Endometrial proliferation and cancer risk

Endometrial hyperplasia is an increase in the number and density of endometrial glandular cells caused by excessive estrogen stimulation without changes in menstrual cycle progesterone. It is the overgrowth of endometrial cells, the cells that make up this lining, that will increasingly crowd together and become abnormal, and can lead to cancer in some cases.

Endometrial hyperplasia is a condition in which the endometrium or lining of the uterus becomes too thick because of excess cell growth. Although this is not cancer, it can lead to uterine cancer in some cases.
The endometrium has the ability to change throughout a menstrual cycle in response to hormones. Early in the cycle, the hormone estrogen made by the ovaries helps the lining to grow and thicken to prepare the uterus for pregnancy. Next, in the middle of the cycle, an egg is released from the ovary (ovulation). After ovulation, another hormone called progesterone begins to develop. Progesterone prepares the endometrium to receive and nourish a fertilized egg. If there is no pregnancy, both the hormones estrogen and progesterone will gradually decrease. When progesterone begins to drop, it either induces menstruation or sloughs off the lining. When the lining is completely peeled off, a new menstrual cycle begins.
Endometrial hyperplasia usually occurs due to excessive estrogen but lack of progesterone. If ovulation does not occur, progesterone is not produced and the lining is not shed. The endometrium may continue to increase in response to estrogen. The cells that make up the lining can accumulate together and can become abnormal. If not treated properly and in time, the disease can progress to cancer.
In endometrial hyperplasia is divided into 4 types:
Simple proliferation: There is an increase in the number of glands, but the glandular structure remains normal. Complex proliferation: Also an increase in the number of pituitary glands but with structural changes. Typical proliferation: is proliferation without the presence of atypical cells (cells with malformed nuclei...). Atypical proliferation: A proliferation in which atypical cells are present. The rationale for this division is based on the natural course of the disease:
2% simple proliferation typically progresses to endometrial cancer. 8% of typical complex proliferations progress to endometrial cancer. 23% of atypical proliferation progressed to endometrial cancer.

Endometrial hyperplasia can occur in many women, but the most common are the following groups:
Around puberty Girls around puberty, due to the lack of real activity maturation of the reproductive system, ovulation occurs irregularly. As a result, there is no ovulation, no ovulation in these subjects, causing the corpus luteum to not form, causing an abnormality in the hormone cycle, thereby leading to the proliferation of the endometrium.
Use of female hormone drugs The use of hormone drugs during perimenopause and menopause to limit uncomfortable symptoms in the body is something that some women apply. But due to the intervention by supplementing this hormone, the hormone levels in the body cannot change according to the inherent cycle but always stay high.
High levels of female sex hormones in the body continuously cause the endometrium to also proliferate continuously. This long-term condition causes endometrial hyperplasia to progress to pathology.
Irregular menstrual cycle An irregular menstrual cycle is also a risk factor for endometrial hyperplasia. Irregularity in the menstrual cycle, too long or too short also causes the endometrium to proliferate abnormally and can progress to pathology.
Obesity Obesity is also known as one of the common causes of endometrial hyperplasia. This is because when you are obese, your body is able to produce a much higher amount of the hormone estrogen than normal. The overproduction of the hormone estrogen is what causes the endometrium to proliferate. Therefore, it has the potential to cause endometrial hyperplasia.

Some evidence suggests that endometrial hyperplasia is a consequence of the excessive presence of the hormone estrogen in the absence of progesterone. If ovulation does not occur, progesterone will not be made and the lining of the uterus will not shed. The endometrium will continue to grow in response to the amount of estrogen in the body. The cells that make up the lining will increasingly crowd together and become abnormal. This condition, called prolapse, can lead to cancer in some women. Because this hormone imbalance is also associated with uterine cancer, hyperplasia is sometimes considered a precancerous condition. Women with little exposure to the hormone progesterone, near menopause (when ovulation is erratic) or postmenopausal women (when ovulation has stopped), some teenagers have just gone through puberty and haven't formed a cycle yet. Regular ovulation increases the risk of this condition. In addition, estrogen replacement therapy without the addition of progestins and the breast cancer drug tamoxifen can also cause this condition.

Endometrial hyperplasia has many different manifestations, but can sometimes be overlooked if not really paying attention. Some common symptoms of endometrial hyperplasia are:
Abnormal heavy menstrual bleeding Abnormal heavy menstrual bleeding is the most typical symptom of endometrial hyperplasia. The proliferation causes the endometrium to thicken, which in turn increases the proliferation of blood vessels to nourish the endometrium. Therefore, when it comes to menstruation, along with the shedding of the endometrium, a lot of blood vessels are broken, causing more menstrual bleeding than usual.
Abnormal bleeding Abnormal bleeding is also very common in cases of endometrial hyperplasia. When the endothelium is abnormally proliferated, if the neovascular vessels are not enough to supply blood to this endothelium, they become hypoxic and necrotic. Areas of endothelium necrosis cause the remaining blood vessels to rupture and cause abnormal bleeding even though the period has not yet come.
Bleeding after menopause This is an important abnormal sign that women who have passed menopause need to remember, especially women who use drugs of female hormone nature to reduce relieve the symptoms of this period. Uterine bleeding at this stage can not only be a signal of endometrial hyperplasia, it can also be a signal of a tumor, or a malignancy in the uterus,...
Signs Ultrasound The signs on ultrasound are also important signs contributing to the definitive diagnosis of endometrial hyperplasia. Patients can accidentally detect endometrial hyperplasia when they go to ultrasound for another disease or come directly to the uterus for an ultrasound when there is bleeding or irregular periods.
Symptoms of endometrial hyperplasia on ultrasound are indicated by abnormal thickening of the endometrium on the display. When the endometrial lining of a woman of childbearing age is more than 12mm thick, and greater than 5mm in menopause without using hormone replacement drugs, endometrial thickening is suspected.

Complications of endometrial hyperplasia are generally not overwhelming, with severe complications occurring immediately. When there is endometrial hyperplasia, the patient mainly encounters the following complications:
Discomfort Endometrial hyperplasia causes the patient to have heavy, irregular menstrual cycles, irregular menstrual cycles affecting the patient. much to the patient's life.
Anemia In addition to affecting the patient's psychology, heavy menstrual bleeding, prolonged menstruation can also cause complications such as anemia due to blood loss. Anemia in patients with endometrial hyperplasia depends on the patient's bleeding status. When the patient bleeds profusely, it will cause acute anemia, when the patient bleeds for a long time, it is easy to cause chronic anemia.
Therefore, patients with endometrial hyperplasia need to pay attention to supplement with substances beneficial for hematopoiesis such as iron, protein, ...
Progression to cancer Progressing to cancer is a serious complication most severe of endometrial hyperplasia. Although the disease's ability to progress to cancer is quite slow, if not treated properly and timely, endothelial proliferation will most likely escape from the body's rules of regulation and inhibition. and cause cancer.
The cancerous progression of endometrial hyperplasia is often not the same, but varies with the pattern of proliferation. For typical simple proliferative patients, the rate of progression to cancer is 2%. In patients with complex prolapse, this rate is typically 8%. Patients with atypical complex types have a 23% cancer rate.

In order to treat endometrial hyperplasia, it is necessary to clearly identify the type of disease, as well as the cause of the disease, so that the appropriate treatment can be given. For typical proliferation without abnormal nuclei - atypical cells, the risk of progression to cancer is only 1-3%, so the treatment will be medical treatment with progestins, which can be used in the form of oral, injection .... Ultrasound will be a monitoring measure based on measuring the thickness of the endometrium. Depending on clinical improvement (indicated by bleeding), hysteroscopy or surgical curettage may be necessary after 3 months.
Particularly for premenopausal and postmenopausal people with complicated hyperplasia, typically, hysterectomy may be considered. With atypical hyperplasia, the risk of developing cancer is 8-30%, so the treatment trend will also be hysterectomy. But if the woman is young, or has not had enough children, she will try to treat it with drugs, if the condition does not improve, then a hysterectomy.

The following steps can be followed to reduce the risk of endometrial hyperplasia:
If estrogen is used after menopause, additional progestin or progesterone may be needed. If your period is irregular, your doctor will advise you to take additional birth control pills. They contain estrogen along with progestin, other forms of progestin may also be used. If you are overweight, you should lose weight. The risk of endometrial cancer increases with obesity. Thereby, it can be seen that endometrial hyperplasia is a rather dangerous disease in women when it can turn malignant. But by the symptoms, using ultrasound can still detect the disease early and treat the disease in time before the disease brings severe symptoms.
Endometrial hyperplasia is a complex disease that affects women's health as well as their fertility. Therefore, women need to monitor their menstrual cycle regularly, if the menstrual cycle has any disturbances, they need to see an obstetrician-gynecologist early to have a positive treatment, to avoid a serious disease that will be difficult to treat. difficult and require longer treatment.
In order to help customers detect and treat gynecological diseases early, Vinmec International General Hospital has a package of basic gynecological examination and screening, helping customers detect early infectious diseases and help treat Easy, inexpensive treatment. Screening detects gynecological cancer (cervical cancer) early even when there are no symptoms.
Basic gynecological examination and screening package for female customers, has no age limit and may have the following symptoms:
Abnormal vaginal bleeding Having menstrual problems: irregular menstrual cycle, irregular menstrual cycle Irregular vaginal discharge (smell, different color) Vaginal pain and itching Female clients have several risk factors such as poor personal hygiene, Unsafe sex, abortion,... Female customers have other symptoms such as: Abnormal vaginal discharge, itching, pain in the private area, abnormal vaginal bleeding. In particular, Vinmec now has implemented the ThinPrep Pap Test method, which has created a turning point for the traditional Pap smear method, through membrane-controlled cell transfer technology, which helps to increase the accuracy of the Pap smear. Sensitivity and specificity in detecting precancerous cells, especially adenocarcinoma cells, a type of cancer cell that is difficult to detect.