Endometrial Hyperplasia

Menstrual Health Advice

Many women in the UK experience changes in their menstrual cycle or unexpected bleeding, which can understandably be concerning. One potential cause is endometrial hyperplasia, a condition involving a thickening of the womb lining. While the term may sound a bit scary, the good news is that it's treatable, especially when caught early. At Evana®, we’re here to help you better understand this condition and empower you to take control of your reproductive health.

What is Endometrial Hyperplasia?

Endometrial hyperplasia is when the lining of the womb (the endometrium) becomes abnormally thick. This happens because of a hormonal imbalance — too much oestrogen without enough progesterone to keep it in check.

Normally, oestrogen helps the endometrium grow during the first half of your menstrual cycle. After ovulation, progesterone steps in to limit that growth and prepare the lining for pregnancy. If pregnancy doesn’t happen, progesterone drops, and the lining sheds — that’s your period. But if progesterone levels were never high enough in the first place (often because ovulation didn’t occur), oestrogen’s growth-promoting effect goes unchecked. The lining keeps thickening, which can cause irregular or heavy bleeding and, over time, abnormal cell changes.

There are two main types of endometrial hyperplasia:

Without atypia: Cells look normal. It’s unlikely to turn cancerous and usually responds to hormone treatment.
Atypical endometrial hyperplasia: Cells look abnormal and carry a higher risk of becoming womb cancer if untreated.
Too much oestrogen is the key problem in both forms — without progesterone to act as the brake, the endometrium just keeps growing.

Endometrial Hyperplasia Symptoms

Recognising endometrial hyperplasia symptoms early can make a big difference. Here are some common signs to look out for:

Heavy periods (menorrhagia) – bleeding that lasts longer than usual or involves passing large clots.
Irregular periods – such as bleeding between periods or cycles that are longer or shorter each time .
Very frequent periods or cycles shorter than 21 days.
Post-menopausal bleeding – any vaginal bleeding after you’ve permanently stopped having periods needs investigation.

These symptoms can often feel disruptive and alarming, but they are your body’s way of signalling that something might be off. Remember: not every case of heavy or irregular bleeding is serious, but it’s always worth checking with your GP.

What causes Endometrial Hyperplasia?

Understanding what causes endometrial hyperplasia can help in managing and preventing it. The primary cause is oestrogen dominance, but other contributing factors include:

Obesity – excess fat increases oestrogen levels.
Polycystic Ovary Syndrome (PCOS) – can disrupt hormone balance.
Diabetes or thyroid issues.
Hormone replacement therapy (HRT) using oestrogen alone.
Late menopause or starting periods very young.
Family history of womb or colon cancer.

Women who are going through perimenopause or are post menopause are particularly at risk, as hormone fluctuations are more common during these stages.

Diagnosing Endometrial Hyperplasia

If you’re experiencing any of the symptoms mentioned above, your GP may refer you for tests such as:

Pelvic ultrasound to measure the thickness of the womb lining.
Endometrial biopsy – a small sample of tissue is taken for analysis.
Hysteroscopy, where a small camera is used to look inside your womb.

While the idea of these procedures may feel daunting, they are usually quick, low-risk, and really important for an accurate diagnosis. And remember, not all thickened linings are dangerous -, some may resolve on their own or respond well to treatment.

Endometrial Hyperplasia Treatment

When it comes to endometrial hyperplasia treatment, options will depend on the type you have and whether you still wish to have children. The goal is to prevent the condition from progressing and manage symptoms.

Hormonal Treatment:
● Progesterone therapy can help balance hormones and thin the womb lining.
● This is often the first line of treatment for hyperplasia without atypia.
Monitoring:
● Regular follow-up biopsies and ultrasounds may be needed to check your progress.
Surgery:
● For atypical hyperplasia, especially if you’re past childbearing age or at high risk of cancer, a hysterectomy (that’s the surgical removal of the womb) might be recommended.

The good news is that most cases, especially when caught early, are highly treatable, and many women go on to lead perfectly healthy lives without long-term complications.

Understanding Heavy Periods

If you’re experiencing heavy or irregular periods, it could be part of your natural cycle, or it could be a sign of something else going on, like endometrial hyperplasia. That’s why it’s so important to speak to your GP. They can assess your symptoms, run any necessary tests, and help you understand what’s happening.

Final Thoughts

Endometrial hyperplasia can feel overwhelming at first, but understanding the condition is the first step towards peace of mind. Most importantly, you are not alone. If you’re experiencing irregular bleeding or any other concerning symptoms, reach out to your GP to explore your options.