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A thickened endometrium — the lining of the uterus — can raise your risk of cancer. This condition is called endometrial hyperplasia. It doesn’t always lead to cancer, and in many cases, it never does. But certain factors, like hormone changes or taking certain medications, can increase the chances that it might. There’s no set timeline for when hyperplasia could turn into cancer, which is why regular checkups and monitoring are so important.
This article will cover what it means to have endometrial hyperplasia and how it may raise your risk of cancer. We’ll also discuss how quickly hyperplasia may progress. Endometrial hyperplasia isn’t a form of cancer, but in some cases — especially those with atypical cells — it’s considered a precancerous condition that can develop into cancer if not treated. To learn more about your risk for endometrial cancer, talk to your primary care provider or obstetrician/gynecologist (OB-GYN).
Endometrial hyperplasia refers to abnormal thickening of the uterine lining. Endometrial tissue naturally thickens throughout your menstrual cycle (period) as your estrogen levels rise. Progesterone levels rise after ovulation and then drop sharply if you don’t get pregnant, which triggers your period.
According to Cleveland Clinic, women who have gone through menopause no longer menstruate. However, if they still have high estrogen levels, they can develop endometrial hyperplasia. This is because they don’t shed the additional tissue without a period.
Endometrial hyperplasia can cause symptoms including:
As always, any abnormal vaginal bleeding is a worrying sign and should be reported to your doctor as soon as possible. But endometrial hyperplasia doesn’t always cause symptoms, especially in those who have gone through menopause. In these cases, endometrial hyperplasia is usually found during an imaging test, like an ultrasound, which was done for another reason.
According to gynecologic oncology specialists at Atlanta Gynecology & Oncology, some women are more likely to develop endometrial hyperplasia than others. Common risk factors include:
You’re more likely to develop atypical endometrial hyperplasia if you have hormonal imbalances. The risk is higher for those taking the breast cancer medication tamoxifen or using hormone replacement therapy with estrogen alone.
In most cases, doctors find endometrial hyperplasia after you start showing symptoms. Many of these symptoms overlap with endometrial or uterine cancer and the beginning of menopause. Your doctor will likely order an ultrasound to look at your uterus and measure the endometrium. This will help them confirm or rule out the cause.
A transvaginal ultrasound uses a wand that’s inserted into the vagina up to the cervix. The doctor will measure different parts of the uterus. A normal endometrial thickness depends on whether you are still menstruating or have gone through menopause.
There are two types of endometrial hyperplasia: one with abnormal cells (called atypia) and one without.
In most cases, hyperplasia involves an overgrowth of normal cells. This is known as hyperplasia without atypia. The chances of endometrial cancer developing without atypia are lower.
Atypical hyperplasia happens when the cells in the lining of the uterus start to look and act abnormally. Doctors also call this condition endometrial intraepithelial neoplasia. It’s not cancer, but it can turn into endometrial cancer if it’s not treated. As these abnormal cells grow too close together, they can form groups called glands. This is called complex hyperplasia — a form of abnormal cell growth that’s considered an early warning sign of cancer.
If you have atypical endometrial hyperplasia, it’s more likely to develop into endometrial cancer.
Studies show that 25 percent to 40 percent of people diagnosed with severely atypical hyperplasia are later found to already have cancer when the uterus is removed. This is why it’s so important to diagnose and treat hyperplasia early. The chances of progressing to cancer are much lower than with mild or moderate atypia.
Some studies have investigated how likely it is that endometrial hyperplasia progresses to cancer. One report from the National Cancer Institute followed 138 women who eventually developed endometrial cancer. The authors found that those with atypical hyperplasia had an 8 percent chance of progressing to cancer within four years. The chances increased to 28 percent after 19 years.
In the study from the National Cancer Institute, overall, women with typical hyperplasia had a much lower risk of progression compared to those with atypical thickening. It’s important to remember that the information found in this study doesn’t apply to everyone, especially because it included only 138 women. Some women who have atypical hyperplasia may never go on to develop endometrial cancer. Your risk depends on your specific test results and how your cells look under a microscope.
If you’ve been diagnosed with endometrial hyperplasia, your doctor will order some tests to take a closer look. A hysteroscopy uses a long, thin tool with a light and a camera to look inside your uterus. The doctor, usually a gynecologist, performing the procedure may also choose to take a small tissue sample or an endometrial biopsy.
Another option is to perform a dilation and curettage (D&C). During this procedure, the doctor will dilate your cervix and use a special tool to take a sample of endometrial tissue. After either procedure, the samples will be sent to a laboratory to look for any changes. They might show atypical endometrial hyperplasia or potentially cancer.
Your treatment options depend on several factors, including:
For those who no longer want children, a hysterectomy is the preferred treatment. This procedure involves removing the uterus and cervix. Doctors usually recommend a hysterectomy for those with moderate or severe atypical hyperplasia. Since women with severely atypical cells often have undiagnosed endometrial cancer, oncology specialists at Atlanta Gynecology & Oncology feel that removing the uterus is the safest bet.
If you haven’t gone through menopause, are under 40, or still want to have children, you may not be advised to have a hysterectomy. Your doctor may recommend a D&C to remove the thickened endometrial lining. They may then prescribe the hormone therapy progestin to treat and even reverse atypical hyperplasia. Progestin therapy mimics the hormone progesterone to help shrink the thickened lining and reduce the risk of cancer.
Three months later, you’ll have a follow-up appointment during which your doctor will use an ultrasound to look at your uterus. They may also take a biopsy or perform another D&C. In some cases, surgery is necessary. If your endometrial hyperplasia is gone, your doctor will recommend birth control or other hormonal treatment plans.
It’s important to work closely with your doctor after an endometrial hyperplasia diagnosis. You’ll get answers to all of your questions to better understand your endometrial cancer risk. Together, you can determine the best next steps for your health. Don’t hesitate to ask for a second opinion. Another doctor may offer different insights or treatment options that better fit your needs.
MyEndometrialCancerTeam is the social network for people with endometrial cancer and their loved ones. On MyEndometrialCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with endometrial cancer.
Have you been diagnosed with endometrial hyperplasia? How has it affected your outlook? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
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