What is Endometrial Hyperplasia?

Endometrial Hyperplasia is a condition that occurs due to the excessive growth of the lining and cells of the endometrium, i.e. the inner lining of the uterus, due to hick estrogen stimulation. This condition is benign, but may lead to cancer at times. Women who experience irregular menstrual cycles are more prone to this disease, as they do not ovulate properly. This condition is a non-cancerous one. If there is an excessive growth of the hormones, then there is a proliferation of cell lining of uterus.

Endometrial Hyperplasia Definition

Endometrial Hyperplasia is an abnormal condition in which there is a proliferation of the lining of the uterus occurring due to a sustained stimulation by estrogen.

Endometrial Hyperplasia Pathology

Endometrial hyperplasia may be generally visible as a single and prevailing mass in the endometrial cavity. It may also diffuse the endometrium. It is a pathologig diagnosis.

Endometrial Hyperplasia Histology

This condition is generally characterized by a proliferation of the uterine glands and the stroma. Even after this proliferation, there may be an over-crowding in glandular regions. Histologically, we can classify endometrial hyperplasia according to its architecture – whether it is simple or complex, i.e. the extent os crowding and glandular complexity. According to the cytologic feature, it can be classified as with atypia, or without it.

Focal Endometrial Hyperplasia

Focal abnormality in the endometrial hyperplasia is a rare type of occurrence. It may occasionally occur in one or more serious cases. This type is very difficult to be differentiated from the endometrial polyps as its characteristic is more or less same. There is a sort of focal endometrial thickening in this case

Endometrial Hyperplasia Symptoms

There are some very visible symptoms that make this disease clear. Endometrial Hyperplasia is a serious condition, and it has it even affects the reproductive system of females. In some cases, it occurs with symptoms that indicates a serious condition. Usually, these symptoms are associated with changes in the menstrual cycle. These symptoms may be experienced daily, or just once in a while. It may be severe, or mild. Some of the symptoms of Endometrial Hyperplasia are as follows:

• Irregular menstruation
• Acne
• Experience dryness in the vagina
• Bleeding between the menstrual periods
• Pain during intercourse
• Hot flushes/ flashes
• Missing of menstrual periods
• Increase in heart rate
• Excessive fatigue
• Severe mood swings
• Increase in growth of body hair
• Menorrhagia – increased bleeding during menstruation
• Discharge from vagina
• Severe pain in abdomen
• Prolonged menstrual periods

Endometrial Hyperplasia Risk Factors

Several risk factors are associated with the occurrence of this disease. The risk factors of this disease are somewhat similar to those of endometrial cancer. The women who did not undergo hysterectomy are more vulnerable to this disease. Apart from this, women who are overweight are more at risk, as the intensity of this disease increases with obesity.

The risk of this disease is more in those women who experience the following symptoms:

• Diabetic
• Polycystic ovarian syndrome
• Obesity
• Menopause

Causes of Endometrial Hyperplasia

The primary cause of this disease is the lack of balance between the two female hormones, i.e. oestrogen and progesterone. There may be cases when there is too much of oestrogen secretion, without corresponding exposure to progesterone. This is an abnormal condition, known as unopposed oestrogen. Too much oestrogen, and lack of progesterone leads to a situation of overgrowth of cells in the endometrium. This results in excessive thickening of the endometrium.

Apart from this reason, this disease can also be caused due to a number of chronic diseases such as diabetes, ovary syndrome and obesity. Tamofixen can also cause Endometrial Hyperplasia as it has a negative effect on the womb to oestrogen, since it is a breast cancer drug.

Endometrial Hyperplasia Classification

Endometrial Hyperplasia can be classified into two types.  It is a sort of a physiological response to the endometrial tissue. The cells that form the glands of the endometrium also undergo certain changes, which may be attributed to cancerous transformation. The classification is useful as it shows its relation with the development of malignancy.  The two types of Endometrium Hyperplasia, as classified by the world health organization are:

Endometrial Hyperplasia –This is the normal Endometrial Hyperplasia, or Endometrial hyperplasia without Atypia. It may be either simple endometrial hyperplasia without hyperplasia, or complex endometrial without hyperplasia.

Simple Endometrial Hyperplasia – In this kind of hyperplasia, the proliferation of cells does not change the relative structure of the endometrium. It is the least harmful of all types.

Complex Endometrial Hyperplasia – In this type of endometrial hyperplasia, there is no change in the internal makeup of the endometrial cell. But there is a proliferation at the point where the normal structure of the endometrium is interfered.

Atypical Endometrial Hyperplasia – This may also be simple or complex.

Simple Atypical Endometrial Hyperplasia – this type of hyperplasia can be cured completely with progestin therapy.  It has low chances of being transformed into cancer.

Complex Atypical Endometrial Hyperplasia – This is the most dangerous category of endometrial hyperplasia, majority of type passes for endometrial cancer. It can be surgically treated through hysterectomy.

Endometrial Hyperplasia Cancer

The patients of endometrial hyperplasia have a probability of developing endometrial cancer. The risk of developing cancer is low in those women who have hyperplasia without atypical chances. The ones with atypical changes are more at risk in this case, especially those who have complex atypical changes. Endometrial cancer is the various type of malignancy that may arise in the endometrium. It is more common in the later stages of life, at the time of menopause. It is also referred to as uterine cancer. It may be cured by performing a endometrium hyperplasia hysterectomy.

Cystic Endometrial Hyperplasia

It is a condition in which a cyst is formed in the uterine lining in females. In this case, the amount of endometrium is ncreased abnormally, as there is no circulation. The gland is swollen, and gets an irregular shape due to the atypical cells. Sometimes, bleeding may occur because of this, but it is not malignant.

Postmenopausal Endometrial Hyperplasia

When endometrial hyperplasia occurs at the time of menopause, it is accompanied by bleeding. It is a sort of vaginal bleeding, which may last for a comparatively long time. At this time, hysterectomy is recommended for cure.

Endometrial Hyperplasia of the Uterus

It is a condition which occurs when the lining of the uterus grows in excess. This condition is benign, and is called a benign endometrial hyperplasia.

Endometrial Hyperplasia Diagnosis

This condition can be diagnosed through a number of methods, it may be done by taking a endometrial hyperplasia biopsy or ultrasound. It can also be done through curettage of the uterine cavity so as to obtain endometrial tissue for the histopathologic analysis. This diagnosis can be done by a pathologist who examines a sample of the endometrial tissue that is removed from the endometrial lining by dilation or biopsy. If the hyperplasia is without atypical cells, then it can even be detected by microscopically by an exam.

Endometrial Hyperplasia Ultrasound

Transvaginal ultrasound can be performed to find out the level of thickness of the endometrial lining in the women. This type of ultrasound evaluates the endometrial thickness, which finds out whether the patient has endometrial cancer or not.

Endometrial Hyperplasia Biopsy

Endometrial hyperplasia can be easily detected through biopsy. This can be performed in a doctor’s office. The doctor performs a biopsy by inserting a narrow tube into the uterus to extract a sample of the cells. These cells are sent to the laboratory for examination.

Endometrial Hyperplasia Treatment

Endometrial Hyperplasia can be treated by Hormonal therapy that may include continuous progestin therapy or even hysterectomy. It may be treated through the consumption of medicines such as Povera which may be taken directly or through injections. It may be cured by a D&C – dilation and curettage test. They can also be treated in young women through intrauterine devices or birth control pills.

The treatment for endometrial hyperplasia depends on the stage of life in which this condition appears. It also depends on how severe this condition is.  Those who experience this problem at the time of menopause or perimenopause can be given a complete course of hormone replacement therapy.  If nothing else works out, the patient can resort to Hysterectomy. It is a surgical method of removing this condition.

Endometrial Hyperplasia Prognosis

Endometrial Hyperplasia can be completely resolved following a D&C.  Hyperplasia that occurs without atypical cells is not that dangerous, and does not progress into cancer.

Endometrial Hyperplasia is definitely a very serious condition. It may also interfere with pregnancy in women. Therefore medical help should be taken to cure this condition. It is curable, but precautions should be taken to see that it does not get very serious.

References:

http://en.wikipedia.org/wiki/Endometrial_hyperplasia

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http://www.rnhinfo.com/Gynaec%20Links/Endometrial%20hyperplasia.htm

http://www.althysterectomy.org/hyperplasia.htm

http://www.bettermedicine.com/article/endometrial-hyperplasia

http://www.mamashealth.com/women/endohy.asp

http://womenshealth.about.com/cs/uterinehealth/a/endohyperplasia.htm

http://www.bettermedicine.com/article/endometrial-hyperplasia/treatments

http://www.womentowomen.com/menopause/uterinehyperplasia.aspx

http://www.diagnose-me.com/cond/C600853.html

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http://www.medscape.com/viewarticle/507187