Hi, Increase in the thickness of endometrium can be seen in conditions like: - Hormonal imbalance due to disturbances in ovulation especially in peri menopausal age group. Which can present with irregular spotting also. In case of irregular periods prolonged period of amenorrhea can lead to increased endometrial thickness followed by excessive bleeding. - Other hormonal causes like poly cystic ovary disease, thyroid imbalance, diabetes can also lead to endometrial abnormalities etc. - And of course malignancy of endometrium or ovary etc can also lead to increased endometrial hyperplasia. But heterogenous thickened endometrium itself may not represent the malignancy always. So unless proved no need to worry. Biopsy will help in finding out the possibility of the cause of the problem. In case of simple endometrial hyperplasia, dilation and curettage while taking biopsy and hormonal treatment can cure the problem. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Sree Gouri S. R., OBGYN