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The lining of the uterus changes throughout the menstrual cycle in response to the hormones (oestrogen and progesterone) that is produced by the ovaries. Oestrogen is made before the egg ovulates and progesterone is made after the egg ruptures. Oestrogen enables the lining to grow and progesterone enables the lining to store glycogen. As and when the fertilized egg comes along, the lining can nourish it and enable it to attach itself to the uterus and thus grow. If fertilization has not happened, then the hormone levels decrease and the lining is eventually shed as a period.

There are times when a woman may not ovulate, oestrogen is produced, progesterone is not produced (as in patients with PCOS, perimenopause women, long term use of drugs like tamoxifen and commonly after menopause). In this case the lining continues to grow in response to oestrogen but it is not shed as there is no progesterone. It is not shed appropriately and the woman may have irregular bleeding and spotting.

The lining can then become very thick. It is then called hyperplasia. This is not cancer but the same lining can become cancerous in the long run.

The commonest presenting symptom for endometrial hyperplasia is abnormal bleeding. This may be in form of heavier cycles, longer duration of flow, short cycles, erratic bleeding and bleeding after menopause.

One must report to the gynaecologist in case one as any abnormal bleeding. The doctor will do a complete gynaecological examination and then suggest tests. These may be blood tests and pelvic sonography.

The sonography is useful in diagnosing a thick lining. But this is not enough to diagnose hyperplasia. A definitive diagnosis is obtained only after the doctor takes a small fragment of the lining and it is examined under the microscope to see changes of hyperplasia.