Did you know that hormonal changes during menopause can impact your health in ways you might not expect? One of the least discussed but highly important topics is endometrial hyperplasia, a condition in which the tissue lining the uterus grows larger than normal. Understanding this condition can help prevent complications and enable better health decisions. 

What is endometrial hyperplasia? 

Endometrial hyperplasia is a condition of the female reproductive system in which the endometrium, the tissue that lines the uterus, thickens more than normal due to an overgrowth of cells ^(1,2). If not properly treated, it can increase the risk of developing uterine cancer ⁽¹⁾.  

There are two main types ⁽¹⁾: 

- Non-atypical: the endometrial cells are thicker, but maintain their normal shape. 

- Atypical: the cells show abnormalities (they are “atypical”) and are more likely to develop into cancer. 

Hormonal changes in the development of endometrial hyperplasia 

Women with this condition often experience a hormonal imbalance, characterized by excess estrogen and insufficient progesterone ⁽²⁾. Estrogen promotes endometrial growth, while progesterone stabilizes the endometrium and prepares it for pregnancy. If pregnancy does not occur, progesterone triggers the shedding of the endometrium during menstruation ⁽⁴⁾. However, in this condition, low progesterone prevents this process, causing uncontrolled thickening of the endometrium ^(1,2).  

This condition is more common in women in perimenopause and menopause, when progesterone levels decrease and estrogen levels continue to fluctuate. As a result, the endometrium may continue to thicken uncontrollably, potentially leading to disorganized cell growth ⁽²⁾. 

Risk factors  

Any situation that increases estrogen levels favors the development of endometrial hyperplasia ⁽²⁾. Among the main risk factors are ^(1-3): 

Although this condition is not directly linked to the following issues, they can coexist with hyperplasia and require concurrent management: 

What are the symptoms of endometrial hyperplasia? 

Some women have no symptoms, and the condition is detected during a routine ultrasound. However, others may experience signs such as ^(1,2,3): 

Diagnostic methods and detection of endometrial hyperplasia 

If you have abnormal bleeding, it is important to consult a specialist. The most commonly used methods to diagnose endometrial hyperplasia are ^(1,2): 

Treatment options and follow-up for endometrial hyperplasia 

Treatment depends on the severity of the condition, the patient’s age, and their desire to preserve fertility ⁽¹⁾. Options include hormonal therapies and surgical procedures. Details are given below:  

Hormonal therapies  

Treatment with progestin (the synthetic version of progesterone) is a common option for balancing hormone levels and reducing endometrial thickness. This approach is ideal for women who wish to avoid surgery, especially if they plan to conceive in the future ^(1,2). 

Surgical alternatives (hysterectomy) 

In cases where hormone therapy has not worked, there is a high risk of cancer, or the woman does not wish to become pregnant in the future, a hysterectomy (removal of the uterus) may be recommended ^(1,2).  

Importance of continuous medical follow-up 

Women undergoing hormonal treatment should have an endometrial biopsy every six months until two consecutive normal results are achieved. In higher risk cases, once these results are achieved, it is suggested to continue with an annual biopsy to monitor the condition and detect possible changes in time ^(2,3). 

In summary, endometrial hyperplasia is a problem that should not be taken lightly. With timely diagnosis and appropriate treatment, it can be controlled, and the risk of complications can be reduced. If you experience irregular bleeding or any other type of discomfort, consult a specialist. 

By the way, if you notice that you have swollen feet, it could be related to varicose veins in the legs, and if you are exploring surgical options for the intimate area, you may be interested in learning more about vaginoplasty. 

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