Endometrial Hyperplasia: What It Is and What to Watch For

Endometrial hyperplasia means the lining of the uterus (the endometrium) has grown thicker than normal. That happens when estrogen drives growth without enough progesterone to balance it. It’s common in women with irregular periods, obesity, or hormone therapy. The big concern is that some forms raise the risk of endometrial cancer, so spotting it early matters.

Recognize the symptoms

The most common warning sign is abnormal uterine bleeding. That includes heavy periods, bleeding between periods, long periods, or any bleeding after menopause. You might also notice spotting, changes in menstrual flow, or pelvic discomfort. These symptoms don’t prove hyperplasia, but they do mean you should see a doctor.

Risk rises with age, especially after perimenopause. Other factors: obesity, polycystic ovary syndrome (PCOS), diabetes, tamoxifen use, and unopposed estrogen therapy. Smoking and family history of uterine or colon cancer can also matter.

How doctors diagnose it

Your doctor usually starts with a pelvic exam and a pelvic ultrasound to measure the endometrial thickness. If the lining looks thick or bleeding is abnormal, the next step is sampling the tissue. An endometrial biopsy, or a dilation and curettage (D&C) in some cases, gives a sample for the lab. The pathologist then says whether hyperplasia is present and whether cells look “atypical.” Atypia means cells look abnormal and the cancer risk is higher.

Treatment depends on the type. For hyperplasia without atypia, many doctors use progestin therapy. That can be a daily oral progestin or a levonorgestrel intrauterine device (IUD) like Mirena. These treatments often reverse the changes and preserve fertility. If atypical hyperplasia is found, doctors may recommend a hysterectomy, especially if childbearing is complete. Some patients who want to preserve fertility try high-dose progestin under close monitoring, but that requires careful follow-up.

Follow-up is critical. After medical treatment, your doctor will repeat biopsies or ultrasounds to make sure the lining returns to normal. If changes persist or get worse, surgery becomes more likely. If you’re treated with an IUD, expect follow-up visits to confirm placement and effect.

Simple prevention steps help lower risk: manage weight, control diabetes, and discuss safe hormone therapy with your doctor. If you have PCOS or irregular periods, regular gynecologic checkups reduce surprises. And if you notice unusual bleeding—don’t wait. Early evaluation gives more treatment choices and better outcomes.

If you have questions about tests, fertility options, or how treatments affect menopause, ask your clinician to explain clearly. Knowing the type of hyperplasia and the available options helps you make the right choice for your health and life plans.