Endometrial Hyperplasia Without Atypia
What is Endometrial Hyperplasia Without Atypia (EH)?
Endometrial hyperplasia is a condition where the lining of the uterus/womb (endometrium) grows excessively. It is not cancer. However, EH can lead to cancer of the lining of uterus (endometrial cancer) in a small portion of women.
What are the symptoms?
- Vaginal bleeding after the menopause
- Abnormal vaginal bleeding before the menopause.
What are the risk factors?
Endometrial hyperplasia is often caused by an excess of the hormone oestrogen. This can be caused by:
- Obesity (fat tissue can convert other hormones into oestrogen).
- Use of Hormone Replacement Therapy (HRT) with no or too little progesterone. If you have not had a hysterectomy (removal of your uterus), your HRT should contain both oestrogen and progesterone.
- Tamoxifen use
- Polycystic Ovarian Syndrome (PCOS) – a condition that can cause irregular menstrual periods, infertility and obesity.
- Rarely, some ovarian tumours can cause high oestrogen levels, for example granulosa cell tumours.
- In some cases, none of these risk factors exist and the cause is unknown.
You are also more likely to develop EH if:
- If you are 35 years of age or older.
- Never had children.
- You are in transitional time before your menopause (perimenopause).
- You have already reached or gone pass the menopause (post-menopause).
- You were 55 years of age or older when you reached the menopause.
- You started your periods at an early age (before 12 years).
- You have Diabetes Mellitus (Type 1 or Type 2) or/and hypertension.
- You have a family history of womb, bowel, or ovarian cancer.
How is it diagnosed?
EH is diagnosed through biopsy of the endometrium. The following tests may also be involved in diagnosis:
- Ultrasound Scan
- Hysteroscopy
- MRI scan
Risk of developing into cancer
If left untreated, EH can develop into endometrial hyperplasia with atypia and endometrial cancer. The exact risk depends on the individual patient’s circumstances/risk factors. EH progressing to endometrial cancer is less than 5% over 20 years. The majority of cases of endometrial hyperplasia without atypia will regress spontaneously.
How is endometrial hyperplasia without atypia treated?
- You will be offered Mirena coil (first line recommendation, small progesterone implant, placed into the uterus)
- If you are unable to have the coil, treatment with oral progesterone is recommended (second line recommendation).
- Treatment with Mirena coil or oral progesterone is known to have 89-96% regression rate.
- You may be asked to stop your HRT and to reduce your weight/body mass index.
- Watch and wait/conservative approach has about 75% chance of natural regression. You will still be recommended to complete surveillance and 6 monthly endometrial biopsies. This may be appropriate for women who can alter their risk factors (for example, by loosing weight or stopping HRT)
Follow up:
Further surveillance will be arranged, depending on your individual risk factors.Normally, you will have 6 monthly hysteroscopy and biopsy until regression is achieved.
What if I wish to have children?
If you are diagnosed with EH and wish to start a family, you will be recommended to undergo the treatment for EH first and ensure regression is achieved.
Contact information: If you have any further questions, please contact hysteroscopy service on chelwest.oph@nhs.net or speak to your GP.
Contact information
FOR ANY MEDICAL EMERGENCIES PLEASE CONTACT NHS 111 OR ATTEND YOUR NEAREST EMERGENCY DEPARTMENT.
If you need to re-schedule your appointment please, ring 24 hours before your appointment to inform our admin team: 0203 315 6666.
Alternatively, you can email chelwest.oph@nhs.net
Patient Advice & Liaison Service (PALS)
If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office in the main atrium or you can complete a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.
WMUH: 020 8321 6261; wmpals@chelwest.nhs.uk
C&W: 020 3315 6727; cwpals@chelwest.nhs.uk
Useful contacts
If you any have questions before or after you leave, any member of the team will be happy to discuss these with you – do ask us.
The RCOG information leaflet will also provide more information: