Endometrial hyperplasia happens when the lining of the uterus thickens due to a hormonal imbalance. This condition can cause symptoms like heavy menstrual periods, spotting, and bleeding after menopause.
Certain conditions that lead to an excess of the hormone estrogen can increase the risk of developing endometrial hyperplasia. Depending on how severe the condition is, treatment options may include monitoring, addressing specific risk factors, medications, or surgery.
This article will cover the symptoms, causes, and risk factors of endometrial hyperplasia, along with how it's diagnosed and treated.
Types of Endometrial Hyperplasia
There are two types of Endometrial hyperplasia:
- Atypical hyperplasia, which involves abnormal cells in the endometrium.
- Hyperplasia without atypia, which involves normal endometrial cells.
Both types can raise the risk of developing endometrial cancer, but the risk is higher if the endometrial cells are abnormal.
What Are the Symptoms of Endometrial Hyperplasia?
Endometrial hyperplasia can lead to abnormal uterine bleeding, which might include:
- Heavier than usual menstrual bleeding
- Bleeding or spotting between periods
- Bleeding after menopause
When to Contact Your Healthcare Provider
Reach out to your healthcare provider if you:
- Have pelvic pain or cramping when you're not on your period
- Experience any abnormal uterine bleeding (whether or not you have lower back pain*)
- Feel weak or faint due to heavy uterine bleeding
- Have a fever along with abnormal uterine bleeding
- Notice worsening or more frequent symptoms
- Bleed after intercourse
*Endometrial hyperplasia is not linked to back pain, but endometrial cancer can be.
What Causes Endometrial Hyperplasia?
Endometrial hyperplasia is caused by a hormonal imbalance, specifically an excess of estrogen compared to progesterone. Estrogen normally causes the endometrium to thicken during the first half of the menstrual cycle. When balanced with progesterone, the endometrium thickens and then thins out. However, if there is too much estrogen, the lining is overstimulated and keeps thickening, which can eventually lead to abnormal changes.
What Are the Risk Factors of Endometrial Hyperplasia?
Conditions that can lead to excess estrogen and result in endometrial hyperplasia include:
- Obesity
- Anovulation (lack of ovulation) caused by perimenopause or polycystic ovarian syndrome (PCOS)
- Taking hormones like estrogen replacement therapy or tamoxifen, a drug used to treat certain breast cancers
- Hormone-producing tumors
Obesity
Fat tissue converts other hormones into estrogen, creating extra estrogen that stimulates the lining of the uterus in addition to the normal estrogen produced by your ovaries. If your BMI is over 35, your risk of developing endometrial hyperplasia is significantly higher.
Anovulation
Anovulation occurs when an egg is not released from your ovaries, which means your ovaries don't increase progesterone production. This increase is necessary for the uterine lining to shed, meaning you won't get your period. In anovulatory cycles, there can be too much estrogen compared to progesterone, causing the endometrium to thicken abnormally and eventually leading to abnormal uterine bleeding. This can result in irregular and heavy periods or bleeding between periods. Common causes of this hormonal imbalance include:
- Perimenopause, the stage leading up to menopause
- Polycystic ovarian syndrome (PCOS), which causes the ovaries to produce excess male hormones or androgens
Taking Hormones
Hormonal medications or therapies can increase estrogen levels relative to progesterone. For example, estrogen replacement therapy requires taking progestin (progesterone) if you still have a uterus to prevent overstimulation of the endometrium.
Tamoxifen, a selective estrogen receptor modulator (SERM), is another medication that can cause abnormal endometrial thickening. It is used to treat hormone-sensitive breast cancers by opposing estrogen's effects in breast tissue. However, in the uterus, tamoxifen acts like estrogen and can stimulate the endometrial lining, potentially leading to endometrial hyperplasia.
Estrogen-Producing Ovarian Tumors
Hormone-producing tumors are not a common cause of endometrial hyperplasia, but certain (usually benign) ovarian tumors can produce excess estrogen.
How Is Endometrial Hyperplasia Diagnosed?
To diagnose endometrial hyperplasia and rule out other causes of abnormal uterine bleeding, your healthcare provider may order several tests, including:
- Endometrial biopsy: In this quick procedure, your healthcare provider removes a small amount of tissue from the endometrium, which might cause some cramping and discomfort. The tissue is then examined under a microscope for abnormal cells.
- Hysteroscopy: This same-day surgical procedure allows your healthcare provider to directly observe the lining of the uterus and ensures all areas of the endometrium are properly sampled.
- Transvaginal pelvic ultrasound: This imaging procedure uses sound waves to produce images of the pelvic cavity and its organs, helping to rule out other causes of abnormal bleeding.
- Blood tests: These tests may be used to rule out other causes of abnormal bleeding, although blood tests cannot diagnose endometrial hyperplasia.
Home Remedies for Endometrial Hyperplasia
Heat
If your symptoms are flaring up and you need relief, heat can help. It relaxes the pelvic muscles, reducing cramping and pain. You can use warm baths, hot water bottles, or heating pads to ease the discomfort.
Bromelain
Bromelain is an enzyme found in pineapples and is available as a supplement. Some studies have shown that bromelain, when combined with N-acetyl cysteine and the antioxidant alpha-lipoic acid, can significantly reduce pelvic pain from endometriosis. However, more research is needed to understand bromelain's effects on endometriosis alone. Before trying bromelain supplements, consult your doctor as they may interact with other medications.
Turmeric
Turmeric has strong anti-inflammatory properties that might benefit those experiencing endometriosis symptoms. Some research suggests that curcumin, a compound in turmeric, may reduce endometriosis pain by reducing inflammation and inhibiting the development of endometriosis. You can take turmeric capsules or make turmeric tea using turmeric root or tea bags. Be sure to talk with your doctor before starting turmeric or any new supplements.
Anti-inflammatory Foods
While more research is needed on diet’s effects on endometriosis, some studies indicate that an anti-inflammatory diet may help reduce pain over time. This approach won't provide immediate symptom relief but could help manage endometriosis in the long term.
To reduce symptoms in the future, try avoiding inflammatory foods like dairy, red meat, and fried foods, and increasing your intake of anti-inflammatory foods such as:
- Green tea
- Fatty fish
- Green leafy vegetables
- Berries
- Cherries
- Walnuts
- Olive oil
- Spices
Ginger Tea
Some people with endometriosis experience nausea due to the condition. Ginger tea is a well-known home remedy for treating nausea, and research has consistently shown that it’s both safe and effective.
You can find ginger tea packets at many supermarkets and grocery stores. When you’re feeling nauseous, simply add a packet to a cup of boiling water, let it steep, and then drink.
Key Takeaways:
Using heat therapy, such as warm baths or heating pads, can ease pelvic pain and cramping associated with endometriosis. Supplements like bromelain and turmeric may offer relief from symptoms, but it’s crucial to consult your doctor before starting them. Additionally, adopting an anti-inflammatory diet rich in foods like green tea, fatty fish, and berries while avoiding dairy and red meat could help manage symptoms long-term. Lastly, ginger tea is a safe and effective remedy for nausea commonly experienced with endometriosis, readily available at supermarkets and grocery stores.