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Uterine hyperplasia, or endometrial hyperplasia, is a condition where the cells that line the uterus, called the endometrium, produce too many cells causing the uterine lining to grow and thicken. This is most commonly caused by an overabundance of the hormone estrogen combined with inadequate amounts of progesterone.
The reason endometrial hyperplasia is so concerning is it increases the risk of cancer of the uterus. For this reason, doctors follow people with endometrial hyperplasia closely to make sure it doesn’t turn into cancer. One question that often arises is whether it’s safe to use birth control pills with endometrial hyperplasia since birth control pills contain estrogen. Are uterine hyperplasia and oral contraceptives a safe combination?
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Uterine Hyperplasia and Oral Contraceptives: Are They a Safe Combination?
Oral contraceptives may be safe for women with endometrial hyperplasia depending upon the composition of the oral contraceptive they use. According to a study published in the Annals of Epidemiology, women who use low-dose oral contraceptives have a lower risk of developing endometrial hyperplasia. This is because endometrial hyperplasia is a disease that comes from the effects of unopposed estrogen - and estrogen causes uterine tissue to grow.
Most of the low-dose oral contraceptives doctors currently use contain more progesterone than estrogen. These progesterone-dominant pills help to prevent endometrial hyperplasia because of the higher levels of progesterone they contain – which offsets the effects of estrogen. Oral contraceptives also reduce the risk of uterine cancer, a serious complication of uterine hyperplasia.
What about women who already have uterine hyperplasia? Are oral contraceptives safe in this case? Low-dose, progesterone-predominant birth control pills are sometimes used to treat uterine hyperplasia in younger women. In older women who are past the menopause and no longer need birth control, doctors may give intermittent doses of progesterone to counteract the effects of estrogen and reduce growth of the uterine tissue. So, the current birth control pills on the market which have more progesterone than estrogen are not only safe but beneficial for young women with uterine hyperplasia.
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Oral Contraceptives Have Changed Over the Years
In the past, oral contraceptives contained much higher doses of estrogen and would not have been a good choice for women with uterine hyperplasia. Estrogen-dominant birth control pills stimulate uterine cells to grow and divide, which could increase the risk of cancer of the uterus. Fortunately, birth control pills have lower levels of hormones these days, particularly estrogen, which has different effects on uterine tissue than the pills of the past.
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Uterine Hyperplasia and Oral Contraceptives: The Bottom Line?
Oral contraceptive pills that contain low levels of estrogen and higher levels of progesterone are not only safe but beneficial for women with uterine hyperplasia. On the other hand, each person is different. It’s important that any woman with this condition consult with her doctor before using any form of hormone therapy or oral contraceptive to be safe.
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Ann. Epidemiol. 2009 January; 19(1): 1-7.
Merck Manual. Eighteenth edition. 2006.
Medscape.com. “Endometrial Hyperplasia"