Can Uterine Hyperplasia Cause Heavy Periods?
Yes, endometrial hyperplasia is a well-established cause of heavy menstrual bleeding, with abnormal uterine bleeding being the most common presenting symptom of this condition. 1, 2
Understanding the Relationship
Endometrial hyperplasia directly causes heavy menstrual bleeding through excessive proliferation of the endometrial lining, which results in increased menstrual blood loss when shedding occurs. 2
Abnormal uterine bleeding is the most common presenting symptom in patients with endometrial hyperplasia, occurring across all age groups but particularly in postmenopausal women and those with unopposed estrogen exposure. 1, 2
The mechanism involves unopposed estrogen stimulation of the endometrium, leading to excessive endometrial thickening that manifests as heavy, irregular, or prolonged menstrual bleeding. 3, 2
Clinical Context and Differential Diagnosis
It's important to distinguish endometrial hyperplasia from other common causes of heavy menstrual bleeding:
Uterine fibroids are the most common structural cause of heavy bleeding in women under 40 years of age, while endometrial polyps predominate in women over 40. 4
Among women presenting with abnormal uterine bleeding who undergo endometrial curettage, approximately 21-22% have simple hyperplasia, with smaller percentages having complex or atypical forms. 5
Up to 14% of women experience irregular or excessively heavy menstrual bleeding from various causes, making proper diagnostic evaluation essential. 3
Diagnostic Approach
When endometrial hyperplasia is suspected as the cause of heavy bleeding:
Transvaginal ultrasound is recommended as the initial imaging modality to evaluate endometrial thickness and characteristics. 1
Endometrial biopsy is mandatory to confirm the diagnosis, with options including diagnostic curettage, hysteroscopic-guided biopsy, or endometrial aspiration biopsy. 1
Women 35 years or older with recurrent anovulation, younger women with risk factors for endometrial cancer, or those with bleeding unresponsive to medical therapy require endometrial biopsy. 3
Important Clinical Caveat
The presence of heavy menstrual bleeding with endometrial hyperplasia carries significant implications beyond symptom management, as atypical hyperplasia represents substantial risk for progression to endometrial carcinoma. 2 This makes accurate diagnosis and appropriate treatment critical for both symptom control and cancer prevention.