Endometrial Hyperplasia: A Gynecologist's Guide to Detection and Diagnosis

Diagnosing endometrial hyperplasia (EH) can present unique challenges. It is important to diagnose early, as atypical hyperplasia or endometrioid intraepithelial neoplasia (EIN) can turn into cancer and usually require surgery.

EH is characterized by thickening of the endometrium, specifically hyperplastic changes in its glandular and stromal structures. The condition can stem from both high levels of estrogen and low levels of progesterone. It is one of the most common reasons for abnormal uterine bleeding, and if left untreated it may lead to endometrial carcinoma. A few key questions can help physicians explore the best techniques for detecting and diagnosing endometrial hyperplasia.

1. Is ultrasound or biopsy better for diagnosing endometrial hyperplasia? Lisbet Hanson, MD, an OB/GYN in Virginia Beach, Virginia, recommends using ultrasound to assess a patient with abnormal bleeding for EH before conducting a biopsy. Ultrasound is readily available and can offer invaluable information about the endometrium, uterus and adnexa. Measuring the endometrium is also more easily done before it is disturbed by a biopsy.

2. How does the WHO's updated classification system make identifying EIN easier? In 2014, the World Health Organization (WHO) simplified its classification of endometrial hyperplasia into two categories: hyperplasia without atypia and atypical EH, also called endometrioid intraepithelial neoplasia (EIN). The latter, EIN, can develop into cancer if not diagnosed and treated. The simplification was made because of a new understanding of the molecular genetic changes that occur in the disorder.

3. How does ultrasound help to diagnose endometrial hyperplasia? Because endometrial carcinoma is the fourth most common type of cancer among women in the United States, accurately and promptly identifying and diagnosing EH is critical. Transvaginal ultrasound can help to assess and measure the endometrium in patients with abnormal uterine bleeding. 3D ultrasound can help further distinguish the causes of abnormal uterine bleeding.

Ultrasound is a readily available imaging modality as well as a central part of identifying and diagnosing EH. Using this technology properly can help physicians diagnose patients as early as possible in the disease process, leading to better outcomes and preventing its development into endometrial carcinoma.