Uterus -

Disordered proliferative endometrium

This article was reviewed and updated on November 20, 2018

by Adnan Karavelic, MD FRCPC

Quick facts:

  • Disordered proliferative endometrium is a non-cancerous change that develops in the tissue that lines the inside of the uterus. 

  • The glands in disordered proliferative endometrium are abnormal in both shape and size. There are many conditions that can cause a disordered proliferative endometrium which you should discuss with your doctor.

The normal uterus and endometrium

The uterus (womb) is a pear-shaped hollow organ that is in the female pelvis between the rectum (distal segment of the large bowel) and the urinary bladder. The upper part of the uterus (fundus) is attached to the fallopian tubes while the lower part is connected to the vagina through the uterine cervix.

The walls of the uterus are made up of three layers: 

  1. Endometrium – The endometrium forms the inner lining of the uterus. The endometrium is composed of endometrial glands lined by one layer of columnar epithelium and surrounded by endometrial stroma.

  2. Myometrium – The myometrium is the middle layer and is made up of smooth muscle which allows the uterus to change size and contract. 

  3. Serosa – The serosa is a thin layer of tissue that surrounds the outside of the uterus.

Changes associated with the menstrual cycle

The endometrium is hormone-responsive and goes through regular menstrual cycles during a women’s reproductive years. Each menstrual cycle is controlled by a complex orchestra of hormones. During the menstrual cycle, the endometrium is preparing itself for the possible pregnancy by becoming thicker and richer in blood vessels.

 

In the first part of the menstrual cycle, the endometrium is growing under the influence of estrogen (a hormone produced by the ovaries) and is known as the proliferative phase (growing phase).

 
After ovulation (ovulation is when an egg is released from the ovary, pushed down the fallopian tube, and is made available to be fertilized), the endometrial changes are under control of progesterone (another hormone released by the ovaries). If pregnancy does not occur (the egg is not fertilized), the thickened endometrial lining is shed, accompanied by bleeding (menses), and the cycle repeats.

Abnormal changes

In some situations, however, the endometrium is exposed to a prolonged influence of estrogen. That results in increased growth and crowding of the endometrial glands, and can lead to endometrial hyperplasia. Some common situations that can result in prolonged estrogen exposure include polycystic ovary syndrome, obesity, eating disorders, thyroid disorders, and estrogen-only birth control pills. Women nearing menopause (perimenopause) may also experience prolonged estrogen exposure.

 

What is disordered proliferative endometrium?
The diagnosis of disordered proliferative endometrium is a descriptive diagnosis. It means that after examining your tissue sample under the microscope, your pathologist saw irregular and dilated endometrial glands in the proliferative phase (growing phase).


The diagnosis of disordered proliferative endometrium is just one piece of the answer and the diagnosis needs to be considered together with your medical history, physical examination, and any other tests that were performed (blood work, imaging tests, etc.). Your doctor will use all of this information in order to determine the final diagnosis and reason for your disordered proliferative endometrium.

 

Why is this important? There are many causes for disordered proliferative endometrium. Your treatment options will depend on your medical history and the results of other tests performed. Talk to your doctor about what the diagnosis of disordered proliferative endometrium means to you. 

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