Emergency? If you are soaking through a pad or tampon every hour, feel faint or short of breath, or might be pregnant and are bleeding with pain, call 911 or go to the nearest emergency room. Know the warning signs
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Endometrial hyperplasia and cancer

Endometrial hyperplasia is an overgrowth of the uterine lining. Some forms can progress to endometrial cancer, the most common gynecologic cancer in the United States. Abnormal bleeding is usually the earliest sign, which is why it is worth checking.

By the AUB editorial teamUpdated September 2026PALM-COEIN: AUB-M

Types of hyperplasia

Hyperplasia without atypia has a low risk of becoming cancer and usually responds to progestin treatment. Atypical hyperplasia, also called endometrial intraepithelial neoplasia, is a true precancer. It carries a substantial risk of cancer that is either already present or develops later.

Risk factors

  • Age, especially after 45 and after menopause
  • Obesity, since fat tissue produces estrogen
  • Long-term lack of ovulation, as in PCOS
  • Estrogen therapy without a progestin in a person with a uterus
  • Tamoxifen
  • Diabetes
  • Lynch syndrome or a strong family history of uterine or colon cancer

Warning signs

Any bleeding after menopause. Before menopause: bleeding between periods, heavier or longer periods, or irregular bleeding, especially after age 45 or with the risk factors above.

Diagnosis

An endometrial biopsy samples the lining in the office. If the biopsy is not conclusive, hysteroscopy with dilation and curettage (D&C) is the next step.

Treatment

  • Hyperplasia without atypia: progestin therapy, often the levonorgestrel IUD, plus follow-up biopsies and treating risk factors
  • Atypical hyperplasia: usually hysterectomy; for people who want to preserve fertility, high-dose progestin with close surveillance can be an option
  • Endometrial cancer: care with a gynecologic oncologist

Sources

  1. American College of Obstetricians and Gynecologists; Society of Gynecologic Oncology. Committee Opinion No. 631: Endometrial intraepithelial neoplasia. Obstet Gynecol. 2015;125(5):1272–1278.
  2. American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–e129.
  3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206 (reaffirmed).

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