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Abnormal Uterine Bleeding Can Be a Sign of Endometrial Disorder

Though Rare in Premenopausal Women, Some Risk Factors Are Known
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By Greg Fulton
WebMD Health News

Nov. 18, 1999 (Atlanta) -- Women who are overweight and in their forties who experience heavy or abnormal bleeding during menstrual cycles should be examined for endometrial hyperplasia or cancer, recommends a study in a recent issue of the medical journal American Journal of Obstetrics and Gynecology.

"Hyperplasia" refers to the thickening or buildup over time of the endometrium, or lining of the uterus. Hyperplasia can be a risk factor for endometrial cancer if left untreated.

The condition is commonly caused by an imbalance in the production of the sex hormones estrogen and progesterone, which can be reversed by hormone therapy

"Endometrial hyperplasia is unusual in premenopausal women but can occur in women who are infertile, overweight, or with a history of irregular periods," David F. Archer, MD, tells WebMD. Archer is professor of obstetrics and gynecology at Eastern Virginia Medical School, Norfolk.

"Most physicians know that an evaluation should include an endometrial biopsy to [rule out] hyperplasia in cases of abnormal bleeding," says Archer, who reviewed the study's results for WebMD.

The study analyzed 1,033 cases of patients with abnormal bleeding and found a relatively low rate of hyperplasia. Overall, 20 cases of simple hyperplasia and 23 cases of complex hyperplasia were confirmed.

From those patients, researchers were able to compile common characteristics they consider risk factors for hyperplasia in premenopausal women experiencing abnormal bleeding.

The risk was found to be highest in women weighing 200 lb. or more and at least 45 years of age. Women who were infertile, had a family history of cancer, and who had never been pregnant also had higher rates of hyperplasia.

Archer recommends that women in their thirties who experience abnormal uterine bleeding should also be evaluated for hyperplasia or cancer. But he stresses that endometrial cancer is rare in younger women -- and that even in older women, hormone therapy can greatly reduce the risk.

"The incidence of [endometrial cancer] in women over 50 is one case in 1,000 women per year. The use of oral contraceptives for one year has been shown to reduce the risk of endometrial cancer by 40% to 50%, and the risk reduction lasts for up to 15 years," he says.

In the study group, where every woman experienced abnormal bleeding, five cases of endometrial cancer were confirmed.

The study found that obesity was the greatest risk factor for hyperplasia, due to the overproduction of estrogen caused by hormonal and metabolic reactions to obesity.

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