Endometrial Hyperplasia: What It Is and How to Manage It

Ever wonder why some women get heavy or irregular periods? One common reason is endometrial hyperplasia – a condition where the lining of the uterus (the endometrium) grows too thick. It’s not cancer, but it can become a problem if left unchecked. Below we’ll break down what causes this over‑growth, what symptoms to watch for, and the most effective ways to treat it.

Why Does the Uterine Lining Grow Too Thick?

Hormones are the main drivers. When estrogen is high and progesterone is low, the endometrium keeps building up without the usual shedding that happens during a normal menstrual cycle. This hormonal imbalance can be caused by:

  • Polycystic ovary syndrome (PCOS)
  • Obesity – fat tissue makes extra estrogen
  • Takeaway birth control pills or hormone therapy
  • Perimenopause – the body’s hormone rhythm gets shaky

These factors raise your risk, especially if you’re over 40. Knowing the why helps you and your doctor target the right treatment.

Spotting the Signs

Most people notice a change in their periods first. Look for:

  • Bleeding between periods
  • Period that lasts longer than usual
  • Heavier flow or clots
  • Spotting after menopause

If any of these sound familiar, don’t wait. A quick office visit can rule out other issues and get a diagnosis.

Doctors usually check the lining with an ultrasound and then confirm with a tissue sample (endometrial biopsy). The biopsy tells them whether the hyperplasia is simple or complex, and if there are any atypical (pre‑cancer) cells. That information decides the next steps.

Treatment Options That Work

Most cases respond well to hormone therapy. The goal is to add progesterone back into the cycle so the lining stops over‑growing and starts shedding normally.

  • Progestin pills – taken daily for several months.
  • Levonorgestrel IUD – a tiny device placed in the uterus that releases progesterone directly where it’s needed.
  • Oral progesterone creams – an option for women who can’t swallow pills.

These treatments are often enough for simple hyperplasia without atypia. If the biopsy shows atypical cells, doctors may suggest a stronger approach, such as a hysterectomy (removal of the uterus) or a more aggressive progestin regimen.

In addition to medication, lifestyle tweaks can lower estrogen levels:

  • Lose excess weight – even a 5‑10% reduction helps.
  • Exercise regularly – it improves hormone balance.
  • Limit alcohol and avoid smoking.

What to Expect After Treatment

Most women see the thickened lining thin out within 3‑6 months of starting therapy. Follow‑up ultrasound or a repeat biopsy confirms that the tissue is back to normal. If it’s not, your doctor may adjust the dose or switch to a different progestin method.

Even after successful treatment, keep an eye on any new bleeding. Recurrence can happen, especially if risk factors stay the same. Regular check‑ups are the safest way to stay ahead.

Bottom line: endometrial hyperplasia is a manageable condition when caught early. Talk to your healthcare provider if your periods change, and don’t ignore spotting after menopause. With the right hormone therapy and a few healthy habits, you can bring your uterine lining back to normal and keep it that way.