Endometrial Hyperplasia

Endometrial hyperplasia is a thickening of the womb lining that needs assessment to identify its type and guide care.

It can develop when this lining is exposed to oestrogen without enough progesterone to balance its effect. A sample of the lining can show whether the cells look typical or atypical; that distinction helps the gynaecology team plan follow-up and treatment.

Heavy or longer periods can be a common presentation of endometrial hyperplasia. Bleeding after menopause is also a very common presentation. Spotting between periods, cycles that become less predictable, or bleeding that resumes after menopause should be assessed promptly, particularly if the pattern is new or continuing.

The lining normally grows and sheds in response to changing hormones. When ovulation does not occur regularly, progesterone may be lower and the lining may keep building up. Hormone medicines, ovarian hormone production, and conditions that affect ovulation can also be relevant. The cause is considered alongside the tissue result rather than from bleeding alone.

Some forms settle when the hormonal environment changes or with progesterone-based treatment. Other forms need closer surveillance because atypical cells can be associated with a greater concern for future womb cancer. Follow-up is tailored to the biopsy result, symptoms, reproductive plans and response to treatment.

Relevant factors can include irregular ovulation, higher body weight, insulin resistance, menopause, and use of medicines that act like oestrogen on the womb lining. Previous bleeding patterns and any hormone treatment are also useful details. Having a factor does not establish a diagnosis; it helps shape the assessment.

A clinician will ask about bleeding, medicines and medical history, then may arrange an ultrasound to look at the womb. An endometrial biopsy collects a small tissue sample for laboratory examination. Sometimes a camera examination of the womb is used to target an area of concern or to investigate a sample that did not answer the question.

Treatment may involve progesterone tablets or a hormonal coil, with repeat sampling to check whether the lining has responded. Hysterectomy may be discussed when atypia is present, hyperplasia persists, bleeding remains troublesome, or pregnancy is no longer planned. The team will explain how each option affects fertility, recovery and monitoring.

Keep a simple record of bleeding days, flow changes and any treatment side effects. Bring a current list of medicines and supplements to appointments. If treatment is intended to preserve the womb, attending planned checks matters because symptoms alone cannot show how the cells have changed.

Ongoing heavy bleeding can contribute to tiredness and iron deficiency. Atypical hyperplasia needs careful specialist discussion because it can exist alongside womb cancer or progress over time. This does not mean that every case becomes cancer, but it is the reason tissue findings and follow-up are taken seriously.

There is no single way to prevent every case. Managing conditions that affect ovulation, reviewing hormone medicines with a clinician, and reporting new bleeding patterns can support earlier assessment. Do not stop prescribed hormones suddenly; ask the prescriber how changes may affect the womb lining.

A gynaecologist can interpret the biopsy result and discuss medical treatment or surgery. Seek urgent assessment for very heavy bleeding, dizziness, fainting, or severe pelvic pain. For postmenopausal bleeding, arrange a medical review even if the bleeding is light or stops.