Endometrial Hyperplasia: Causes, Symptoms & Fertility Impact

Introduction

Endometrial Hyperplasia is a gynaecological condition affecting women, where there is an abnormal thickening of the uterine lining. Studies suggest that hormonal changes, lifestyle factors, and prolonged exposure to certain hormones are possible causes, highlighting the need for immediate diagnosis for early treatment.

What is Endometrial Hyperplasia?

Endometrial Hyperplasia occurs when the lining of the uterus, which is called the endometrium, gets abnormally thick. The endometrium is the lining of the uterus that is shed during menstrual cycles and serves as the tissue where a fetus develops during pregnancy. This condition results in heavy and irregular bleeding. There are different types of Endometrial Hyperplasia, which are determined by the type of cell changes in one’s endometrium. Some endometrial hyperplasia puts you at a higher risk for cancer, while others don’t.

What are the Symptoms of Endometrial Hyperplasia?

The symptoms of endometrial hyperplasia often get mistaken for common menstrual or perimenopausal symptoms. However, be sure to consult a healthcare provider just to rule out endometrial hyperplasia. The symptoms one can experience are:

• Abnormal menstrual bleeding or bleeding between periods
• Short menstrual cycles (Less than 21 days)
• Heavy menstrual bleeding
• Bleeding after menopause
• Periods have stopped coming (Amenorrhea)

What are Some of the Risk Factors for Endometrial Hyperplasia?

Individuals in the perimenopause or menopause stage are at a higher risk of developing endometrial hyperplasia. It rarely occurs in people younger than 35. Other risk factors include:

• Certain breast cancer treatments: Especially treatments like tamoxifen.
• Diabetes and hypertension: Metabolic diseases that offset hormonal balance.
• Early age of menstruation or late onset of menopause: Increased exposure to hormones over time.
• Family history of ovarian, uterine, or colon cancer: Genetic predisposition can increase risk.
• Gallbladder disease: May influence hormonal metabolism.
• Hormone therapy: Using only estrogen when you still have a uterus.
• Never being pregnant or having Infertility: Due to low cycles of progesterone.
• Obesity: Excess body fat increases estrogen production.
• Polycystic ovary syndrome (PCOS): Results in chronic anovulation and hormonal imbalance.
• Smoking cigarettes: Poor overall reproductive health.
• Thyroid disease: Disrupts hormonal imbalance.
• History of pelvic irradiation: Radiation therapy around your pelvis.
• Compromised immune system: Due to autoimmune diseases and medications.

What Complications Can Endometrial Hyperplasia Cause?

Endometrial hyperplasia can cause a number of complications if left untreated, including:

• Endometrial Cancer: If atypia cells are present, there is a chance that cancer will develop.
• Extreme Bleeding: Anaemia or exhaustion may result from ongoing bleeding.
• Problems with Fertility: It may make it more difficult to conceive or sustain a pregnancy.
• Endometrial Problems: Chronic pelvic pain may result from endometrial thickening.
• Psychological Effects: Anxiety and depression may result from the fear of having cancer.

How Does Endometrial Hyperplasia Impact Fertility?

Endometrial Hyperplasia impacts fertility by hampering the normal ovulation process and implantation. Since the uterine lining is excessively thick, the embryo might find it hard to be implanted. This condition can also cause hormonal imbalance, due to low levels of progesterone, resulting in little to no chances of conceiving. In most cases, treatment can restore fertility and hormonal balance.

How is Endometrial Hyperplasia Diagnosed?

Early diagnosis can help prevent cancer risk in patients with endometrial hyperplasia. There are several ways to diagnose it:

• Transvaginal Ultrasound: In this procedure, sound waves are used to produce images of the uterus. This helps healthcare providers notice whether the lining is thick.
• Biopsy: It removes tissue samples from the uterine lining. Pathologists examine the samples to detect cancerous cells.
• Hysteroscopy: Hysteroscopy is a thin camera device used to view the uterus to identify abnormal areas more precisely.

What is the Treatment for Endometrial Hyperplasia?

The most commonly used treatment to manage endometrial hyperplasia is to take progestin. Progestin is the man-made hormone that is basically a synthetic version of progesterone. It comes in many forms:

• Oral Progesterone Therapy
• Intrauterine device
• Injection (Depo-Provera)
• Vaginal Cream or Gel

If the condition worsens, healthcare providers may prescribe a hysterectomy to remove the uterus, especially if:

• Complications occur or cancerous cells develop
• The condition doesn’t improve with progestin treatment

What Happens if Endometrial Hyperplasia is Left Untreated?

If the condition is left untreated, endometrial hyperplasia can lead to endometrial cancer, especially if atypia cells are present. Continuous abnormal bleeding can also lead to anaemia, fatigue, and poor quality of life. Chronic hormonal imbalance can disrupt reproductive health, resulting in infertility and other reproductive issues

Can One Prevent Endometrial Hyperplasia?

Unfortunately, endometrial hyperplasia cannot be fully prevented. However, the probability of getting endometrial hyperplasia can be vastly reduced by maintaining hormonal balance. This can be done by:

• Keeping track of ovulation and menstrual cycles
• Managing weight and blood sugar levels
• Taking contraceptives that contain progesterone but only when prescribed
• Visiting the gynaecologist for regular pelvic exams and check-ups

When to See the Doctor?

Individuals should consult their gynaecologist if they experience:

• Heavy or abnormal bleeding
• Menstrual bleeding after menopause
• Dysmenorrhea (Painful cramps)
• Dysuria (Painful urination)
• Painful intercourse (dyspareunia)
• Pelvic pain
• Abnormal vaginal discharge
• Frequently missing menstrual periods

Conclusion

Endometrial Hyperplasia requires timely diagnosis and treatment to lower the chances of complications, especially preventing it from progressing into endometrial cancer. Many individuals mistake the signs for normal menopausal symptoms. However, people should pay attention to their reproductive behaviour and seek medical advice if they notice anything unusual. As technology advances, it is easier to manage endometrial hyperplasia and maintain reproductive health. Early diagnosis, customised treatment, and regular follow-up are essential in the treatment of endometrial hyperplasia.