What it is
The lining of the uterus thickens and sheds on a cycle. Estrogen builds it. Progesterone holds it in check and triggers the shed.
When estrogen acts month after month without progesterone, the lining keeps building and the cells crowd. That crowding is hyperplasia.
A pathologist sorts it into two kinds. Without atypia it usually responds to progesterone. With atypia it is treated more seriously, because cancer is sometimes found alongside it.
What you might notice
- Bleeding after menopause, even once, even a spot
- Periods that soak a pad or tampon within an hour
- Bleeding between periods
- Cycles that skip for months, then bleed heavily
- A lining reported as thick on an ultrasound done elsewhere
- Bleeding while taking estrogen without progesterone
How Dr. Mueller finds the cause
- 1
Bleeding history
Dr. Mueller pins down the pattern, the amount and what changed.
- 2
Pelvic ultrasound
The lining is measured, usually with a probe placed in the vagina.
- 3
Endometrial biopsy
A thin straw takes a sample of the lining in the office.
- 4
Pathology report
It says whether atypia is present.
- 5
Treatment choice
Progesterone by pill or hormonal IUD. Atypia is usually treated with surgery.
- 6
Repeat biopsy
She rechecks in three to six months to confirm the lining cleared.
Questions people ask
- Is endometrial hyperplasia cancer?
- No. It is an overgrowth of the lining. The kind with atypia carries real risk, which is why the biopsy report matters.
- Does the biopsy hurt?
- It cramps hard for about thirty seconds. Most women describe a strong period cramp that passes quickly.
- Can it be treated without a hysterectomy?
- Often. Hyperplasia without atypia usually clears on progesterone or a hormonal IUD, then is rechecked by biopsy.
- Why did this happen?
- Estrogen acting for long stretches without progesterone. Skipped ovulation, PCOS, extra body fat and estrogen-only therapy all do that.
- I bled once after menopause and it stopped. Does it still need looking at?
- Yes. One episode is reason enough to measure and sample the lining.