What are the other Names for this Condition? (Also known as/Synonyms)

• Complex Non-Typical Endometrial Hyperplasia
• Endometrial Hyperplasia without Atypia
• Simple Non-Typical Endometrial Hyperplasia

What is Benign Endometrial Hyperplasia? (Definition/Background Information)

• Benign Endometrial Hyperplasia is a condition that occurs in the endometrium due to an abnormally increased growth of the endometrial glands. It results in an uncharacteristic thickening of the endometrium (lining of the uterus)
• The condition is also known as Endometrial Hyperplasia without Atypia. It generally occurs due to long-term exposure to estrogen hormone that is not counterbalanced by progesterone hormone (a condition described as unopposed estrogen stimulation)
• A majority of Benign Endometrial Hyperplasia cases are seen in women following menopause. The risk factors for the condition include obesity, polycystic ovarian syndrome, and treatment for breast cancer using the drug tamoxifen
• Benign Endometrial Hyperplasia can lead to signs and symptoms, such as abnormal vaginal bleeding/discharge, and the presence of a polypoid mass in the endometrium
• The most important and significant complication of Benign Endometrial Hyperplasia is that it portends a high risk for endometrial carcinoma (sometimes, as high as 10 times)
• A treatment may be undertaken for the underlying cause of Benign Endometrial Hyperplasia, as required. The prognosis is related to the underlying cause and its treatment

Who gets Benign Endometrial Hyperplasia? (Age and Sex Distribution)

• Benign Endometrial Hyperplasia is a condition observed in adult women around and after the age of 35-40 years
• A majority of cases are generally noted in postmenopausal women (women above 48-50 years)
• No racial or ethnic group predilection is observed, although Caucasians are at a higher risk for some unknown reason

What are the Risk Factors for Benign Endometrial Hyperplasia? (Predisposing Factors)

The risk factors for Benign Endometrial Hyperplasia may include the following conditions:

• Women on unopposed estrogen therapy
• Postmenopausal status in women
• Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 years have an elevated risk. The longer the duration between menarche and menopause, the greater is the risk. This is due to hormonal influences during the reproductive period on the endometrial tissue
• Obesity and/or poorly-controlled diabetes
• Polycystic ovarian syndrome (PCOS): Polycystic ovarian syndrome is a condition in which women’s hormones are out of balance. This can lead to irregular menstrual periods that increases the risk
• Disorders affecting the thyroid gland and gallbladder
• A positive family history of cancer of the ovary, uterus, or large intestine (colon)
• Ovarian cancer; some ovarian tumors are known to secrete estrogen
• Breast cancer treatment with drug tamoxifen
• Infertility
• Nulliparous women: Women who have never been pregnant have an increased risk for endometrial hyperplasia, than women who have had at least one or more pregnancies
• Chronic smoking

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Benign Endometrial Hyperplasia? (Etiology)

• Benign Endometrial Hyperplasia is an abnormal overgrowth of the endometrium that is usually caused by hormonal effects
• It typically occurs due to long-term exposure to estrogen that is not counterbalanced by sufficient progesterone (a condition termed unopposed estrogen stimulation)
• This can occur when ovulation is not regular, due to irregular periods, or when periods stop completely following menopause. A stoppage of ovulation or erratic ovulation, stops or decreases the quantity of progesterone produced in the body causing unopposed estrogen effect
• The hyperplasia due to proliferation of endometrial glands, depends upon the dosage of estrogen and the time length of exposure

What are the Signs and Symptoms of Benign Endometrial Hyperplasia?

On examination of the uterine corpus, the healthcare provider may observe the following features of Benign Endometrial Hyperplasia:

• Abnormally increased growth of endometrial glands; though, cell changes are not noted
• An abnormal thickening of the endometrium (uterine lining) is noted. Normally it is 5 mm thick, however with endometrial hyperplasia the endometrium is abnormally thicker
• The hyperplasia may appear like a polyp or may be spongy-surfaced

The signs and symptoms associated with Benign Endometrial Hyperplasia may include:

• Abnormal bleeding from the uterus that does not match with menstrual cycle
• Heavy or prolonged bleeding during periods; short menstrual periods less than 21 days
• Postmenopausal bleeding
• Vaginal discharge

How is Benign Endometrial Hyperplasia Diagnosed?

Benign Endometrial Hyperplasia is diagnosed by a pathologist on examination of endometrial tissue under a microscope. This can be established through the following procedures:

• A detailed medical history evaluation followed by a physical and pelvic exam is undertaken
• Ultrasound scan of the pelvis: It is a noninvasive procedure that uses high frequency sound waves to produce real-time images
• Transvaginal ultrasound: Transvaginal ultrasound inserts an ultrasound probe into the vagina designed to take pictures of the insides of the uterus
• Abdominal and pelvic CT scan: It is a noninvasive procedure that provides more details of soft tissues, blood vessels, and internal organs
• Pelvic MRI scan: It is a noninvasive medical test that uses a powerful magnetic field to produce images of soft tissues, bones, organs, and all other internal structures of the abdomen and pelvis
• Hysteroscopy: This procedure involves placing a probe through the cervix to examine the cavity of the uterus
• Hysterosalpingography: It is usually performed in individuals with infertility. In this procedure, the structure of the uterus and fallopian tubes are studied by using a dye and X-ray images

Tissue biopsy:

• An endometrial tissue biopsy is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Benign Endometrial Hyperplasia?

• The main complication associated with Benign Endometrial Hyperplasia is an increased risk for endometrial carcinoma. The condition can cause the development of endometrial cancer in 1-3% of women
• It has been researched that there is a 3-4 times higher risk for cancer in women undergoing unopposed estrogen therapy. If the therapy is continued for 10 years or more, the risk factor increases 10 fold
• Complications associated with the underlying condition may be noted

How is Benign Endometrial Hyperplasia Treated?

Benign Endometrial Hyperplasia is caused by various conditions. The treatment depends upon the underlying cause of the condition.

• In many cases, the treatment involves hormonal manipulation (restoring any hormonal imbalance in the body)
• Any source of unopposed estrogen should be removed:
  • If the source of unopposed estrogen is an ovarian tumor, then surgical removal of the tumor may be undertaken
  • In some women, a balanced progesterone and estrogen therapy/treatment may mitigate any unopposed estrogen status
• Undertaking suitable treatment for obesity and diabetes through suitable medications, proper diet control, and weight loss programs (if necessary)
• Avoid or completely stop smoking
• Follow-up care with regular screening and check-ups are important and encouraged

How can Benign Endometrial Hyperplasia be Prevented?

Currently, there are no known and available methods to prevent Benign Endometrial Hyperplasia. However, various steps may be taken to help decrease the incidence risk:

• Avoid obesity: Individuals with higher physical activity levels have a decreased risk
• Avoid or completely stop smoking
• Combination of oral contraceptives: Taking a combination of oral contraceptives, such as estrogen and progestin, can help decrease the risk
• Undertake adequate early treatment for polycystic ovarian syndrome and other related disorders
• Medical screening at regular intervals with scans and physical examinations are advised

What is the Prognosis of Benign Endometrial Hyperplasia? (Outcomes/Resolutions)

Benign Endometrial Hyperplasia by itself does not indicate a medical condition. However, the reason for hyperplasia may be of clinical significance and may need to be investigated and addressed further.

• The risk for endometrial cancer is high-to-very-high in women with Benign Endometrial Hyperplasia. Hence, adequate treatment and long-term follow-up measures are advocated
• The prognosis of Benign Endometrial Hyperplasia depends upon the underlying condition causing it. It also depends upon the individual’s response to treatment. Those who respond positively to treatment, have better outcomes
• If the condition is caused by a malignant ovarian tumor, then the outcome is dictated by the stage and other parameters involving the ovarian cancer
• The outcome also depends upon the duration of unopposed estrogen activity. The longer the duration of estrogen activity, the greater is the risk for endometrial cancer, which can complicate the prognosis

Additional and Relevant Useful Information for Benign Endometrial Hyperplasia:

• Endometrial cancer is a type of cancer that begins in the lining of the uterus (the endometrium). The majority of endometrial cancer cases are detected and diagnosed in women aged 50 years and older

The following link can help you understand endometrial cancer:

http://www.dovemed.com/diseases-conditions/endometrial-cancer/