Endometrial hyperplasia is a condition that affects women. Doctors say that it is important to note that endometrial hyperplasia is not endometrial cancer, however, it is considered a pre-cancerous condition.
Dr Jean Claude Nkundabagenzi, a gynaecologist obstetrician at Clinique Bien-Naitre, in Muhima, says that endometrial hyperplasia is an abnormality of the lining of the uterus or endometrium. It is usually common in women of childbearing age, but in some cases, also in women after menopause.
He says that the formation and destruction of the endometrium depends on an extremely precise balance between the female hormones (progesterone and estrogen). Both are produced by the ovaries, on the stimulation of the hormones of the pituitary gland (a small pea-sized gland that plays a major role in regulating vital body functions and general wellbeing) and the hypothalamus (a portion of the brain that maintains your internal balance by regulating many of the body’s key processes, such as heart rate and body).
According to Dr Mohamed Okasha, a gynaecologist obstetrician at Legacy Clinics, Kigali, there are two types of endometrial hyperplasia; hyperplasia without atypia, here, there are no atypical cells present, the possibility of endometrial hyperplasia ultimately becoming endometrial cancer is very doubtful. The evidence suggests that only about five per cent of women with endometrial hyperplasia without atypia, will develop endometrial cancer.
He says, the second type is atypical hyperplasia, for this type; there is a bigger risk of rising endometrial cancer. The management is a bit more hostile because of that increased risk.
Okasha adds that endometrial hyperplasia carries a risk of underlying or progression to malignancy. It can be symptomatic by abnormal uterine bleeding. The risk factors mainly are unopposed estrogen effect, such as, obesity and infertility.
Nkundabagenzi notes that the causes of endometrial hyperplasia are regularly hormonal disorders, often, the ovarian origin or imbalance between female hormones (estrogen and progesterone). It is often found at the extreme ages of the reproductive period in women, that is to say, the first years after the onset of menstruation, and in the pre-menopausal period.
The causes may also be an abnormal development of the endometrium with a creation of abnormal cells of this tissue, which may be early signs of cancerous lesions often found in women after menopause, he adds.
Nkundabagenzi explains that the diagnosis of hyperplasia is essentially vaginal ultrasound, but a biopsy is sometimes necessary to estimate the severity of the pathology, especially when hyperplasia occurs after menopause.
For prevention, Okasha says that, you should have a correction of risk factors, do regular screening for high risk grounds, like women on hormone replacement therapy.
Nkundabagenzi says that the treatment is often medical, it basically consists of progesterone. But in some cases, an endometrial biopsy is needed to eliminate any abnormal growth that can lead to endometrial cancer. This is especially true for older people.
He adds that if the diagnosis of a simple hyperplasia of the endometrium is carried out, a conservative treatment can be put in place, for instance, putting a hormonal coil with progesterone. In case of abnormality, endometrial ablation may be necessary. Currently, it is essentially by hysteroscopy. Hysteroscopy is a procedure to look at the inside of the womb (uterus). In extreme cases, a hysterectomy may be necessary.
"Treatment can be through being conservative with follow ups on cases of endometrial hyperplasia without atypia, progesterone supplements with follow up biopsy, surgical treatment in form of total hysterectomy for patients with atypia or persistent symptoms and fertility is not needed,” Okasha notes.