Endometrial Hyperplasia is the excessive growth of the layer lining the inner wall of the uterus (endometrium), commonly referred to as uterine thickening. This condition does not mean that the person has cancer, nor is it something to be considered insignificant or ignored.
What Symptoms Suggest Endometrial Hyperplasia?
One of the most common complaints encountered in clinics is menstrual changes. Individuals report that the amount of menstrual flow has increased, as well as the duration of menstruation. Inability to menstruate for an extended period and having more than 40 days between menstrual cycles are also frequent complaints.
In Whom Does Endometrial Hyperplasia Occur?
Endometrial Hyperplasia can occur in all age groups that experience menstruation, but there are some defined risk factors for this condition:
a. Perimenarchal period (the first years of menstruation)
b. Perimenopausal period (the last years of menstruation)
c. Polycystic ovary patients
d. Those undergoing treatment for infertility
e. Obesity
f. Those receiving Hormone Replacement Therapy (HRT)
g. Those using the medication tamoxifen due to breast cancer
h. Patients with diabetes and hypertension
i. Individuals with estrogen-secreting tumors
How Is Endometrial Hyperplasia Diagnosed?
Following the patient's visit with complaints, if the individual's medical history indicates risk factors for Endometrial Hyperplasia, a diagnosis can be easily made through an abdominal or vaginal ultrasonographic examination. After diagnosis, we can categorize the biopsy procedures based on the patient's condition into three types:
Pipel biopsy (for patients of reproductive age)
Dilatation and curettage biopsy (for postmenopausal patients)
Hysteroscopy biopsy (for patients who also wish to conceive)
Regardless of the type of biopsy performed, it is crucial to ensure that samples are taken from all four regions of the uterine lining. Biopsies that do not sample all four regions may provide incomplete information and can lead to inadequate treatment or surgery. Anesthesia can be used during the biopsy based on the patient's request, but performing the procedure under sedation tends to yield better comfort and safety outcomes.
What Is the Relationship Between Endometrial Hyperplasia and Endometrial Cancer?
The risk of progression to uterine cancer varies by type of Endometrial Hyperplasia:
- Simple non-atypical hyperplasia: 1%
- Complex non-atypical hyperplasia: 3%
- Simple atypical hyperplasia: 8%
- Complex atypical hyperplasia: 29%
As seen, there is a risk of Endometrial Cancer present in all types of Endometrial Hyperplasia, and diagnosed patients should be monitored and treated accordingly.
How Should Endometrial Hyperplasia Be Treated?
The treatment for patients diagnosed with Endometrial Hyperplasia depends on their age group, desire to have children, and the pathological classification of the Endometrial Hyperplasia.
For patients of reproductive age who can attend regular check-ups, progestin-containing birth control pills may be prescribed. For individuals of reproductive age who do not wish to have children, a hormone-containing IUD may be used. For patients at the end of their reproductive years who do not desire or plan for children, TAH+BSO (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy) may be performed.
