Endometrial Hyperplasia With Atypical Features: Symptoms, Identification, Therapy
Atypical Endometrial Hyperplasia (AEH) is a condition that affects the lining of the uterus, and it's important for individuals to be aware of its symptoms and potential causes.
If you experience periods that are heavier or last longer than usual, fewer than 21 days between each period, bleeding between periods, postmenopausal bleeding, having no periods before menopause, or unusual vaginal discharge, it's crucial to consult your doctor.
AEH is a type of endometrial hyperplasia (EH), a condition where the lining of the uterus grows too thick. The primary cause of AEH is prolonged estrogen stimulation without progesterone opposition, often due to obesity, hormone therapy, or anovulation.
Obesity increases unopposed estrogen exposure, as excess adipose tissue converts androgens to estrogens. Hormone therapy, particularly estrogen-only hormone replacement therapy (HRT), is another significant cause, especially when used without accompanying progesterone. Anovulatory cycles, common in perimenopausal women and those with conditions such as polycystic ovary syndrome (PCOS), also contribute to this imbalance.
Medical conditions like diabetes, hypertension, and PCOS are associated with hormonal imbalances predisposing to AEH. A person's reproductive history, such as never having been pregnant or late menopause, can also increase the risk. Age is another factor, with the risk increasing with advancing age, particularly postmenopausally.
Additional contributors may include the use of medications like tamoxifen that have estrogen-like effects on the uterus and the presence of benign uterine growths (fibroids, polyps) which may coexist with or contribute to abnormal bleeding, signaling underlying endometrial pathology.
AEH is a precancerous condition, meaning it's not cancer but can lead to cancer of the uterus. If left untreated, AEH progresses to cancer in approximately 50% of cases.
Diagnosis of AEH involves a transvaginal ultrasound, endometrial biopsy, hysteroscopy, and dilation and curettage. If a person wants to become pregnant in the future, they may be able to be treated using progesterone therapy without a hysterectomy.
To reduce the chances of developing AEH, individuals can take progesterone or progestin, use hormonal contraception, maintain a moderate weight, and stop smoking. It's also essential to clarify with your doctor which conditions they are referring to if they use EH as an umbrella term for EH without atypia and AEH.
In some cases, a total hysterectomy may be recommended to eliminate the risk of progression to cancer. However, it's important to note that AEH can be caused by various factors, including hormone replacement therapy, diabetes mellitus, polycystic ovary syndrome, immunosuppression in the form of tamoxifen, obesity, age, genetics, tumors on the ovaries, or Lynch syndrome.
Lynch syndrome is a condition that causes the growth of tumors in the uterus and ovaries. The lining of the uterus thickens and thins during ovulation and pregnancy and usually sheds if a person is not pregnant, causing a menstrual period. In people with AEH, this process is disrupted.
Treatment for AEH varies depending on the abnormality of the cells, surgical risks, bleeding, and future pregnancy plans. It's crucial to discuss these factors with your healthcare provider to determine the best course of action.
- In women's health, AEH, a precancerous condition, can lead to cancer of the uterus, emphasizing the importance of mental health during medical-condition discussions, as the diagnosis and treatment can be stressful.
- Science highlights that medical conditions like diabetes, hypertension, and PCOS, and hormone therapy, particularly estrogen-only HRT, can contribute to endometriosis-related conditions such as AEH, necessitating ongoing health-and-wellness awareness and regular medical check-ups.
- Besides affecting physical health, AEH and related medical-conditions can impact reproductive health in women, with complications such as infertility, unusually heavy periods, or increased risk of cancer, underscoring the importance of considering mental health alongside physical care for a holistic approach to women's health.
