Precancerous conditions of the uterus

Atypical endometrial hyperplasia is a precancerous condition that can develop in the lining of the uterus (called the endometrium). It is an overgrowth of abnormal cells, or it can develop from endometrial hyperplasia, which is an overgrowth of normal cells. Sometimes polyps that grow in the uterus will have atypical endometrial hyperplasia.

Atypical endometrial hyperplasia is not yet cancer. But if it isn’t treated, there is a chance that these abnormal changes may become uterine cancer.

Atypical endometrial hyperplasia is usually seen in older women. It can also develop in younger women who do not ovulate or are obese.

Atypical endometrial hyperplasia develops when the female hormones, called estrogen and progesterone, are out of balance, and the endometrium is exposed to somewhat more estrogen than progesterone. This is called unopposed estrogen. Several things can cause this imbalance, including:

• hormone changes during menopause
• estrogen-only hormone replacement therapy (HRT)
• tamoxifen (Nolvadex, Tamofen) given to treat breast cancer

The most common symptom of atypical endometrial hyperplasia is abnormal vaginal bleeding. Some women may have abnormal vaginal discharge or an abnormal Pap test result, but these are less common.

If you have symptoms or your doctor thinks you might have atypical endometrial hyperplasia you will be sent for tests. Tests used to diagnose atypical endometrial hyperplasia may include the following.

Endometrial biopsy removes small pieces of the lining of the uterus (called the endometrium) so they can be looked at under a microscope. It is usually done in the doctor’s office.

Dilation and curettage (D&C) is a procedure in which the cervix (the lower, narrow part of the uterus, or womb) is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium (the inner lining of the uterus).

Treatment for atypical endometrial hyperplasia depends on:

• how different the abnormal cells are from normal cells
• the amount of bleeding
• surgical risks
• whether the woman might want to have children in the future

Treatment options for atypical endometrial hyperplasia may include:

• hysterectomy for post-menopausal women
• progesterone therapy for women who might want to have children in the future