Endometrial Hyperplasia


Endometrial hyperplasia is when the lining of your womb (endometrium) becomes too thick. It is a pre-cancerous condition and a precursor of endometrial (womb) cancer.

There are two types of endometrial hyperplasia based on the kind of cell changes in your lining of the womb:

  • Hyperplasia without atypia
  • Hyperplasia with atypia

Symptoms of endometrial hyperplasia

People with endometrial hyperplasia may experience:

  • Abnormal vaginal bleeding or bleeding between periods.
  • Short menstrual cycles (less than 21 days).
  • Heavy periods
  • Bleeding after menopause
  • Not having a period at all 

People with endometrial hyperplasia produce too much oestrogens and not enough progesterone. These hormones play essential roles in menstruation and pregnancy. During ovulation, oestrogen thickens your endometrium, while progesterone prepares your uterus for pregnancy. If conception doesn’t occur, progesterone levels drop. The progesterone drop triggers your uterus to shed its lining as your menstrual period.

People who have endometrial hyperplasia make little, if any, progesterone. As a result, your uterus doesn’t shed its endometrial lining. Instead, the lining continues to grow and thicken. The cells that make up the lining can grow close together and become irregular.

Diagnosis of endometrial hyperplasia

Many conditions can cause abnormal uterine bleeding. To identify what’s causing your symptoms, we may perform one or more of these tests:

  • Ultrasound: A transvaginal ultrasound  can show if your uterine lining is too thick and/or abnormal.
  • Biopsy: An endometrial biopsy removes tissue samples from your uterine lining. Pathologists study the cells under a microscope to confirm or rule out cancer.
  • Hysteroscopy: We use a thin, lighted tool called hysteroscope to examine your neck of the womb (cervix) and look inside your womb. With hysteroscopy, we are able to visulise abnormalities within the endometrial cavity and take a biopsy of any suspicious areas.


Treatment for most cases of endometrial hyperplasia involves taking progestin. Progestin is the human-made version of progesterone, the hormone your body is lacking. Progestin comes in many forms:

  • Oral progesterone therapy (you swallow a pill).
  • Intrauterine device containing progesterone (Mirena).


MIRENA intrauterine device

Mirena coil consists of a small, soft, flexible plastic T-shaped frame which is inserted into the uterus. This carries the hormone in a sleeve around its stem, and has two fine threads attached to the base to help with removal. 

Mirena Insertion only takes a couple of minutes and can be done as an “in rooms procedure” in some instances or as a simple, quick day procedure at our practice. It is effective for up to 5 years.

Hysterectomy for endometrial hyperplasia

A hysterectomy is usually not necessary for treating endometrial hyperplasia. Most women respond well to progestin treatment. If your risk for uterine cancer is high or you are diagnosed with atypical endometrial hyperplasia, hysterectomy may be a possible treatment option. A hysterectomy to remove your womb can also be offered when:

  • Your condition worsens or cancerous cells develop.
  • Your condition doesn’t improve with progestin treatment.

About Dr. Tranoulis

Dr. Tranoulis is a Consultant Gynaecological  Surgeon with sub-specialisation in Gynaecological Oncology. He is certified as both a specialist Gynaecologist and sub-specialist Gynaecological Oncology Surgeon by the Royal College of Obstetricians and Gynaecologists (RCOG) and the European Society of Gynaecological Oncology (ESGO). He has extensive  experience as a lead of Gynaecology Rapid Access Clinic (the outpatient clinic where women with symptoms suspicious of gynaecological cancer are referred and seen) at several Tertiary Hospitals in Great Britain. He is certified in diagnostic and therapeutic hysteroscopy by the Royal College of Obstetricians & Gynaecologists (RCOG).