How is endometrial hyperplasia treated?

Hyperplasia means the lining of the womb has become thicker than expected. An endometrial biopsy checks the cells and helps distinguish hyperplasia without atypia from hyperplasia with atypia, which has a greater concern for developing into womb cancer. Heavy periods and bleeding after menopause are symptoms that need assessment, but they do not by themselves establish the cause.

A hormonal coil releases progesterone inside the womb and may be used to thin the lining. Progesterone tablets are another option. Follow-up biopsies or imaging may be arranged to see how the lining responds. If atypical cells are found, fertility is not a priority, or medical treatment is unsuccessful, removal of the womb may be discussed. Radical hysterectomy is a different, more extensive operation generally used for selected cancers.

Keep a record of bleeding, pain and any medicines you take. Ask how the biopsy result changes the plan, when repeat sampling is needed, and whether treatment affects fertility or contraception. Do not stop progesterone without discussing it with the prescriber. Review conditions such as irregular ovulation or medicines that may influence the womb lining with your clinician.

Seek medical review for new or worsening heavy periods, bleeding between periods, or any bleeding after menopause. Get urgent help if bleeding makes you faint, causes marked weakness, or comes with severe pelvic pain. After a procedure, fever, increasing pain or foul-smelling discharge should be reported promptly.

Did my biopsy show atypia? How long should progesterone treatment continue? When will the next biopsy be needed? Can I try for pregnancy during treatment? What would make surgery the safer option?