Endometrial Hyperplasia: Symptoms, Risks, and Management

Endometrial hyperplasia

Hello Dr.
Chen: Recently, my menstrual cycle has been quite irregular, sometimes arriving early or late, and the amount of bleeding varies, with some cycles being longer.
This time, my period started on August 2 and has been intermittent with some blood clots until now, August 22.
I have already seen a doctor who prescribed me hemostatic and uterine contraction medications.
After taking them, my bleeding decreased, but once I stopped the medication, the bleeding resumed, and this time there were many blood clots, along with abdominal pain.
When I visited the doctor again, they prescribed similar hemostatic medications but mentioned that the endometrium might be too thick and shedding slowly.
Five years ago, I underwent a dilation and curettage (D&C) procedure for a similar condition, and the biopsy results were positive.
After that, I was diagnosed with fibroids during follow-up visits.
Occasionally, I experienced bleeding that lasted nearly a month, but it improved and stopped after medication.
However, this time there has been no improvement at all.
I would like to ask if endometrial hyperplasia can recur? If I do not want to undergo another D&C, what kind of care should I consider?

Wen Zizi, 40~49 year old female. Ask Date: 2023/08/23

Dr. Chen Zhiyu reply Obstetrics and Gynecology

It is recommended to follow up on the causes of endometrial hyperplasia in the outpatient setting, and please have the physician evaluate subsequent treatment options.
Thank you.

Reply Date: 2023/08/23

More Info

Understanding endometrial hyperplasia is crucial, especially for women experiencing irregular menstrual cycles, heavy bleeding, and associated symptoms. Endometrial hyperplasia refers to the thickening of the endometrium, the lining of the uterus, often due to an imbalance of estrogen and progesterone. This condition can manifest in various forms, including simple hyperplasia without atypia, complex hyperplasia without atypia, simple hyperplasia with atypia, and complex hyperplasia with atypia. The latter two types carry a higher risk of progressing to endometrial cancer.

In your case, the symptoms you describe—irregular menstrual cycles, prolonged bleeding, and the presence of blood clots—are concerning and warrant thorough evaluation. The fact that you have a history of endometrial scraping (d&C) and have been diagnosed with fibroids adds complexity to your situation. It is not uncommon for endometrial hyperplasia to recur, particularly if the underlying hormonal imbalance persists.
The management of endometrial hyperplasia often depends on the type and severity of the condition. For women with simple hyperplasia without atypia, hormonal treatment, such as progestin therapy, may be sufficient to regulate the menstrual cycle and reduce the thickness of the endometrium. However, in cases of complex hyperplasia with atypia, more aggressive treatment, including a hysterectomy, may be recommended, especially if there is a concern for cancer.

Given your history and current symptoms, it is essential to have a comprehensive evaluation by your healthcare provider. This may include imaging studies, such as an ultrasound, to assess the thickness of the endometrium and the presence of any abnormalities, as well as a possible repeat endometrial biopsy to rule out any progression to cancer.
If you wish to avoid another surgical procedure, there are several lifestyle modifications and management strategies you can consider:
1. Hormonal Therapy: Discuss with your doctor the possibility of hormonal treatments that can help regulate your menstrual cycle and reduce the risk of hyperplasia recurrence. This may include birth control pills or progestin therapy.

2. Regular Monitoring: Regular follow-up appointments with your gynecologist are crucial. This will allow for close monitoring of your symptoms and any changes in your endometrial lining.

3. Healthy Lifestyle: Maintaining a healthy weight, engaging in regular physical activity, and eating a balanced diet can help regulate hormones and may reduce the risk of hyperplasia.

4. Stress Management: High levels of stress can impact hormonal balance. Consider incorporating stress-reducing practices such as yoga, meditation, or other relaxation techniques into your routine.

5. Avoiding Certain Medications: Some medications can exacerbate bleeding or hormonal imbalances. Discuss with your doctor any medications you are currently taking to ensure they are not contributing to your symptoms.

6. Alternative Therapies: Some women find relief from heavy bleeding and menstrual irregularities through alternative therapies, such as acupuncture or herbal supplements. However, it is essential to consult with your healthcare provider before starting any new treatment.

In summary, endometrial hyperplasia can recur, especially if hormonal imbalances are not addressed. It is vital to work closely with your healthcare provider to monitor your condition and explore treatment options that align with your preferences and health goals. Regular follow-ups and proactive management can help mitigate symptoms and reduce the risk of complications.

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