Atypical endometrial hyperplasia (AEH) occurs when the lining of the uterus is too thick and contains abnormal cells. It can cause vaginal bleeding and may progress to cause further symptoms.

AEH is a type of endometrial hyperplasia (EH), a condition where the lining of the uterus grows too thick due to excess estrogen. AEH is also called endometrial hyperplasia with atypia or atypical hyperplasia.

The rare condition affects around 17 out of 100,000 people with uteruses per year. It is a precancerous condition, which means that it is not cancer but can lead to cancer of the uterus.

Read on to learn about what AEH is, its causes, diagnosis, risk factors, and more.

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AEH is a condition that occurs when abnormal cells grow in a person’s uterine lining.

The lining of the uterus thickens and thins during ovulation and pregnancy and will usually shed if a person is not pregnant, causing a menstrual period. However, in people with EH, an imbalance of hormones will prevent the lining from shedding.

When this occurs, the lining of the uterus continues to thicken, and the cells there can grow too close together. This can result in the cells becoming abnormal.

Research shows that, without treatment, AEH progresses to cancer in around 25% of cases.

EH can occur with or without atypia. Atypia means abnormal cells.

EH without atypia is a condition in which the lining of a person’s uterus does not shed, causing the cells to continue growing. When a person has EH without atypia, the cells in their uterus tend to be overgrown, but not abnormal. This condition can usually be treated with progesterone therapy.

However, EH with atypia, or AEH, is a precancerous condition that occurs when the cells are abnormal.

Doctors sometimes use EH as an umbrella term for EH without atypia and AEH, so a person should clarify with their doctor which conditions they are referring to if needed.

AEH occurs when a person experiences an ongoing imbalance of the hormones estrogen and progesterone. These hormones both play an important role in the function of the uterus.

When there is an imbalance, it can affect the way a person’s uterine system functions. AEH occurs when a person’s estrogen levels are too high, and their progesterone levels are too low.

This hormone exposure may occur due to some of the following reasons:

The main symptom of AEH is abnormal bleeding from the uterus. Several other conditions can also cause this, so a doctor will need to conduct some tests to identify the cause.

They will ask a person about their medical history and symptoms and then conduct one or more of these tests:

  • Transvaginal ultrasound: This allows the doctor to check the thickness of the uterine lining and look for other causes of bleeding.
  • Endometrial biopsy: A doctor removes cells from the uterine lining to be analyzed under a microscope. This can help to rule out or confirm the presence of cancerous cells.
  • Hysteroscopy: A doctor uses a thin camera and light to check for abnormalities inside the uterus.
  • Dilation and curettage: A doctor removes tissue from the uterus to analyze it for signs of abnormalities.

A person can take some steps to reduce their chances of developing AEH, such as:

  • taking progesterone, or progestin, if they are taking estrogen
  • taking hormonal contraception to regulate the menstrual cycle
  • maintaining a moderate weight
  • stopping smoking, if they smoke

Treatment for AEH can vary depending on the following:

  • the abnormality of the cells
  • surgical risks for that person
  • how much bleeding the person experiences
  • whether the person wishes to get pregnant in future

As research shows that EAH progresses to cancer in nearly 25% of cases, doctors may recommend a total hysterectomy to eliminate this risk. However, if a person wants to become pregnant in the future, they may be able to be treated using progesterone therapy without a hysterectomy.

A person should speak with their doctor about the risks and benefits of each type of treatment to find out which would be best for them.

The main symptom of AEH is abnormal bleeding from the uterus.

A person should contact their doctor if they experience:

AEH is a precancerous condition where the lining of the uterus is too thick, and the cells become abnormal. It is usually treated with a total hysterectomy but, in some cases, may also be managed with progesterone therapy.

If a person experiences unusual uterine bleeding, they should contact their doctor.