What is endometrial hyperplasia?

Endometrial hyperplasia is a pathological thickening of the uterine lining (endometrium) due to excessive proliferation of glands and stroma.
It is a benign condition but may represent a precancerous state, particularly in the presence of atypia.

Causes and risk factors

It develops under prolonged estrogen stimulation with relative or absolute progesterone deficiency.

Risk factors include:
•    Anovulatory cycles, including PCOS
•    Obesity and metabolic syndrome
•    Long-term estrogen-only HRT
•    Hormone-producing tumors (e.g., granulosa cell tumor of the ovary)
•    Diabetes mellitus
•    Nulliparity
•    Family history (genetic predisposition)

Types and classification

Two main forms are distinguished:
•    Endometrial hyperplasia without atypia – Increased gland number without significant structural changes; low risk of malignancy.
•    Endometrial hyperplasia with atypia – Higher risk of progression to endometrial cancer.

Key symptoms
•    Acyclic uterine bleeding
•    Prolonged or heavy menstruation
•    Irregular menstrual cycles
•    Postmenopausal bleeding
•    Infertility
•    Signs of anemia (fatigue, dizziness)
Sometimes asymptomatic and detected incidentally by ultrasound or biopsy.

Diagnosis

Essential methods:
•    Transvaginal ultrasound — assessment of endometrial thickness (M-mode)
•    Endometrial Pipelle biopsy or
•    Hysteroscopy with dilation and curettage (gold standard)
In postmenopausal women, endometrial thickness >4 mm with bleeding requires exclusion of hyperplasia or cancer.

Treatment

Treatment depends on the type of hyperplasia, patient's age, and reproductive plans.

Conservative treatment:
•    Hormonal therapy (oral forms or levonorgestrel-releasing intrauterine device)
•    Dynamic follow-up with repeat biopsies

Surgical treatment:
•    Hysterectomy — for selected indications

Complications and prevention

Possible complications:
•    Malignant transformation (especially with atypia)
•    Chronic blood loss → anemia
•    Infertility

Prevention:
•    Weight control, correction of metabolic disorders
•    Rational use of HRT
•    Routine gynecological exams and pelvic ultrasound
•    Management of anovulation (e.g., in PCOS)

Hyperplasia and pregnancy

Hyperplasia can impair embryo implantation.
Successful pregnancy is possible after appropriate treatment and restoration of normal endometrial structure.

When to see a doctor?

Consult a gynecologist if you experience:
•    Bleeding outside of menstruation
•    Heavy or irregular periods
•    Postmenopausal spotting
•    Infertility or repeated IVF failures
•    Endometrial thickness that doesn’t correspond to cycle phase (by ultrasound)
 

Karina Tonoyan, Gynecologist

Karina Tonoyan, Obstetrician-gynecologist

 

Education

 

• Faculty of Medicine of Yerevan State Medical University named after Mkhitar Heratsi
• Clinical residency in obstetrics and gynecology at the Altai State Medical University, 2020
• Ultrasound diagnosis, 2022, Barnaul
• Gynecological endocrinology, 2024, Moscow

 

Professional activity

• Maternity hospital No. 2, Barnaul, 2020-2022
• Hospital of urgent treatment, Barnaul, 2020-2022
• "VitaMed" Medical Center, Yerevan, 2022

 

Conferences

 

• "Unresolved problems of diagnosis, treatment and recovery in obstetrics and gynecology" scientific conference
• "Antibacterial therapy in obstetrics: controversial issues" scientific conference
• "Principles of diagnosis and treatment of non-infectious diseases of the anogenital area" scientific conference

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