Women's Health Community

Dear djembegirl: Whilst there is a rare possibility of cancer of the uterine lining among young women who have had many years of not ovulating, my best GUESS is that this may not be the case with you. I would concur with your diagnosis that a "hormone problem" has been present for a while. In the US the usual term for this is polycystic ovarian syndrome (PCOS).

Currently a woman could be considered to have PCOS is she had any two of these characteristics:
1. Irregular, or absent periods due to missed ovulations (leads to erratic bleeding patterns)
2. Increased male hormone levels (e.g., androgens like testosterone which cause unwanted hair growth)
3. Multiple small ovarian cysts ("string of pearls") visualized on pelvic ultrasound.
You apparently have both number 1 and 2. With missed ovulations one can acquire a too-thick uterine lining.

Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for too thick lining.

If you have a too-thick lining a GYN might want to do a biopsy of the lining ("endometrial biopsy"). If the results show just a thickened lining ("hyperplasia") without any abnormal appearing cells ("hyperplasia without atypia") then the treatment is simply to give the woman extra progesterone.

When you see the MD be sure and ask about PCOS. Be sure they know that you are worried about cancer. Honestly, in my 30 years of practice, I have had only one young patient with actual uterine cancer--and she had been without ovulations since her early teens. By contrast, perhaps 10% of younger women have PCOS.

If you can, consider writing us all back so we can know what happened. Your shared experience may be very beneficial to another woman with similar symptoms.

In Support,
Jane

Researching to gain an understanding of a condition can go a long way toward easing the fear and making an informed decision about your short and long-term health.

These links may be helpful in understanding as well as preparing to discuss "next steps" with your doctor:
http://radiographics.rsna.org/content/21/6/1409.full - Imaging the Endometrium: Disease and Normal Variants
http://www.jfponline.com/Pages.asp?AID=3184 - Conservative Management of Endometrial Hyperplasia

Table 2 shows "Regression, persistence, and progression rates of endometrial hyperplasia."