What is endometrial hyperplasia with atypia?
Is Endometrial Hyperplasia a serious disorder and problem?
What do you know about endometrial hyperplasia?
If endometrial hyperplasia has been reported for you, we recommend that you read the following.
In this article, we intend to provide comprehensive information about endometrial hyperplasia with atypia.
First let’s see what is meant by endometrial hyperplasia and what conditions do doctors call endometrial hyperplasia?
If you or your friends are experiencing unusual vaginal bleeding, we will talk about one of the conditions that causes abnormal female bleeding.
What is meant by endometrial hyperplasia?
It is better to first see what endometrial hyperplasia means
Doctors call this condition hyperplasia of a tissue when the cells of a tissue have abnormally proliferating, that is, if the number of cells in a tissue increases abnormally.
The endometrium is the inner layer that covers the uterus. So now you can tell for yourself what endometrial hyperplasia refers to.
Yes, increased endometrial proliferation is called endometrial hyperplasia.
What is the endometrial layer of the uterus and what is its role?
If we look at the walls of the uterus from the inside of a non-menopausal woman, the coating we see on the wall is called endometrial layer by doctors.
What is the function of the endometrial layer?
In postmenopausal women, this layer is removed and excreted every month during menstrual bleeding. In fact, it is the shedding and excretion of endometrial cells forms menstrual bleeding.
How does this cycle and endometrial shedding occur?
Doctors say that the hormone estrogen in women causes the endometrial cells to increase in number and stack up like bricks, but between these bricks there must be a material that sticks them together. This material is the same hormone as progesterone.
So by the time of ovulation, which is in the middle of the cycle, the number of these cells, that is, the number of endometrial cells under estrogen increases, and the endometrium thickens to be ready for pregnancy.
With the onset of ovulation, estrogen levels fall and progesterone levels rise in the last fourteen days of the menstrual cycle. In fact, progesterone prepares the uterine wall to receive the product of pregnancy, and in fact, like mortar, it strengthens these proliferating cells. If you do not get pregnant, estrogen and progesterone fall and the beginning of a new cycle and the fall of endometrial cells and vaginal bleeding begin
After complete loss of endometrial cells during vaginal bleeding, the above cycle will resume.
What happens in endometrial hyperplasia?
In endometrial hyperplasia, the proliferation of cells in the inner layer of the uterine wall occurs excessively. The proliferation of these cells has increased to such an extent that the endometrial layer has become too thick.
Endometrial hyperplasia presents with unusual vaginal bleeding.
Endometrial hyperplasia is considered the beginning of uterine progression to cancer.
Diagnosis of endometrial hyperplasia, as well as diagnosis of endometrial hyperplasia and timely treatment, which will usually be successful, will prevent a person from developing uterine cancer, which is a common tumor in postmenopausal women.
What are the types of endometrial hyperplasia?
Before studying the types of endometrial hyperplasia, it is necessary to pay attention to the following explanation.
If endometrial tissue cells that have proliferated under the microscope have the characteristics of a normal endometrial cell, it is a typical cell And if they have abnormal properties, it is called atypical cell.
The terms typical and atypical, respectively, refer to the normal or abnormal characteristics of endometrial cells in tissue with hyperplasia.
Now it is better to know the types of endometrial hyperplasia
- Endometrial hyperplasia without atypia:
That is, the inner lining of the uterine wall (endometrium) has increased in thickness due to the proliferation of cells
But all these cells are completely normal and have the normal structure of a normal and healthy endometrial cell. Doctors say that in some cases, the process of abnormal proliferation in atypical endometrial hyperplasia may stop spontaneously without the need for treatment.
Sometimes it is necessary for the doctor to prescribe medication to stop the abnormal proliferation.
But basically these conditions, endometrial hyperplasia, without atypia are unlikely to turn into cancer.
- Endometrial hyperplasia with atypia:
That is, the inner lining of the uterine wall (endometrium) has increased in thickness due to the proliferation of cells, but these cells do not have the normal structure of a normal and healthy endometrial cell. These proliferating cells have unusual and abnormal properties and structures
Doctors say that if these types of hyperplasias are not diagnosed and treated in time, they are more likely to progress to cancer over time.
Atypical endometrial hyperplasia is the precursor to the most common gynecological cancer in women, (uterine cancer.)
Each year, 200,000 cases are diagnosed in Western societies with endometrial hyperplasia.
- New cases of simple endometrial hyperplasia
- For every one hundred thousand women, one hundred and forty-two
For every one hundred thousand women, two hundred and thirteen
The age range of affected women was in their early fifties
Incidence of new cases of endometrial hyperplasia with an annual atypia of fifty-six per 100,000 women
The age range of affected women was in their early sixties
Aging has been a factor in the development of endometrial hyperplasia with atypia
(The above statistics according to the most authoritative studies in the years 1995-2014)
What are the risk factors for endometrial hyperplasia?
- Increasing age
- Menstruation at a young age
- Delayed menopause
- Lack of experience of pregnancy and childbirth
- Polycystic ovary syndrome
- Being obese
(In general, X syndrome or metabolic syndrome)
- Have a history of taking Tamoxifen
- Having a history of estrogen intake alone
- Having a family history of the following cancers
- Endometrial cancer
- Breast cancer
- Ovarian cancer
- Colon cancers
- Estrogen-producing tumors
- Lynch syndrome
Why does endometrial hyperplasia occur?
Doctors consider the most important factor to be the exposure of the uterine endometrium to estrogen.
We mentioned above that estrogen plays an role in increasing the number of endometrial cells, or the walls of the uterus, so girls who menstruate at a young age or women who menopause late will have more exposure to estrogen in their uterus.
Women with polycystic ovary syndrome who have periods of non-menstruation will also be exposed to long-term estrogen exposure.
Absence of chronic ovulation such as PCOS and obesity and in general metabolic syndrome and insulin resistance and menopause will be more cases of uterine exposure to estrogen.
A person may receive extra estrogen from the outside, for example estrogen therapy alone in HRT procedures.
Or taking a drug such as tamoxifen that has the same effect as estrogen on endometrial cells
In all of the above, there are risk factors for uterine cancer
Doctors say the prevalence of uterine hyperplasia is three times higher than the prevalence of endometrial cancer
What are the symptoms of endometrial hyperplasia?
Doctors say the most common clinical manifestations of endometrial hyperplasia is Abnormal Uterine Bleeding or AUB and others are in the following:
- Having periods with heavy and bulky bleeding
- Irregular bleeding
- Bleeding at intervals of cycles
- Vaginal bleeding in any case in a postmenopausal woman
- Vaginal bleeding in a woman undergoing HRT or hormone replacement therapy.
- In general, estrogen should never be administered alone without the presence of progesterone.
- Long-term use of estrogen is prohibited in postmenopausal women whose uterus has not been removed.
The only exception is the use of topical estrogen creams alone, which are used to prevent and treat vaginal atrophy.
Remember that your doctor cannot diagnose endometrial hyperplasia without sampling the wall inside your uterus, so biopsy will be the basis of the diagnosis.
First, after obtaining your detailed history and personal or family history of cancers and the list of your medications and routine clinical examinations, an ultrasound is requested.
With ultrasound, your doctor can also diagnose the possible causes of abnormal bleeding, such as fibroids and uterine masses or ovarian cysts.
Ultrasound also determines the thickness of the endometrium.
- In postmenopausal women:
The normal endometrium should be very thin
The thickness of the endometrium is normally less than three to four millimeters
If the thickness is less than three millimeters, the risk of endometrial hyperplasia is very low.
- In non-menopausal women:
Normal endometrial thickness varies throughout the menstrual cycle, but in general in non-menopausal women, if the endometrial thickness is less than 7 mm, the risk of endometrial hyperplasia is low.
If endometrial tissue is suspected, endometrial biopsy is performed and the removed tissue is examined under a microscope after preparation.
Your doctor will insert a small, narrow tube into your vagina and remove the sample. You may have some discomfort and minor bleeding a few days after the endometrial biopsy that resolves.
This sampling is an outpatient procedure that will be performed at an office or clinic.
Intrauterine observation with a device equipped with a camera is called hysteroscopy.
The device is a narrow tube that enters the uterus from the vagina and projects images from inside the uterus onto a monitor in front of a doctor.
During this process, it is seen inside the uterus and while direct examination, it will be possible to remove a biopsy from the suspicious tissue.
This procedure can be performed in the office and clinic under local anesthesia or in a hospital under general anesthesia.
In general, the first procedure in women with AUB will be endometrial biopsy
In the following women, an endometrial sample must be taken:
- Women under the age of forty who have AUB
- All women over the age of forty who have AUB
- AUB in women taking estrogen alone
- Existence of abnormal Pap smear results based on the presence of endometrial cells
- When they took medication for AUB treatment but did not improve with medication
- Hysteroscopy, TVUS, and sonohysterosalpingography will be other diagnostic methods.
A very important point in the treatment of endometrial hyperplasia is whether endometrial hyperplasia is with atypia or without atypia
The treatments of the two groups will be different
1-Treatment of endometrial hyperplasia without atypia
We have said that without atypical cells, the possibility of endometrial hyperplasia turning into cancer is very rare, and that many of these cases will stop spontaneously proliferating within a few months.
One method is to stop the treatment and have the patient have regular follow-up and endometrial biopsy again in a few months.
It is said that if the following treatments are given, the patient is less likely to have recurrence of hyperplasia later.
- Installation of IUD:
The best treatment for endometrial hyperplasia without atypia is the placement of progesterone-containing IUDs.
This reduces the thickness of the endometrium
The IUD stays in the uterus for six months to five years
The most successful treatment for endometrial hyperplasia without atypia belongs to progesterone IUDs.
- Prescribing progesterone pills:
It is consumed daily for six months and thins the endometrium.
Side effects will be more than iodine and the success rate of treatment will be less.
- Hysterectomy or surgery to remove the uterus:
It is necessary in the following cases
Failure to respond to treatment after six to twelve months
Recurrence of hyperplasia after treatment
Transformation of atypical hyperplasia into atypical endometrial hyperplasia
Doctors say a hysterectomy is more likely to be needed in obese and overweight women than in women of appropriate weight.
- Treatment of endometrial hyperplasia with atypia:
Hysterectomy or surgical removal of the uterus is the treatment of atypical endometrial hyperplasia.
Because hysterectomy will prevent atypical endometrial hyperplasia from turning into endometrial cancer.
- If a woman has atypical menopausal endometrial hyperplasia:
The uterus and two fallopian tubes and two ovaries will be removed at the same time
- If a woman with atypical endometrial hyperplasia is not menopausal and of childbearing age:
Progesterone administration for six months and then endometrial biopsy again.
Hysterectomy is necessary if biopsy shows atypical hyperplasia of the uterus.
But if it is removed, she is given the opportunity to become pregnant and the hysterectomy is postponed until after the pregnancy and childbearing.
In these cases, the person should know that the risk of recurrence of atypical endometrial hyperplasia is high and should be followed up.
Endometrial hyperplasia without atypia can be successfully treated with treatment in most cases.
Only less than 5 percent of people with a history of endometrial atypical hyperplasia develop uterine cancer within 20 years of being diagnosed.
Twenty-eight out of every 100 people with atypical endometrial hyperplasia develop uterine cancer within twenty years.
Obesity and overweight will be the most important factors for the subsequent recurrence of endometrial hyperplasia and hysterectomy is the only definitive way to prevent recurrence.
How to prevent endometrial hyperplasia?
- Avoid estrogen consuming alone and without progesterone or progestin
- Use combination pills to prevent pregnancy
- Avoid obesity because endometrial cancer is directly related to overweight and obesity
- Avoid fats because excess fat in the body tends to be converted to estrogen.
- There will be no problem in getting pregnant after endometrial hyperplasia treatment.