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Endometrial Hyperplasia: Treatment, Procedure, Cost and Side Effects

What is the treatment? How is the treatment done? Who is eligible for the treatment? (When is the treatment done?) Who is not eligible for the treatment? Are there any side effects? What are the post-treatment guidelines? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is the treatment?

Endometrial hyperplasia is a condition which occurs when the lining (endometrium) of the uterus (womb) becomes too thick. In some cases it can also lead to uterine cancer. Throughout the menstrual cycle of a woman, the endometrium changes as a response to the hormones. During the first phase of the cycle, estrogen in a woman’s body is mainly made by the ovaries. The estrogen makes the uterine wall a bit thick for the body to prepare itself for pregnancy. If the walls get too thick without the presence of progesterone level to control the estrogen level, endometrial hyperplasia occurs. If a woman doesn’t go through ovulation at any menstrual cycle, the progesterone doesn’t get made and this in turn avoids the lining to be shed. The endometrium can grow as a response to the excessive estrogen, this can make the cells inside the uterine lining crowded, thus forming an abnormal growth.

Endometrial hyperplasia can occur after menopause when progesterone is no longer made by the uterus because ovulation stops naturally. In most cases, it also occurs during perimenopause (ovulation doesn’t occur naturally). Other causes of endometrial hyperplasia include, use of estrogen boosting medicines, long term use of estrogen in women who have already gone through menopause, irregular periods, polycystic ovary syndrome (PCOS) and obesity. However, it can be treated effectively by a gynaecologist. Consuming progestin orally or using it as a vaginal cream can make the progesterone level balanced with the estrogen content, hence treating endometrial hyperplasia.

How is the treatment done?

In many cases, progestin can also be given as a shot inside an intrauterine device. However, the doctor decides what quantity of progestin should be given to you depending upon the severity of the condition and your age. Excessive progestin can be fatal so it is advisable to seek advice from a doctor before getting this treatment. Sometimes, if endometrial hyperplasia is diagnosed too late and it has already developed into complex atypical hyperplasia, the risk of cancer rises. In such cases, a doctor usually prescribes surgery like hysterectomy.

Symptoms of endometrial hyperplasia include, bleeding during menses which is heavier than usual and lasts long, menstrual cycles which are shorter than twenty-one days and vaginal bleeding after menopause. You should get diagnosis as soon as you experience these symptoms. Diagnostic tests will be performed by your doctor for signs of uterine cancer or endometrial hyperplasia. A transvaginal ultrasound test can be done to calculate the thickness of the uterine wall (endometrium). Sometimes, a small tissue can also be extracted from your vagina and studied under a microscope. This can also be done along with hysteroscopy, curettage, dilation and endometrial biopsy.

Who is eligible for the treatment? (When is the treatment done?)

Women who don’t have regular menstruation and have signs of amenorrhea can also consume progestins. It can also be consumed along with OHT (Ovarian hormone therapy) or ERT (Estrogen replacement therapy). Endometriosis causes a lot of pain, so progestin can be given to reduce the pain.

Who is not eligible for the treatment?

If you do not have enough estrogen in your body, progestin should be only consumed after a doctor’s advice.

Are there any side effects?

Progestin can have a number of side effects such as irregular menstrual cycles, bleeding or spotting between periods, sore breasts, headache, nausea, dizziness, weight gain, bloating or complete ceasing of menstrual periods. Most of the times, these side effect are temporary and will disappear as soon as you quit progestin medications.

What are the post-treatment guidelines?

After the treatment, it is vital to take care of your health properly and maintain a good diet so that endometrial hyperplasia doesn’t reoccur in future. Smoking and being obese can increase the chances of this disorder, so it is recommended to quit smoking completely and exercise regularly to control weight gain. Smoking also results to female infertility, so it should not be continued if you aim for a healthy lifestyle.

How long does it take to recover?

Recovery usually depends on your own capacity and metabolism rate, but if you are on progestin medications, endometrial hyperplasia can become completely treated in a period of a few months. However, progestin should be continued as recommended by your doctor and should not be consumed in excess or the results can be fatal.

What is the price of the treatment in India?

The price of progestin in India ranges from Rs. 70 to Rs. 2,000.

Are the results of the treatment permanent?

The results of the treatment are only permanent if proper prevention measures and care is taken after the treatment. However, there is still a possibility of the relapse of endometrial hyperplasia.

What are the alternatives to the treatment?

Women who have atypical hyperplasia can go through a surgery known as hysterectomy. This surgery should be considered keeping in mind, that she will not be able to conceive children after undergoing hysterectomy. Women with endometrial hyperplasia without atypia should consider using an IUS (Intrauterine system). This device releases progestogen in the lining of the uterus and reduces the symptoms of endometrial hyperplasia.

Popular Questions & Answers

I was on hrt (evatone2 & meprate) for last 1 years due to premature ovarian failure.(evatone for 21 days starting from 4th day of period and then meprate after 11 days). I stopped medicine 4 months back & did not get periods. Last month I started meprate twice for 10 days but even after 15 days did not get periods back. So now how and on which day should I start again my course of hrt (evatone2 and meprate) to start my periods? Can I start from tomorrow the full course again as I was taking earlier? Please suggest the course and when to start.

MBBS, M.S Obstetrics & Gynaecology, F.MAS FELLOWSHIP IN MINIMAL ACCESS SURGERY, D. MAS Dipolma in MINIMAL ACCESS SURGERY, FICRS, Fellowship in COSMETIC GYNAECOLOGY, Diploma in advanced Laparoscopy for Urogynaecology & Gynaec oncology, Basic training course in minimal invasive surgery in Gynaecology, Basics of Colposcopy, Fellowship in Cosmetic Gynaecology, Certificate course in diagnostic ultrasound imaging, Certificate of hands on training in hysteroscopy, Certificate course in diabetes, Fellowship in assisted reproductive technology, Certificate program in aesthetic Medicine, Certificate of operative Hysteroscopy, Certificate course in clinical embryology
Gynaecologist, Chennai
As you said you don't have the ovarian reserve that is there is premature ovarian failure you need to have priming of endometrium with the estrodiol tablets prior to taking meprate.

I am on hrt (rvatone and meprate) for last 1 years due to premature ovarian failure. I stopped medicine 4 months back. So did not get periods. Last month I started meprate twice for 10 days but it has been even 14 days now but I am not having periods. How to start periods now?

MS OBG
Gynaecologist, Guwahati
Since you have premature ovarian failure, taking only meprate won't help unlike others who have anovulation. You need to take evatone along with meprate to get your periods.

I got operated of hysterectomy, that time they has cut small part of urinary bladder bag was sticked with ovaries (bag). There was stitches inside so for healing doctor gave me linid 600. Now when m going to pass my stool it is not able to come easily waste out. Doctor said because of antibiotics the veins of became thick of anus. It is true. Or it is ide effects of linid?

MBBS, M.D., Dip.in pelvic surgey,
Gynaecologist, Kottayam
Linid 600 is a powerful antibiotic .but it is not likely to produce constipation, you can take mild laxative to overcome this problem. Anyway it is better to see your doctor for final opinion.
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