• Hyperplasia of the endometrium: symptoms, treatment, causes

    What is it? - Endometrial hyperplasia( hyperplastic endometrium processes) is such a pathological condition, in which there is an increase in thickness and a change in the structure of the inner layer.

    At the heart of the disease is a violation of the hormonal background, which leads to increased proliferative activity of endometrial cells.

    Classification of

    In view of the histological structure, endometrial hyperplasia is divided into the following types:

    1. 1) Glandular - only thickening of the inner layer of the uterus
    2. 2) The glandular-cystic - thickening of the inner layer of the uterus is combined with the presence of cystic formations( occluded endometrial glands)
    3. 3) Atypical, or adenomatosis( the presence of signs of atypia of endometrial cells).
    In practical gynecology, basically distinguish two main types of hyperplasia of the inner layer of the uterus:

    1. 1) Atypical, which requires active action on the part of the doctor, as it is a precancerous process of
    2. 2) Non-atypical.

    Causes of

    The cause of the development of hyperplastic endometrial processes is associated with a violation of the hormonal regulation of the menstrual cycle. This leads to hyperestrogenemia, which is both relative and absolute. Relative hyperestrogenemia is indicated in the case when the synthesis of estrogens remains within normal limits, and the production of progesterone decreases.

    Absolute hyperestrogenemia occurs in the case of decreased estrogen production, regardless of the level of progesterone. The following pathogenetic mechanisms lead to these conditions:

    1. 1) Follicular atresia, in which there is no ovulation. Atrezirovanny follicle produces monotonous low concentrations of estrogens, which can not cause the onset of ovulation. Therefore, the endometrium remains in the proliferative phase, not passing into the secretory phase, which precedes menstruation.
    2. 2) Excess amount of adipose tissue, which is currently considered as an endocrine organ. It is synthesized by estrone, which causes inadequate proliferation of the endometrium.
    Given the common pathogenesis of hyperplastic processes of the endometrium with other gynecological diseases, there is a combined pathology. So, the hyperplasia can be combined with:

    • by the myoma of the uterus
    • with ovarian cysts
    • by endometriosis.
    Thus, the basis for the development of endometrial hyperplasia is a violation of normal regulation in the hypothalamic-pituitary-ovarian system. This creates a background for increased proliferative activity of the inner layer of the uterus.

    Symptoms of endometrial hyperplasia

    For a long time, endometrial hyperplasia can not manifest itself clinically. However, over time, when the process of separation of the functional layer of the mucous membrane of the uterus is disrupted, there are profuse menstruation. They can last longer than usual. Gradually menstruation goes to uterine bleeding.

    There are no other clinical signs of endometrial hyperplasia. However, the clinical picture can be supplemented by other symptoms that are associated with the presence of background pathology. So, in case of uterine fibroids, the pain in the lower abdomen, frequent urination, constipation, and others can be troubling.

    Endometriosis is characterized by the appearance of painful menstruation, as well as pain during intercourse. Against this background, the depletion of the nervous system is gradually developing. Thus, the clinical picture of endometrial hyperplasia can not be fundamental in establishing a definitive diagnosis. She can only guide the doctor about the thought of this pathology.

    Diagnosis of endometrial hyperplasia

    Endometrial hyperplasia is clinically manifested by the presence of uterine bleeding. By the time of occurrence, they can coincide with menstruation( menorrhagia) or not coincide( metrorrhagia).

    However, in order to establish an accurate diagnosis it is necessary to conduct a thorough diagnosis. Since the vaginal examination does not reveal the characteristic signs of the disease, the diagnostic search includes the following research methods:

    1. 1) Ultrasonic diagnosis
    2. 2) Hysteroscopy
    3. 3) Histological examination of the uterine mucosal scraping, which allows differentiating atypical and non-atypical endometrial hyperplasia.
    The ultrasonic criteria for hyperplasia are as follows:

    1. 1) Endometrial thickness increase greater than 10 mm
    2. 2) Unevenness of contour
    3. 3) Atypical hyperplasia, there is abundant blood flow in the mucous membrane of the uterus( non-atypical hyperplasia is characterized by weak vascularization).
    Hysteroscopy allows you to visualize the uterine cavity with the help of endoscopic technique under magnification. As a result, it is possible to consider the most suspicious areas and to perform an aiming sampling of biological material. Also it is possible under the control of vision to remove polyps of endometrium as a variant of local hyperplasia.

    Material for histological examination is obtained by scraping the uterine cavity and the cervical canal, which are performed separately. This procedure is therapeutic and diagnostic and puts an end to the establishment of the final diagnosis.

    Treatment of endometrial hyperplasia

    Treatment of endometrial hyperplasia is divided into two main types:

    1. 1) Surgical
    2. 2) Conservative.
    As a rule, to achieve a good therapeutic result, these two species are combined with each other.

    Conservative therapy of endometrial hyperplasia mainly involves the use of hormonal drugs, which are pathogenic agents of treatment. For this, the following groups of drugs are used:

    • combined estrogen-progestogen preparations
    • gestagenes
    • antigonadotropins
    • analogues of gonadoliberin
    • antiestrogens.
    The duration of hormone therapy should be at least 3 months. On average, it is 6 months. In addition to this, symptomatic therapy is performed:

    • hemostatic( using hemostatics)
    • Anemia treatment with iron preparations
    • Anesthetic therapy, which consists in the use of non-steroidal anti-inflammatory drugs.
    Surgical treatment depending on the clinical situation can be represented by several types:

    • scraping of the uterine cavity
    • uterine removal
    • hysteroresectoscopy
    • ablation of the endometrium.
    Treatment of endometrial hyperplasia in women of reproductive and perimenopausal age should start with scraping of the uterine cavity. It allows you to determine the morphological substrate of hyperplasia, as well as stop bleeding.

    The removal of the uterus is indicated in the following cases:

    1. 1) Atypical endometrial hyperplasia in women who do not plan pregnancy, as well as in the perimenopause
    2. 2) Ineffective conservative therapy for 6-12 months
    3. 3) There are contraindications to hormonal therapy.
    Hysteroresectoscopy and ablation of the endometrium are performed in cases when uterine removal is indicated, but for health reasons it can not be performed. These are the following situations:

    • Decompensated diseases of internal organs
    • Mental diseases
    • An increased anesthetic risk.

    Complications of

    The main serious complication of endometrial hyperplasia is the possibility of malignancy( its risk is 10%), that is, the development of malignant process of the inner layer of the uterus. This risk is especially high for atypical hyperplasia.

    In addition, hyperplastic endometrial processes can lead to the following conditions:

    • plentiful and prolonged menstruation
    • uterine bleeding
    • iron deficiency anemia.

    Prevention of

    Prophylaxis for hyperplastic endometrial processes is normalization of hypothalamic-pituitary-ovarian connections. To this end, the woman needs to adhere to the following recommendations:

    • use of contraceptive methods to prevent abortion
    • rejection of intrauterine spirals
    • to prefer hormonal methods of contraception
    • regular visit to gynecologist( at least once a year)
    • normalization of body weight, etc.
    In conclusion, it should be noted that endometrial hyperplasia is a background pathological process for the development of endometrial cancer. Therefore, timely diagnosis and treatment of this disease.

    Diagnostic search is based on clinical examination data and additional research methods.

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