Endometrial hyperplasia means the lining of the womb (the endometrium) has become too thick. It usually happens when there is too much of the hormone oestrogen without enough progesterone to balance it. It is not cancer — but some types can develop into cancer of the womb if left untreated, which is why finding it early and treating it properly matters so much.1

What raises the risk?

Several things can increase the chance of developing endometrial hyperplasia:

  • Being overweight — fat tissue produces extra oestrogen
  • Polycystic ovary syndrome (PCOS)
  • Oestrogen-only hormone replacement therapy (HRT) without progesterone
  • Tamoxifen (a breast cancer medicine)
  • Never having been pregnant
  • Lynch syndrome — an inherited condition (also called HNPCC) that increases the risk of womb and bowel cancer

Symptoms to look out for

Some women have no symptoms, but the most common sign is abnormal bleeding, such as:

  • Heavy, prolonged, or irregular periods
  • Bleeding or spotting between periods
  • Any bleeding after the menopause

Bleeding after the menopause always needs to be checked promptly — you can read more in our guide to postmenopausal bleeding. If you notice any of these, please see your doctor.

How it is diagnosed

To find out what is causing abnormal bleeding, your doctor may arrange:

  • A pelvic ultrasound scan — to measure the thickness of the womb lining.
  • An endometrial biopsy — a small sample of the lining, taken with a very thin tube, usually in the clinic.
  • A hysteroscopy — a slim camera to look inside the womb, with a sample taken at the same time if needed.

The two types — and why it matters

Endometrial hyperplasia is now grouped into two types, because this decides the treatment:1

  1. Hyperplasia without atypia — the cells look normal apart from the extra thickness. The risk of it becoming cancer is low (less than 5% over 20 years), and it very often settles with hormone treatment.
  2. Atypical hyperplasia — the cells themselves look abnormal. This carries a much higher risk: a significant proportion of women either already have, or go on to develop, womb cancer. For this reason it is treated more definitively.

How it is treated

Treatment depends on the type, your age, and whether you hope to have children in future.

For hyperplasia without atypia, the aim is to reverse the thickening with progesterone:

  • Progestogen tablets are the usual first-line treatment in our practice.
  • The hormone coil (levonorgestrel intrauterine system, LNG-IUS) is an equally effective — and in the guidelines, preferred — alternative that releases progesterone directly into the womb. Where it is accessible and affordable, it is an excellent option, and can stay in place for up to five years to reduce the chance of the problem returning.
  • Addressing the underlying cause (for example, weight loss, or adjusting HRT) is an important part of treatment.

For atypical hyperplasia, because of the higher cancer risk, a hysterectomy (removal of the womb) is usually recommended once a woman has completed her family. For younger women who still wish to have children, hormone treatment (often the hormone coil) may be used to try to reverse the changes, with very close monitoring — this is decided case by case with a specialist.1

Follow-up: making sure it has cleared

If you are treated with hormones rather than surgery, follow-up is essential. This usually means repeat endometrial biopsies about every six months, and treatment continues until at least two normal results in a row are obtained.1 After that, if any abnormal bleeding returns, you should be reviewed again, as it may signal the problem has come back.

Reducing your risk

You can lower your risk by keeping to a healthy weight, managing conditions like PCOS with your doctor's help, and only using HRT under medical supervision — women with a womb should not take oestrogen-only HRT.1

The takeaway

Endometrial hyperplasia is common, treatable, and — caught early — very often reversible. The key is not to ignore abnormal bleeding. With the right treatment and proper follow-up, most women clear the condition and protect themselves from womb cancer. If you have any concerning symptoms, please come and see us at Sugabi Clinic.

References

  1. Royal College of Obstetricians and Gynaecologists, British Society for Gynaecological Endoscopy. Management of endometrial hyperplasia (Green-top Guideline No. 67) [Internet]. London: RCOG/BSGE; 2016 [cited 2026 Jul 21]. Available from: https://www.rcog.org.uk/media/knmjbj5c/gtg_67_endometrial_hyperplasia.pdf
  2. NHS. Womb (uterus) cancer [Internet]. London: NHS; [cited 2026 Jul 21]. Available from: https://www.nhs.uk/conditions/womb-cancer/