hyperplasia

I was dx. with hyperplasia. I am currently on provera for 7days trying to stop bleeding. I have been bleeding now for 15days pretty heavy with clots. I just had a uterine biopsy in nov of 2010 that was negative and now this one is showing hyperplasia. I am 49yrs old and the hormone profile shows perimenopause. My question is what is the next recommended options. Of course I am having some anxiety since she said the hyperplasia was precancerous. I am afraid and would like an opinion as to what to do. My doctor did recommend stronger hormone therapy for three months and repeat the biopsy. Or, up to me if I want a partial hysterectomy. Thank you for any opinion.

[Elaine Brown, MD]

Hi!
Hyperplasia is thought to occur when hormones are out of balance.  In particular progesterone prevents and treats hyperplasia.  In the peri-menopause, ovulation occurs irregularly and therefore progesterone is only produced sporatically.  After menopause, estrogen levels tend to drop too which helps to reduce the risk of hyperplasia, although continued production in adipose tissue, or excess estrogen in hormone replacement therapy can still lead to hyperplasia.

If there are any atypical cells in the biopsy specimen, hysterectomy is usually recommended.  If there are no atypical cells, treatment with hormone therapy is a widely accepted alternative. If hyperplasia is NOT treated, it can eventually progress to cancer of the uterus.

In the absence of atypcial cells, the decision to treat hyperplasia with medications or surgery can be made by the patient/doctor pair.  Important considerations include the patient's surgical risk (eg are there other medical conditions such as hypertension or diabetes which makes surgery risky) and the risk for recurrence of the hyperplasia.

Hope this helps!
Dr B

[HessyKat]

Thank you so very much. I feel much better now about the hormone therapy I will be trying for three months and then rebiopsy to see if everything has returned to normal. Just the dx. of very very early signs of precancer had me scared to death. Thanks again.