If the lining of your uterus is abnormally thick, your doctor may diagnose you with endometrial hyperplasia. This is a pre-cancerous condition that can lead to uterine cancer if left untreated. It usually develops over years in a step-wise way from simple thickening of the uterine lining to formation of glands and cellular changes. It can also become a cancer that grows in the wall of your uterus and can invade your bowels. The treatment for this depends on what type of endometrial hyperplasia you have.
The normal lining of your uterus (endometrium) is thin at the start of each menstrual cycle, measuring 2-4 millimeters. The lining thickens during the proliferative phase of the menstrual cycle, which lasts from day 6 to 14 and prepares the uterus for possible pregnancy. As a woman goes through the proliferative phase, she produces estrogen, which increases uterine lining thickness to up to 11 mm. After an egg is released from the ovary (ovulation), estrogen levels drop and the uterine lining sheds. This process is known as your period. In some women, the ovaries produce too much estrogen compared to progesterone, which leads to a thickening of the uterine cloaking that isn’t part of the normal menstrual cycle.
This is a hormone imbalance and can be caused by a variety of factors including the use of birth control pills that contain both estrogen and progestin, taking the anti-cancer drug tamoxifen, or being overweight. Abnormally thickened linings can also be caused by hormone replacement therapy, especially in postmenopausal women.
Women who have atypical or complex hyperplasia, which are more likely to become cancerous, are at higher risk for uterine cancer and need more intensive treatment. In general, treatment for these types of hyperplasia involves taking hormones to reduce the amount of estrogen in the body. These hormones can be taken as a pill, injection, vaginal cream or through an intrauterine device (IUD). They are often called “hormonal therapy” or “HRT” for short.
If you have atypical or complex hyperplasia, your doctor may recommend surgery to remove your uterus and cervix, or a hysterectomy, if you don’t want to have more children. For some women with severe atypical hyperplasia, this is a good option because it can lower your risk of developing endometrial cancer in the future.
The most common treatment for endometrial hyperplasia is a combination of estrogen and progestin. This can be taken as a pill, shot, vaginal cream or through an intrauterine system (IUD). It is important to talk to your doctor about what option is best for you.
