Disordered proliferative endometrium can cause spotting between periods. It occurs when the uterine lining grows atypically during the proliferative phase.

A range of conditions can cause spotting, but it does not always mean someone has disordered proliferative endometrium. However, according to Alan Lindemann, MD, an obstetrician and maternal mortality expert, people with atypical menstrual bleeding should always contact a doctor.

Disordered proliferative endometrium is not a diagnosable condition. Instead, it is a general term healthcare professionals use to describe irregular endometrium growth.

Read on to learn more about disordered proliferative endometrium, including the symptoms, causes, treatment, and when to contact a doctor.

The endometrium lines the uterus and is responsible for menstrual periods and maintaining pregnancy.

“The growth, or proliferative, phase of the endometrium happens in the first half of the menstrual cycle prior to ovulation when an ovary releases a mature egg,” explains Dr. Lindemann.

During proliferation, estrogen causes the endometrium to get thicker.

“Under normal circumstances, the endometrium responds uniformly,” says Dr. Lindemann. Growth is symmetrical, and there is no bleeding. “However, when some parts of the endometrium fail to respond to estrogen in the same way, the growth is asymmetrical. Doctors refer to this as disordered proliferative endometrium.”

The primary symptom of disordered proliferative endometrium is bleeding between menstrual periods. Some people also experience cramping, heavy bleeding, painful periods, and irregular periods.

Complications of disordered proliferative endometrium depend on a person’s age and the severity of the bleeding.

“Although proliferative stage bleeding is generally benign — or noncancerous — sometimes irregular bleeding indicates cancer,” says Dr. Lindemann. “Much depends upon whether the bleeding occurs before or after menopause.”

The following are possible complications of premenopausal and postmenopausal bleeding.

Premenopausal bleeding

For premenopausal bleeding, the choices for diagnosis and treatments are complex.

“This is because endometrial cancer can develop before menopause in young people,” said Dr. Lindemann. “When endometrial cancer presents in premenopausal individuals, the bleeding usually occurs between periods, just like disordered proliferative endometrium.”

While spotting in premenopausal people is not likely to be cancer, recommendations state to contact a doctor regardless. Possible causes of bleeding between periods include:

  • endometriosis
  • adenomyosis, when the cells of the uterine lining grow into the muscular wall of the uterus
  • pelvic inflammatory disease
  • uterine myomas, benign growths in or around the uterus
  • pregnancy loss

Postmenopausal bleeding

If spotting occurs in a postmenopausal individual, they should always make an appointment with a doctor because it requires investigation.

“A dilation and curettage (D&C) is the best way to determine the cause,” said Dr. Lindemann. This is a procedure where a doctor dilates the cervix, the part of the uterus that connects to the vagina, and uses an instrument to scrape away tissue from the interior of the uterus.

“Postmenopausal people have a greater risk for cancer of the uterine lining than those who are premenopausal,” said Dr. Lindemann. If doctors diagnose cancer early, they can recommend appropriate treatment options.

However, irregular bleeding postmenopause does not mean that a person has uterine cancer.

According to an older 2006 study, the treatment of disordered proliferative endometrium involves progesterone. Dr. Lindemann adds that treatment of the condition in a premenopausal person might involve a therapeutic D&C.

Regardless of the treatment option that a person’s doctor recommends, early intervention is key. “Early treatment of disordered proliferative endometrium is the best way to prevent more serious problems later,” he said.

Additionally, it is important to note that because a range of conditions may cause disordered proliferative endometrium, treatment options can vary.

Disordered proliferative endometrium occurs when all parts of the uterine lining do not respond to the growth-stimulating effects of estrogen in the same way. This causes proliferation to be asymmetrical and results in bleeding.

The condition is usually benign, but sometimes it can suggest cancer. For this reason, anyone with irregular bleeding between periods should talk with a doctor. This is particularly true if spotty bleeding happens after menopause.


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