining will not shed.
The endometrium will continue to thicken according to the existing levels of estrogen. Although not cancer, this condition can be a risk factor for cancer.
Risk Factors
Endometrial hyperplasia disease generally occurs after menopause, when the fertile period has not occurred and progesterone levels are low.
However, endometrial hyperplasia can also occur in people who are not yet menopausal but are taking drugs containing high doses of estrogen.
In addition, the following things can increase the risk of endometrial hyperplasia:
- Age 35 and over
- Never been pregnant or experienced infertility
- Age of onset of menopause over 50 years
- Starting menstruation at a very young age
- Having diabetes mellitus
- Have polycystic ovary syndrome
- Obesity
- Smoke
- Family history of ovarian cancer, colon cancer, or endometrial cancer
Diagnosis
The diagnosis of endometrial hyperplasia will be made through a thorough interview, especially regarding the menstrual cycle for the last six months.
Next, the doctor performs a physical examination. If necessary, an examination of the vagina and uterus is sometimes performed.
After that, a radiological examination in the form of an ultrasound (USG) needs to be done. Generally, the ultrasound performed is a transvaginal ultrasound.
In this type of ultrasound, an ultrasound probe is inserted through the vagina. Through this examination, the doctor will measure the thickness of the endometrium.
If the endometrium is too thick accompanied by a suspicion of cancer, then the examination will be continued with an endometrial biopsy.
In this procedure, a sample of endometrial tissue will be taken and examined under a microscope.
Treatment
Endometrial hyperplasia should be treated by an obstetrician. There are several types of treatment for endometrial hyperplasia.
However, the most frequently administered are progestin preparations. This drug can be given in the form of tablets taken by mouth, injections, or in the form of vaginal creams.
Another treatment that can be done is to perform curettage, by ‘scraping’ the endometrial tissue to reduce its thickness. This action can be done in conjunction with a biopsy.
If endometrial hyperplasia is suspected of leading to cancer, aggressive action in the form of surgical removal of the uterus (hysterectomy) can be performed.
This is especially considered to be done in patients with endometrial hyperplasia who are no longer planning to have children.
In addition, surgical therapy with hysterectomy can be done with the indications:
- Atypical hyperplasia occurs during treatment
- There was no improvement after 12 months of nonoperative treatment
- Endometrial hyperplasia recurred
- The bleeding continues
- Patients who refuse monitoring and follow-up
Prevention
There are several actions you can take to prevent endometrial hyperplasia, namely:
- If taking estrogen after menopause, it is also necessary to take progestin or progesterone according to the doctor’s advice
- If the menstrual cycle is irregular, birth control pills can be taken according to the doctor’s recommendation
- If you have an excessive body mass index, lose weight until you reach your ideal body weight
Complications
Endometrial hyperplasia can be a trigger of endometrial cancer. If left untreated, especially in the atypical type, this has a 27.5 percent risk of turning into malignancy.
When to see a doctor?
Immediately visit a doctor if you experience the symptoms of endometrial hyperplasia above.