Endometrial Hyperplasia and the Risks of Leaving it Untreated

You may have read in the press that The Royal College of Obstetricians and Gynaecologists (RCOG) and British Society for Gynaecological Endoscopy (BSGE) recently published national guidance on the management of endometrial hyperplasia. This is a condition where there is an overgrowth of the cells that line the womb that causes the womb to thicken.  This often leads to vaginal bleeding that can be described as ‘abnormal’ because it is heavy and perhaps heavier than normal during menstruation. The bleeding associated with this condition can also occur between periods, at irregular times when a woman is on HRT, and it can also occur after the menopause. There are 2 types of endometrial hyperplasia; hyperplasia without atypia and atypical hyperplasia.

What is the Danger?

The danger of endometrial hyperplasia for some women is that it can develop into one of the most common gynaecological cancers, womb cancer. Figures quoted put the number of women diagnosed with this kind of cancer at 8,500 per year, with the number of women with endometrial hyperplasia thought to be around 25,000.  Many women may be suffering from symptoms of endometrial hyperplasia but may not even know that they are and therefore will not have seen a medical professional to be diagnosed and treated. The problem here is that endometrial hyperplasia can be treated if it is caught early, and the risk of the development into womb cancer in many cases could therefore be avoided.

Risk Factors

Woman who are likely to be more at risk of suffering from endometrial hyperplasia are those who are older, those who have a higher Body Mass Index (BMI) i.e. more body fat, those who have polycystic ovarian syndrome, or those who are using tamoxifen or are having HRT.

What to do

It is important therefore to look out for symptoms such as abnormal bleeding or discharge, particularly after the menopause. If you have been / are experiencing these kinds of symptoms it is well worth getting them checked out just to make sure.

Gynaecology

I offer the full range of office gynaecology including rapid sexual health screening, fertility management, polycystic ovaries and in one visit, I will be able to carry out assessments for pelvic pain and heavy menstrual bleeding.  I am trained to carry out and treat major gynaecological conditions including endometriosis, investigation of treatment for polycystic ovaries, HRT, menopause, pelvic pain and pre-menstrual tension.

I also offer the NovaSure therapeutic treatment for heavy menstrual bleeding for women who have not responded to any medical (pill or Mirena coil) treatment.  Find out more about it on my website here.

Polycystic Ovaries & Polycystic Ovarian Syndrome

There is a lot of information available out there about polycystic ovaries, and one important thing that I need to point out here is that an ultrasound finding of polycystic ovaries is not the same thing as having the metabolic disease called Polycystic Ovarian Syndrome. This is why if you have an ultrasound finding of a polycystic ovary you should not be alarmed, particularly if you have normal periods. It is not uncommon for polycystic ovaries to show up the scan of a patient who has periods and who will get pregnant. In fact it is thought that only a small proportion of the estimated 20% of middle class women who have polycystic ovaries will actually go on to have Polycystic Ovarian Syndrome.

Reasons for the Increase in Diagnosis Numbers

The number of women who are being (correctly) diagnosed with Polycystic Ovarian Syndrome (PCOS) appears to me to be on the increase. This is likely to be due to factors such as the obesity epidemic and also the change in the UK population dynamics. The UK population for example now includes more women from South Asia and the Middle East who are at risk of developing this disease. Many of these women have abnormal endocrine disease, may suffer from thyroid disease, and can have abnormal adrenal disease (Congenital Adrenal Hyperplasia). They can also have high levels of male hormones like Testosterone and Androstenedione. In these cases it is common to find a strong history of either early onset or late onset diabetes, and in these families the male members often have premature balding under the age of 30.

Overweight Risk

We now know that PCOS is associated with Diabetes, Metabolic Syndrome, and with infertility because PCOS patients do not ovulate and may need ovulation induction treatment. PCOS also increases the risk of miscarriage, and leaving the condition untreated is therefore very risky as far as your reproductive health is concerned. The situation could be most serious for women who are overweight because they run the risk of developing Diabetes and becoming infertile.

Symptoms & Physical Examination

The most noticeable symptom of the condition in the patient is irregular periods that can be very heavy and can be spaced by more than 6 weeks. When examining physical signs, indicators for this condition can also include increased facial and body hair (particularly on the abdomen and back), acne, male pattern baldness in the family, a history of a late puberty, and a black mark in the armpit known as Acanthosis Nigrans.

Taking Action

Getting an early diagnosis is the best way to safeguard your reproductive health and, as you may read in medical literature the combined oral contraceptive pill can protect the PCOS ovary, and can stop the disease from getting worse. It is really important therefore to see a Gynaecologist who has a specialist interest in this disease, and who also works with an interested Endocrinologist. I always like to exclude Diabetes because PCOS is related to Insulin Resistance, and this is the precursor to Diabetes. I carry out a formal Glucose Tolerance Test as part of my screening, and if my patient is screened positive, I ensure that they are seen by an Endocrinologist.

When it comes to treatment there are a number of things that can be done depending on the individual circumstances. These can include working with a Dermatologist to address the acne and hair loss (Dianette, sometimes a combined pill, and Cypropterone Acetate), use of the drug Metformin (particularly if you want to become pregnant), ovulation induction with Clomiphene (sometimes with Clomiphene – great for weight loss and improving ovarian function), ovarian drilling (a laprosopic keyhole treatment), and often dietary advice.

For more information visit my main website, or to arrange for an appointment call 0203 318 0263 or contact me online.