Is there a link between Endometriosis and Endometrial Hyperplasia?

Bloomin' Uterus logo surrounded by question marks

One of my readers recently contacted me asking if I could do some research for her.  Her physicians suspect she may have hyperplasia.  What is that, you may ask?  It’s the changing or enlarging of cells or organs which may develop into cancer.  Specifically, she is undergoing tests to see if she has endometrial hyperplasia.  Now what’s that?  It’s when the uterine lining (the endometrium) is too thick.  Her question?  Is there a link between Endo and hyperplasia?

I found this to be very interesting as I had an MRI before my diagnostic surgery which found I had abnormally thick uterine lining.  The first part of my surgery last year was to go in and perform a D&C (dilation & curettage) to remove some of the thick lining.  So now I’m not only researching for my reader, but for myself (although my D&C biopsy came back normal).

How does endometrial hyperplasia develop?

It appears to be estrogen-dominant (sound familiar…Endometriosis may very well be an estogen-driven disease).  Many women who have high levels of estrogen, but lower levels of progesterone, may develop endometrial hyperplasia.  It has to do with hormones, ovulation, and the lack of progesterone, which may mean the lining of the uterus does not shed (at all, or as well as it should).  The over-dominant estrogen may encourage the lining to grow and thicken, and these over-crowded cells may develop into hyperplasia.

Mostly, endometrial hyperplasia occurs after menopause, once ovulation stops and progesterone is no longer produced.  It may also most likely occur during “the change of life” when ovulation is irregular (oh the things we have to look forward to).

Other reasons it may occur: an over-abundance of estrogen in your system (many foods or medications may heighten estrogen levels), taking medications that mimic estrogen, hormone replacement therapy, irregular periods, or if you are taking Tamoxifen (a breast cancer drug).  As as side note, Tamoxifen has been shown to increase Endometriosis activity and it’s use may need to be re-evaluated if you are treating for breast cancer and have Endometriosis.

You may also be at a higher risk of developing endometrial hyperplasia if you’re: older than 35; are white; haven’t ever been pregnant; were an older age at menopause; had your first period at a younger age; have diabetes mellulits, PCOS, gallbladder disease, or a thyroid disease; are obese; smoke cigarettes; or have a family history of ovarian, color, or uterine cancer.

Symptoms of endometrial hyperplasia

Abnormal/lengthy/heavy bleeding or cycles shorter than every 21 days appear to be the most common symptoms of endometrial hyperplasia. Bleeding between periods or post-menopausal bleeding may also be a sign.  An additional red flags may be pain during sex.

There are different stages of endometrial hyperplasia : simple, complex, simplex atypical, and complex atypical.  The atypical categories mean that abnormal cells are now present, which may (or may not) develop into cancerous cells.

Simple (aka mild) hyperplasia carries the smallest risk of developing into cancer.  Atypical hyperplasia carries the largest risk of cancer (8% if left untreated for simple atypical; 29% if left untreated for complex atypical).

Diagnosing endometrial hyperplasia

It’s the usual tests any EndoSister has undergone : transvaginal ultrasounds, biopsies, possibly a D&C, and possibly a hysterscope (a tiny lit-up tube going up your vagina to look inside your uterus).

There have been studies that discuss an increased rate of misdiagnoses for endometrial hyperplasia, though.  It may be a common occurrence called disordered proliferative endometrium, which is normal for perimenopausal women (going through “the Change”). It may also be a multitude of other conditions, many of which I cannot pronounce nor care to type up.  But you can read them in The Perimenopausal Blog entry here.

Treating endometrial hyperplasia

Many times, the additional of progestin to a medical regimen may successfully treat non-atypical endometrial hyperplasia.  Having a D&C to scrape out the excess lining is also an accepted treatment for the non-atypical hyperplasia.  A 2009 study showed that women with atypical hyperplasia who underwent a D&C had a lowered risk of cancer; however, 18% of those women still had invasive cancer cells at the time they had hysterectomies.  A D&C isn’t a guaranteed fix for atypical endometrial hyperplasia.

Some physicians will recommend ablation (where the lining of the uterus is destroyed by heat or laser), but it may not be successful.  And the scarring of the ablation procedure to the inside of the uterus may make it next to impossible to detect any remaining hyperplasia growth in the uterus.

If the diagnosis is for atypical hyperplasia (which again may develop into cancerous cells), a hysterectomy may be recommended to lessen the chances of developing uterine cancer.  If this is a decision you choose, please tell your doctor NOT to use a morcellator, as it may spread cancerous cells within your abdominal cavity.

How to avoid endometrial hyperplasia

If you are post-menopausal and taking estrogen, talk to your doctor about also taking progestin or progesterone.  If you’re still menstruating, talk to your doctor about a birth control pill that also contains progestin or progesterone; or taking them separately (as a pill, cream, or injection).  Keep within your healthy body weight, eat a healthy diet, and exercise; being obese may raise the risk of endometrial cancer.  Estrogen is stored in fatty tissues; the more fatty tissues you have, the more room you have to store excess estrogen.

Finally, go in for your regular examinations with your gynecologist, including a pelvic exam.  They don’t call it preventative medicine for nothing!

Is there a link between Endo and endometrial hyperplasia?

Depends on your school of thought.  If you’re one that believes Endometriosis is an estrogen-driven disease, then I would feel confident in theorizing that YES, there is a link.  I believe it is an estrogen-driven illness.  And endometrial hyperplasia is also an estrogen-dominant driven disease (too much estrogen; not enough progesterone).  So I, in my laymen wisdom, would call that a link.

But do I think you’re at a higher risk of developing endometrial hyperplasia if you have Endometriosis?  I truly don’t know.  Any higher than women without Endometriosis?  I have no idea.  Dr. M. Agarwal summed it up best in his 2/4/2012 response to an inquiry on Healthcaremagic, “Whether a given patient with endometriosis will have hyperplasia cannot be told before hand. It is best to keep a visit a gynecologist who will keep track of endometrial thickness by USG and guide you accordingly.”

What I did find for certain is that there are women with Endometriosis and endometrial hyperplasia all over the place.  Again, you are not alone in this:

LisaM posted in 4/2001 on Hystersisters.  She has adenomyosis, Endometriosis, fibroids, and endometrial hyperplasia.

Gee posted in 2/2002 on Hystersisters.  She had a hysterectomy due to atypical endometrial hyperplasia, adenomyosis, fibroids, ovarian cysts, and Endometriosis.

NYC_Grrl posted in 11/2006 on Hystersisters. She decided to have a hysterectomy because of her complex endometrial hyperplasia (not atypical), and was glad she did.  While in surgery, the physician also found that she had severe Endometriosis and a cyst “the size of a tennis ball” on her ovary.

Spoonerbear posted in 9/2007 on MedHelp. She had a D&C and ablation due to her endometrial hyperplasia.  She also has Stage IV Endometriosis.

Disneyheartlove posted in 2008 on MDJunction.  Not only does she have Endometriosis and uterine polyps, but she also suffers from atypical endometrial hyperplasia.

Catwoman posted in 4/2010 on Valvereplacement.  She received a hysterectomy at 34 due to her endometrial hyperplasia and also Endometriosis.

Bam1011 posted in 8/2010 on hystersisters. Not only does she have atypical endometrial hyperplasia, but also Endoemtriosis and ovarian cysts.

Tinkerbell_0609 posted in 1/2011 on IVF-Fertility. She has PCOS, endometrial hyperplasia, and Endometriosis.

MollyWiggles posted in 7/2012 in Hystersisters.  She had her hysterectomy a month earlier due to atypical endometrial hyperplasia.  She also has Endometriosis.

DJLadybug posted in 3/2013 in Hystersisters. Her physicians were pressing her for a hysterectomy due to her fibroids, Endometriosis, and possible endometrial hyperplasia.

Angiestaff posted in 9/2013 on Hystersisters.  She has Endometriosis and endometrial hyperplasia.

Skaduce posted in 3/2014 on Hystersisters. She suffered from fibroids, infertility, complex endometrial hyperplasia, and Endometriosis.

Little Volcano posted in 8/2014 on Hystersisters. She has endometrial hyperplasia, polyps, cysts, and Endometriosis.  She was waiting for further diagnostic tests to be done regarding her hyperplasia to make sure it’s not cancerous.

Jennn19 posted in 9/2014 on Hystersisters.  She has Endometriosis, but many women in her family have uterine cancer, endometrial hyperplasia, enlarged uterus, fibroids, ovarian cysts, and Endometriosis.

Anabus48 posted in 11/2014 on Hystersisters.  She has Endometriosis, Adenomyosis, and endometrial hyperplasia.

Pblonde posted in 1/2015 on Hystersisters.  She had complex atypical endometrial hyperplasia and Endometriosis.  Her physician recommended a hysterectomy, which she did, and is glad she did.  The biopsy results came back with Stage 1 uterine cancer.

Guest posted in 2/2015 on SteadyHealth.  She has endometrial hyperplasia, fibroids, PMS, PMDD, amenorehea, and Endometriosis.

Adamsmt posted in 9/2015 on Hystersisters.  She was going in for a hysterectomy because of her endometrial hyperplasia, polyps, and possible Endometriosis.

Do you have Endometriosis and hyperplasia?  Let us know!  Don’t have Endometriosis, but have hyperplasia?  Please, drop a comment below.  Trying to greater understand both conditions.

(Updated March 25, 2019)

Resources:

Cancer Network – (1997; Article) Benign and Hyperplastic Endometrial Changes Associated with Tamoxifen Use

Cancer Network – (1995; Article) The Effect of Tamoxifen on the Endometrium

Cancer Research UK

Everyday Health Medica, LLCToo Much Estrogen

Everyday Health Media, LLC – What is Endometrial Hyperplasia?

Healthcommunities.com

HERS Foundation

Mayo Clinic

The American Congress of Obstetrics and Gynecologists – Endometrial Hyperplasia

The American Congress of Obstetrics and GynecologistsTamoxifen and Uterine Cancer – Committee Opinion

The Perimenopause Blog

US National Library of Medicine – (2009; Abstract) : Complex Atypical Endometrial Hyperplasia : the Risk of Unrecognized Adenocarcinoma and Value of Preoperative Dilation and Curettage

US National Library of Medicine – (1994; Abstract) : Endometriosis and Tamoxifen

US National Library of Medicine – (1996; Abstract) : Prognostic Importance of Hyperplasia and Atypia in Endometriosis

West Coast Gynecologic Oncology

Womens Health Advice

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Reader’s Choice : Hysterectomies & Myomectomies Spreading Cancer?

I have heard that sometimes when physicians conduct a hysterectomy where the uterus was shredded/broken down and removed through small incisions then biopsied, cancerous cells could be detected during the biopsy.  And that the presence of those cancerous cells may remain in the abdominal cavity post-procedure, which may spread and continue to develop.  Some women who this happened to ended up having to go through a intense radiation therapy treatment to remove the cancerous cells.

In April of 2014, the U.S. Food and Drug Administration (F.D.A.) published a warning between hysterectomy, myomectomies, and cancer when the Morcellation Procedure is used.  The Morcellation Procedure uses a small “power saw” called a Morcellator to slice and dice the tissue. A myomectomy is a surgery performed to remove uterine fibroids (which are noncancerous masses of growth inside the uterine wall). The procedure is similar, the tissues are broken up, possibly releasing any cancerous cells into the abdominal cavity.  The F.D.A. found that 1 in 350 women undergoing these procedures have ” anunsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma.” If these tissues are ruptured and/or shredded, it may spread the cancerous cells throughout her abdominal cavity.  “For this reason, and because there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.”

The New York CBS ran this story in May 2014, which can be viewed here: http://newyork.cbslocal.com/video?autoStart=true&topVideoCatNo=default&clipId=10114650

In 2015, AETNA ended coverage of most procedures using the morcellator.  More info can be read here.  In May 2015, the FBI opened an investigation of Johnson & Johnson to see if they knew of the risks of spreading cancerous cells.  More info can be read here.  (As of April 6, 2017, I cannot find any outcome of that investigation)

A report published in 2017 found that using specific specimen bags (in this instance, the Espiner EcoSac 230) led to fewer complications or spreading of cells and no bag-breakage during procedures.

So it has been suggested:

  1. If you have any history of uterine, ovarian, pelvic, or some sort of abdominal cancer in your family, avoid the “shredding” hysterectomy/myomectomy, known as the Morcellation Procedure.  Even if you don’t have a family history for any of these cancers, you may want to play it safe and avoid this procedure.
  2. Don’t get a hysterectomy unless absolutely necessary.
  3. If you DO need a hysterectomy or myomectomy, see if your physician can perform the vaginal hysterectomy, or conventional hysterectomy which removes the uterus as a whole, rather than breaking it down into pieces (thus avoid “freeing” the cancerous cells inside your abdominal cavity).
  4. In light of new research, also talk to your doctor about the possibility of using a contained specimen bag if you opt to use a morcellator during surgery.

Is this post meant to terrify you? NO!  It’s meant to educate you, to push you to have thorough discussions with your physician, to educate you to ask these types of situations. I learned SO much today, and thank my Reader who prompted this topic.  Always, always, allllways have deep, intimate, and long talks with your physician.  It’s what we’re paying them for…

**Updated 4/6/17**

Resources:

AETNA

CBS News

Journal of the Society of Laparoendoscopic Surgeons

New York CBS News

The Telegraph

U.S. Food and Drug Administration

*Sunday is “Reader’s Choice” where my readers, friends, and family get to suggest a topic.  Today’s topic came from my friend, who shall remain anonymous, “There is a laproscopic procedure where they shred the uterus to remove it, and there are issues with cancer being spread throughout the abdomen by this if there is any cancer in the uterus.” So let the research began!  Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa