Individuals with PCOS may be at 10x the risk of developing endometrial hyperplasia relative to individuals without PCOS.[1],[2]  In this article we explore the link between PCOS and endometrial hyperplasia.

Endometrial hyperplasia is a condition where the lining of the uterus, called the endometrium, becomes thicker than normal.  The thickening is usually caused by an imbalance in two hormones, estrogen and progesterone.   When there is excess estrogen without enough progesterone, endometrial hyperplasia can occur.  

Symptoms associated with endometrial hyperplasia include:[3],[4]

• Bleeding during your period that is heavier or lasts longer than usual;

• Bleeding between periods;

• Short menstrual cycles of less than 21 days; and

• Bleeding from the vagina after menopause.

Note that some of these symptoms overlap with those associated with PCOS, endometriosis and peri-menopause in addition to other conditions.

Endometrial hyperplasia is a pre-cancerous condition where the endometrial cells crowd and develop abnormalities and can become cancerous.[5]

PCOS is associated with anovulation, the failure to release an egg through a regular menstrual cycle:[6]

• Without ovulation, the endometrium, the lining of the uterus, does not shed in a regular monthly cycle;[7]

• In addition, whilst the ovaries continue to produce estrogen despite lack of ovulation, less progesterone is produced resulting in an estrogen rich environment;

• The endometrium that remains for an extended period without shedding is exposed to estrogen;[8] and

• In an estrogen-rich environment, the endometrial cells continue to grow and thicken the lining of the uterus, a process known as hyperplasia.[9]

There are other risk factors for endometrial hyperplasia, including:[10],[11],[12]

• Increasing age;

• Early menstruation or late menopause;

• Never having been pregnant;

• Previously diagnosed with infertility;

• Obesity;

• Personal history of diabetes, gallbladder disease or thyroid disease;

• Family history of ovarian, colon or uterine cancer;

• Having Lynch syndrome, also known as Hereditary Nonpolyposis Colorectal Cancer (HNPCC);[13]

• Having Cowden syndrome, a rare inherited disorder characterized by multiple noncancerous growths and increased risk of developing certain cancers;[14]

• Personal history of radiation of the pelvis;

• Medications such as estrogen without progesterone or hormone therapy for breast cancer;

• Compromised immune system due to autoimmune conditions and/or medications;

• Being diagnosed with a tumor that excretes estrogen; and

• Use of tobacco.

Endometrial hyperplasia may be diagnosed through a variety of procedures:[15]

• Transvaginal ultrasound where a probe is inserted into the vagina to examine the reproductive organs;

• Endometrial biopsy where a small sample of the endometrium is taken to examine for cancerous cells; and

• Hysteroscopy where a thin tube with a small camera is inserted into the uterus.

Endometrial hyperplasia is typically treated with progestin administered orally, via injection, in a vaginal cream or via an intrauterine device (IUD).[16]  Where the condition persists or pre-cancerous cells are detected, hysterectomy may be recommended.[17]

Reviewed by Dr. O, one of Neuraura’s friends and trusted advisors.

Source/(s)

[1] https://www.jogcr.com/article_708957.html

[2] https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.788772/full

[3] https://my.clevelandclinic.org/health/diseases/16569-atypical-endometrial-hyperplasia

[4] https://www.acog.org/womens-health/faqs/endometrial-hyperplasia

[5] https://www.acog.org/womens-health/faqs/endometrial-hyperplasia

[6] https://fertility.womenandinfants.org/services/women/anovulation

[7] https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics/

[8] https://my.clevelandclinic.org/health/body/22353-estrogen

[9] https://www.acog.org/womens-health/faqs/endometrial-hyperplasia

[10] https://my.clevelandclinic.org/health/diseases/16569-atypical-endometrial-hyperplasia

[11] https://www.acog.org/womens-health/faqs/endometrial-hyperplasia

[12] https://www.yalemedicine.org/conditions/endometrial-hyperplasia

[13] https://medlineplus.gov/genetics/condition/lynch-syndrome/

[14] https://medlineplus.gov/genetics/condition/cowden-syndrome/

[15] https://www.sinaihealth.ca/areas-of-care/cancer/endometrial-hyperplasia

[16] https://www.yalemedicine.org/conditions/endometrial-hyperplasia

[17] https://www.yalemedicine.org/conditions/endometrial-hyperplasia