What is endometrial hyperplasia?
Endometrial hyperplasia is a pathological thickening of the uterine lining (endometrium) due to excessive proliferation of glands and stroma.
It is a benign condition but may represent a precancerous state, particularly in the presence of atypia.
Causes and risk factors
It develops under prolonged estrogen stimulation with relative or absolute progesterone deficiency.
Risk factors include:
• Anovulatory cycles, including PCOS
• Obesity and metabolic syndrome
• Long-term estrogen-only HRT
• Hormone-producing tumors (e.g., granulosa cell tumor of the ovary)
• Diabetes mellitus
• Nulliparity
• Family history (genetic predisposition)
Types and classification
Two main forms are distinguished:
• Endometrial hyperplasia without atypia – Increased gland number without significant structural changes; low risk of malignancy.
• Endometrial hyperplasia with atypia – Higher risk of progression to endometrial cancer.
Key symptoms
• Acyclic uterine bleeding
• Prolonged or heavy menstruation
• Irregular menstrual cycles
• Postmenopausal bleeding
• Infertility
• Signs of anemia (fatigue, dizziness)
Sometimes asymptomatic and detected incidentally by ultrasound or biopsy.
Diagnosis
Essential methods:
• Transvaginal ultrasound — assessment of endometrial thickness (M-mode)
• Endometrial Pipelle biopsy or
• Hysteroscopy with dilation and curettage (gold standard)
In postmenopausal women, endometrial thickness >4 mm with bleeding requires exclusion of hyperplasia or cancer.
Treatment
Treatment depends on the type of hyperplasia, patient's age, and reproductive plans.
Conservative treatment:
• Hormonal therapy (oral forms or levonorgestrel-releasing intrauterine device)
• Dynamic follow-up with repeat biopsies
Surgical treatment:
• Hysterectomy — for selected indications
Complications and prevention
Possible complications:
• Malignant transformation (especially with atypia)
• Chronic blood loss → anemia
• Infertility
Prevention:
• Weight control, correction of metabolic disorders
• Rational use of HRT
• Routine gynecological exams and pelvic ultrasound
• Management of anovulation (e.g., in PCOS)
Hyperplasia and pregnancy
Hyperplasia can impair embryo implantation.
Successful pregnancy is possible after appropriate treatment and restoration of normal endometrial structure.
When to see a doctor?
Consult a gynecologist if you experience:
• Bleeding outside of menstruation
• Heavy or irregular periods
• Postmenopausal spotting
• Infertility or repeated IVF failures
• Endometrial thickness that doesn’t correspond to cycle phase (by ultrasound)