I am on HRT and have had severe breakthrough bleeding. I recently had an endometrial biopsy and hysteroscopy and have been diagnosed as having simple hyperplasia. What is simple hyperplasia, and how is it treated?

R.D.

Hyperplasia means the uterine lining is thickened. Simple hyperplasia means it is thick but the normal architectural pattern is preserved. Sometimes the cells themselves appear abnormal, and then the phrase "with atypia" is added. Simple hyperplasia is the most benign type of hyperplasia, and the least likely to progress to cancer.

Treatment for simple hyperplasia can be medical or surgical. Medical treatment consists of either progesterone (natural or synthetic) for three to six months or cyclic estrogen and progesterone, followed by repeat endometrial biopsy (sampling of the tissue inside the uterus) at the end of therapy. Surgical treatment can be a D&C or a hysterectomy (removal of the uterus). In cases of simple hyperplasia, hysterectomy is usually recommended only if there is another reason to consider this surgery, such as uterine prolapse.

Which option is the best for you depends on what symptoms you are having, other medical conditions you may have, whether you are at high risk for endometrial cancer, and your comfort level with each option. Only a discussion with your own doctor will help you arrive at that best decision.