Endometrial Hyperplasia Warning
An endometrial hyperplasia warning was issued in February 2016 but the signs and symptoms are still not being communicated to women. Endometrial hyperplasia is a condition which may develop into cancer if left untreated or there is a delay to treatment. Guidance was published by the RCOG and British Society for Gynaecological Endoscopy (BSGE) national guidance in February 2016.
Endometrial hyperplasia is a thickening of the lining of the womb which is caused by overgrowth of the cells that line the womb. In some women it can develop into womb cancer, the most common gynaecological cancer with over 8,500 diagnoses each year. The incidence of endometrial hyperplasia is estimated to be at least three times higher. Most women diagnosed with womb cancer have had their menopause. Almost three quarters of cases in women aged 40 to 74.
Symptoms of Endometrial Hyperplasia
The most common symptom of endometrial hyperplasia is abnormal vaginal bleeding. This can include heavy menstrual bleeding, bleeding in between periods, irregular bleeding whilst on hormone replacement therapy (HRT) and bleeding after the menopause. Such bleeding can also be caused by other conditions and do not necessarily mean cancer. However, a misdiagnosis or a delay to diagnosis if not properly investigated can have devastating consequences.
Many women are fitted with a Mirena coil for irregular bleeding and investigations for other causes are not undertaken. The Mirena coil then ‘masks’ the symptoms by controlling the bleeding.
Endometrial hyperplasia is treatable and with early diagnosis, Doctors can minimise the risks of developing womb cancer in the future.
There are two types of endometrial hyperplasia; hyperplasia without atypia and atypical hyperplasia. The risk of endometrial hyperplasia without atypia progressing to cancer is less than 5% over 20 years and for the majority of women, the lining of the womb will return to normal without any treatment, especially if risk factors can be identified and reversed.
For some women, progestogen treatment (levonorgestrel-releasing intrauterine system [LNG-IUS]) for a minimum of six months should be offered as a first line treatment; it is the most effective way of thinning the lining of the womb, has minimal side effects and treats abnormal bleeding.
Atypical hyperplasia has an 8% risk of cancer within 4 years which increases to 27.5% after 19 years and should therefore be treated with a total hysterectomy. This decision should be individualised, in particular, for women who are premenopausal and wish to preserve their fertility.
Risk Factors for Endometrial Hyperplasia
Risk factors include: age, an increased BMI, polycystic ovarian syndrome, the use of tamoxifen as a treatment for breast cancer and the use of HRT for menopausal symptoms.
Using HRT for 1 year increases your risk of breast cancer, with a higher risk for longer use. According to the NHS Guidance the risk appears to remain for more than 10 years after stopping HRT. It also seems that there’s a higher risk with combined preparations than with oestrogen-only HRT.
Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the larger the risk. So, oestrogen-only HRT is usually only offered to those who have had their womb removed (a hysterectomy) as they have no risk of womb cancer to begin with according to Cancer Research UK.
It is estimated that at least 25,000 women in the UK are suffering from endometrial hyperplasia. Many women aren’t aware of the condition.
Dr Victoria Handley, Director of Handley Law and Solicitors for Women stated that
“it was hoped that the publication of the guideline would help to raise awareness of the signs and symptoms. Particularly those which can be a precursor to womb cancer. Sadly there are increasing numbers of women experiencing abnormal bleeding or discharge. Particularly those after the menopause, who are experiencing a delay to investigations or misdiagnosis of their condition”.
If you have been diagnosed with womb cancer and have suffered a misdiagnosis or delay to diagnosis then get in touch with our Solicitors for Women team on 0800 470 2009 or contact Dr Victoria Handley at firstname.lastname@example.org