WOMENS-HEALTH Messages for May, 1997: Re: Hyperplasia

Re: Hyperplasia

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Mon, 19 May 1997 19:42:26 -0500 (CDT)

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In reply to: Sara: "Hyperplasia"

Sara asked about endometrial hyperplasia:

This is a condition caused by a relative excess of the hormone estrogen. One of estrogen's jobs is to stimulate growth of the lining of the uterus, called the endometrium. When there is a little too much estrogen relative to it's counterpart, progesterone, the endometrium can become over-stimulated and slowly grow, until too much growth, or hyperplasia, develops. In most cases this growth is benign, but in some cases it can lead to pre-cancer or even cancer of the endometrium (a type of uterine cancer). In fact, this is the most common type of gynecologic cancer in the U.S.

A number of situations predispose a woman to this, including being very overweight (fat cells help produce estrogen), taking postmenopausal estrogen alone (without progesterone), being "anovulatory" (where an egg is not released every month and periods are very irregular), having a strong family history of uterine cancer, and, probably, being hypertensive, overweight, and diabetic.

The diagnosis is made by one of three methods: endometrial biopsy done in the office, a hysteroscopic biopsy, or a D&C done as an outpatient surgical procedure. Treatment usually consists of either hormonal treatment (progesterone agents) or surgery (hysterectomy). In most cases hormones are adequate, but in bad cases a hysterectomy may be necessary. You mentioned a D&C, which *can* be used in some cases, but this has fallen out of favor with many gynecologists as it can miss some areas. An endometrial ablation *may* work, but most would not advocate this for cases of hyperplasia, since it, too, can miss areas, and since it will usually make subsequent biopsies much harder to do (the uterine cavity becomes scarred after this procedure) there is a risk of hyperplasia developing into cancer before a diagnosis is made in this situation. So, most Ob/Gyns do a biopsy, then treat with either hormones, or sometimes a D&C or a hysterectomy.

Good luck with your situation, and thanks for posting your question!

Ashley

--
Ashley Hill
D. Ashley Hill, M.D.
Assistant Director, Department of Ob/Gyn
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

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