Making Sense of Hyperplasia
by Laura Dolson
“I have to have a hysterectomy,” my friend Connie announced recently. “I have hyperplasia, which is pre-cancerous. My doctor says there’s a 25% chance that I already have cancer in my uterus that wasn’t picked up on the biopsy.”
Jana, sitting next to Connie, sounded worried at this news. “I have hyperplasia too,” she said. “But I’m taking hormone treatments, and the doctor says we’ll just keep an eye on it.” She paused. “A 25% chance?”
They both turned to me for information, and I suddenly realized how little I knew about the varieties of hyperplasia and probabilities of cancer. Still, I figured that a few minutes with some books and Web sites would yield the answers they were looking for.
To my surprise, my initial net search produced more confusion than clarification. Within half an hour, I had found about nine different, seemingly overlapping classifications of hyperplasia, each with varying references to cancer development. Realizing that most women with hyperplasia would have a similar experience, I decided to devote more serious attention to the subject, and turned to the medical literature. Here's what I found out.
Hyperplasia basics: The endometrium of the uterus is unusual tissue, perhaps even unique in the human body. It is tissue with a definite structure and function, yet for much of a woman’s life, her body sloughs off most of it monthly, and the rebuilding starts over again! This rise and fall is regulated by the hormones of the menstrual cycle, chiefly estrogen and progesterone.
During the first half of the cycle, when estrogen predominates, the endometrium builds up. Then, in the second half of the cycle (after ovulation), estrogen and progesterone prepare the endometrium to nourish a fertilized ovum. If fertilization doesn’t occur, the level of progesterone drops precipitously, and the endometrium is sloughed off in the form of a menstrual period.
However, things aren’t always this smooth. One common scenario develops in the years prior to menopause ("perimenopause"), as a woman’s periods are becoming less regular. Often, she will have some “anovulatory” cycles, where no ovulation occurs. During these cycles, the endometrium builds up, but isn’t properly sloughed off because there’s not enough progesterone present (and, consequently, there’s no triggering drop in the level of progesterone). Over time, this lack of regular sloughing can lead to the condition known as hyperplasia (literally, too many cells). In fact, too much estrogen (at any age), or an imbalance between estrogen and progesterone, is implicated in most hyperplasias. This is why women taking hormone replacement therapy are at increased risk as well.
So, you have hyperplasia. What does this mean?
You may hear that it means you have a precancerous condition, and this might be the case. However it is important to know what type of hyperplasia you have. The “type” of hyperplasia basically refers to 1) what the individual cells look like, and 2) how they are distributed in the endometrium. The terms for these changes can be confusing, mainly because there have been several different attempts to categorize them in the past few decades. Unfortunately, each new proposed system of terminology has been adopted to differing degrees in different areas. I found references to all of them in a quick Internet search.
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