Often, endometrial hyperplasia occurs in women whose hormonal levels are disturbed. This condition is characteristic of the following conditions - diabetes, menopause, thyroid disease.
The disease has a negative effect on the reproductive system. As a result, there is observed: irregular menstruation, problems with conceiving and carrying a child.
But an increase in the volume of the inner lining of the uterus is a benign phenomenon.
Endometrial hyperplasia occurs in various diseases that can be combined into a separate group. In the process of their appearance, various morphological changes occur. As a result, benign tissue proliferation can become malignant.
Causes of endometrial hyperplasia
In the body, the ovaries are responsible for the level of sex hormones. The production of the main sex hormone in a woman, estrogen, also directly depends on them. Ovarian function can be impaired when multiple cysts form on them.
In this case, the level of estrogen in the body will increase, as a result of which the chances of developing endometrial hyperplasia will increase. In practice, quite often these two pathological conditions are combined.
The following pathological conditions can affect the occurrence of endometrial hyperplasia:
- disruption of the liver,
- frequent anxiety and stress,
- thyroid disease,
Stress is the main enemy of women's health. Such a condition can provoke a delay in menstruation. This happens because the mucous membrane of the uterus thickens.
Seizing stress favorite food, a woman begins to gain extra pounds. This can lead to obesity and problems associated with the work of the thyroid gland. It is during this period that favorable conditions are created for the appearance of endometrial hyperplasia in the body. It would seem that hormones are to blame. But the true reason lies precisely in stress.
The reasons for the increased risk of endometrial hyperplasia:
- infectious diseases of the genital organs,
- genetic predisposition
- uterine fibroids,
- hormonal disorders during menopause,
- taking contraceptive drugs that contain only estrogen,
- frequent abortions.
The first signs of endometrial hyperplasia
Sometimes a woman may notice the appearance of minor discharge that will not be related to menstruation. At first they will be minimal, but later their number will increase. Bleeding may result. This in turn is fraught with other complications, one of which is anemia.
But you can highlight other symptoms:
- weakness, constant feeling of tiredness,
- loss of consciousness.
Symptoms of endometrial hyperplasia
The disease in each patient may have a different course. Sometimes a woman does not feel any signs and does not suspect the presence of pathology. In other cases, the disease is accompanied by unpleasant symptoms that can be life-threatening. For endometrial hyperplasia such clinical manifestations are characteristic:
- menstruation irregularity
- the occurrence of bleeding long before the beginning of menstruation and after their passage,
- the appearance of bleeding in the middle of the menstrual cycle,
- accompanying menstruation with pronounced pain in the abdomen,
- the occurrence of bleeding during menopause,
- problems with conception,
Common signs that occur with endometrial hyperplasia are:
- feeling tired even after sleeping,
- frequent abdominal pain,
- dizziness and headaches
- high blood pressure.
If you have noted any of the listed symptoms in yourself, then immediately contact a doctor. A timely examination will help determine the presence of the disease in its early stages and begin treatment. Thus, the risk of the onset of the effects of pathology significantly reduced.
The main manifestation of endometrial hyperplasia in women of child-bearing age is the impossibility of becoming pregnant. If you notice that your menstrual cycle is irregular, it is better to visit a doctor, as well as undergo a diagnostic examination.
Which doctors should be treated for endometrial hyperplasia:
The first group is combined oral contraceptives. Examples - Janine, Yarin and others. They are assigned to women of childbearing age and girls who have begun the process of puberty. It is necessary to take the medicine within half a year.
The next group is gestagens, which include drugs such as Duphaston and Utrogestan. The course of treatment should be from 3 months to six months. Both drugs are suitable for women of any age.
Women of childbearing age are sometimes prescribed by doctors with a gestagen-containing intrauterine contraceptive coil Mirena. Unlike oral contraceptives, which were described earlier, it has a local effect.
Buserelin and Zoladex are hormonal drugs that are analogues of the hypothalamus rizing hormones. Such drugs should be prescribed to women after 35 years. The course of treatment should last from 3 months to six months. The drug should be administered 1 time in 28 days.
In addition to hormonal drugs, doctors may prescribe B vitamins as well as ascorbic acid to treat women for treatment. To combat stress, experts advise taking sedatives, such as motherwort broth. If anemia occurs as a result of blood loss, iron preparations are prescribed, for example, Ferlatum.
Uterine scraping is a medical procedure in which polyps are removed from the organ walls along with hyperplastic endometrium. At the end of the operation, histological examination of the removed tissue should be carried out. This allows you to determine the type of hyperplasia. The patient, in turn, is prescribed hormone therapy based on personal characteristics - age and the presence of other diseases.
After the curettage procedure, the patient can be sent home the next day. About 10 days after surgery, small bleeding may occur. This is normal. During this period, you must refrain from having sex.
If in the process of histological examination adenomatosis is detected, and the woman’s reproductive function is not necessary to preserve, then experts advise performing an ablation operation on the endometrium. This manipulation implies the complete destruction of the uterine mucosa without the possibility of its restoration under the action of a laser or high temperatures. After such a procedure, a woman will not be able to get pregnant.
After scraping or resection of the endometrium, the woman will have to undergo a follow-up examination by a gynecologist, as well as an ultrasound scan. Preventive examination is best done 1 time in three months.
After the curettage to restore the body, you can refer to the recipes of traditional medicine. At the very beginning, they can have a really positive effect.
Folk remedies for the treatment of endometrial hyperplasia
Nettle tincture is a well-known agent that promotes blood clotting, and also increases the level of hemoglobin and serum iron in it. The medicine also helps to improve overall well-being.
It should be understood that any popular recipes can not completely eliminate such pathologies as endometrial hyperplasia. These methods of treatment can only alleviate the symptoms of the disease. That is why you can not be limited to their reception. Traditional recipes will bring more benefits if combined with the traditional treatment prescribed by the doctor. True, you will need to get his approval first.
Glandular hyperplasia of the endometrium, unlike others, is considered more favorable, since the risk of its transformation into a malignant tumor is minimal. In addition, it is characterized by slow growth in all parts of the uterus. Glandular hyperplasia is benign and when it appears, the glands work is not disturbed.
Complications of endometrial hyperplasia
Oncology is the most dangerous complication that endometrial hyperplasia can cause. To avoid this, it is necessary to undergo a thorough examination by a doctor who must prescribe the correct treatment. Usually therapy involves taking hormonal drugs. If the result was not achieved, the therapy can be repeated.
Endometrial hyperplasia affects the bladder. Emerging neoplasms can squeeze it and in connection with this, the urination function is disturbed.
Infertility is another very dangerous complication for women of reproductive age. Such a diagnosis can be avoided only with timely diagnosis of endometrial hyperplasia, as well as its correct treatment.
Hyperplasia and pregnancy
The diagnosis of endometrial hyperplasia, which the doctor can make, already suggests that a woman cannot become pregnant. To fix this, it is necessary to cure the disease. If the patient had previously planned to conduct an IVF procedure, then from the beginning of the treatment until the fertilization, she should go into the interval not less than half a year.
If a woman in the presence of hyperplasia could become pregnant, then the doctors in this case are advised to have an abortion, because during pregnancy the risk of a malignant neoplasm increases. But this is not worth much worry, because endometrial hyperplasia is a disease in which the possibility of becoming pregnant is very small.
Ultrasound scan of the pelvic organs
This procedure makes it possible to determine the thickness and structure of the endometrium, assess the uterine cavity, as well as identify the presence of concomitant pathologies in the uterus and its appendages.
If the thickness of women of reproductive age exceeds 16 mm, and in the climacteric period is 5 mm, then experts advise to conduct a morphological study of the uterine mucosa. He is also prescribed if, in the course of the ultrasound examination, violations in the structure of the endometrium were detected.
Diagnostic curettage of the uterus
This manipulation is the main way to diagnose endometrial hyperplasia. Scraping, which eventually receive, must be sent to histopathological examination.
This allows you to determine the course of the hyperplastic process, as well as the sensitivity of endometrial receptors to the effects of sex hormones on it - estrogen and progesterone.
Prevention of endometrial hyperplasia
If a woman has a disease of the genital organs of an infectious or inflammatory nature, then it is necessary to begin its treatment as soon as possible. Abortion is a procedure that can be harmful to a woman’s health, therefore it is better to refuse it.
To agree to an abortion is possible only as a last resort. In addition, in order to avoid health problems, it is necessary to lead a healthy lifestyle, eat right and give up bad habits.
Questions and answers on "Endometrial hyperplasia"
Question:M echo 0 83. Diagnose endometrial hyperplasia, do I have to clean or can I treat it?
Question:I am 52 years old. I have hyperplasia. The endometrium in November 2017 was 7 mm, at the end of March 13 mm. Four years ago, she underwent a course of treatment "Buserelin ". 4 months there was no monthly, and here came. In the hospital, where I was in November, they offer the removal of the uterus, while the doctor in the consultation says that there is no hyperplasia. And in general, there will be a climax - everything will pass by itself. What to do? To be operated or not?
Answer: The diagnosis of the disease is confirmed by transvaginal ultrasound. Endometrial hyperplasia will not pass by itself - pathology requires drug therapy, regardless of the woman's age. If the woman’s fertility function is not necessary to preserve, then experts advise performing an operation on ablation of the endometrium - removal of the uterine mucosa, using various methods of exposure.
Question:Hello. I am 54 years old. On ultrasound such data: the contours of the uterus are smooth, clear. Central location. Pear-shaped form. Dimensions: 65-53-65mm. The structure of myometrium is heterogeneous. On the front wall of the left edge myoma node 19 mm. In the area of the bottom of the uterus, large dense areas create an acoustic shadow-zone of adenomyosis. Metric up to 22mm poorly differentiated from the surrounding myometrium. The cervix b / o. Ovaries: Right 24-15 mm. Left removed. The pelvic veins are not dilated. There is no fluid in the pelvis. Conclusion: adenomyosis. Uterine fibroids small size. Endometrial hyperplasia. I'm very afraid. And you can immediately remove the uterus? Without any scruples.
Answer: Hello! If in the process of histological examination adenomatosis is detected, and the woman’s reproductive function is not necessary to preserve, then experts advise performing an ablation operation on the endometrium. This manipulation implies the complete destruction of the uterine mucosa without the possibility of its restoration under the action of a laser or high temperatures. After such a procedure, a woman will not be able to get pregnant.
Question:Hello! I conclude by ultrasound: Diffuse enlargement of the uterus. The structure of the myometrium may correspond to fibromiomatosis, adenomyosis up to 1-2 tbsp. Persistence and reverse development of a non-ovulatory follicle on the right, moderate secondary glandular hyperplasia of the endometrium in premenopausal women. Final diagnosis: Glandular hyperplasia of the endometrium (№85,0). 4.09 I took a analysis of the histology - scraping or vacuum. I do not know. Asked - did not say. When after that you can engage in intimate life? After what time? And is oncology sexually transmitted or otherwise?
Answer: Hello! After scraping for 2 weeks, do not recommend having sex. Oncology is not transmitted.
Question:Hello. I am 28 years old and my husband and I are planning a pregnancy. There have never been any pregnancies before. For several months, I was worried about the spotting brown discharge before menstruation (up to 7 days). As a result, an ultrasound revealed a cystic formation of the left ovary 37 mm in diameter, anechoic with a thin net pattern and endometrial hyperplasia. Ultrasound done on the 31st day of the menstrual cycle, endometrium 19 mm, non-uniform, clear contours smooth. I note that a year ago, there was also a cyst on the left ovary, follicular, and it was possible to remove it by taking Duphaston 2 months from day 16 to day 25 of the MC. I'm still waiting for menstruation and will do a control ultrasound on the 5-10 day of the cycle. The doctor insists on cleaning. Can I do without this procedure?
Answer: Hello! The cause of cystic changes and endometrial hyperplasia are hormonal abnormalities. Previously, you had not a cyst, but the persistence of the follicle, which also occurs as a result of a deficiency of the luteal phase. You need to go through folliculometry, donate blood for sex hormones (the Pregnancy Planning Complex), thyroid hormones, and if necessary, undergo CT or MRI of the brain. According to the results of the examination, you will be assigned the appropriate treatment. For the LDV should be compelling evidence. Check with your doctor about taking folic acid and iodomarin.
Question:Hello. I am 52 years old, after the ultrasound examination was discovered: the uterus is not displaced, the dimensions are 56 * 48 * 52, the contours are smooth, the myoma node is 18 * 12 * 9 and the endometrium is 23 mm thick, the uterus is endometrium with anechoic inclusions up to 1.5 mm 01, cervix - cysts up to 10 mm. Ovaries: right - dimensions 27 * 9, structure - single follicle D 8 mm, left - 21 * 13 mm - afollicular. Conclusion: Ultrasound endometrial hyperplasia - signs of adenomyosis, uterine myoma. Tell me if you need surgery and what?
Answer: Hello! I recommend to conduct ERD (curettage of the uterus) under the control of hysteroscopy, with confirmation of endometrial hyperplasia in combination with uterine myoma and adenomyosis, it is advisable to conduct a 6 month course of therapy with GnRH agonists. After this course, to continue treatment, I recommend discussing with your doctor the possibility of using the drug Esmia in combination with uterine fibroids in combination with adenomyosis, which by blocking the division of pathological cells, leads to a significant inhibition of growth and reduction in the size of myomatous nodes and endometrioid heterotopies.
Question:Hello! I am 48 years old, ultrasound - hyperplasia - 6.9 mm. Prescribed to do scraping. Is it possible to do without it when the uterus bends, to undergo treatment with folk remedies?
Answer: Hello! It is necessary to conduct a separate therapeutic and diagnostic curettage of the uterus with subsequent drug therapy aimed at preventing the recurrence of endometrial hyperplasia.The occurrence of a hyperplastic process of the endometrium is due to the violation of the mechanisms of antioxidant protection and the characteristics of tissue metabolism. I recommend discussing with your physician the possibility of using Actovegin (2 tablets 3 times a day, for at least 6 months) in the complex therapy of endometrial hyperplasia (without atypia), which significantly reduces the risk of recurrence of the disease. Treatment must be carried out under the supervision of a physician.
How often does endometrial hyperplasia occur?
Endometrial hyperplasia is a fairly common pathology, occurring in 5 percent of gynecological patients. This diagnosis in recent years sounds more and more often for various reasons. The life expectancy of women has increased, the number of patients with metabolic syndrome and other pathologies has increased, the environmental situation has worsened. All this affects the reproductive health of the population. Most often, hyperplasia occurs in adolescent girls or in women during the premenopause, that is, when hormonal changes occur in the body.
How is hyperplasia related to the menstrual cycle?
The normal menstrual cycle consists of 3 phases:
- increase in the thickness of the functional layer of the endometrium - proliferation
- endometrial maturation - secretion
- functional layer rejection leading to bleeding - desquamation
The first phase begins on the first day of menstruation. Approximately in the middle of the cycle, ovulation occurs - the process of release of the egg from the ovary, during this period a woman can pay attention to the appearance of stretching mucous transparent secretions. If at this moment fertilization does not occur, then under the action of hormones the functional layer, together with the egg cell, is rejected - menstruation occurs, bloody discharge occurs. All processes during the menstrual cycle are controlled by sex hormones:
In addition, during cell proliferation, the planned cell death occurs - apoptosis, which does not allow the endometrium to grow more than necessary. This happens only if a woman has ovulation, that is, when the ratio of hormones allows her to come. If there was no ovulation (anovulatory cycle), there is a prolonged effect of estrogen on the endometrium and it thickens - as a result, endometrial hyperplasia is formed.
Why does it occur?
The starting factor for the development of endometrial hyperplasia is an absolute or relative increase in the content of estrogen in the blood - hyperestrogenism, which occurs for various reasons:
- age-related changes in the central regulation of sex hormones - change in the amount of estrogen before menopause
- hormonal disorders - excess estrogen with progesterone deficiency
- hormone-producing ovarian tumors, polycystic ovary syndrome
- adrenal gland dysfunction
- misuse of hormonal drugs
- frequent abortions (complications), diagnostic curettage
- genetic predisposition
- inflammation of the female genital organs
- associated diseases - hypertension, breast diseases, obesity, diabetes, thyroid disease.
What types of hyperplasia exist?
According to the type of structure, the scale of distribution and the presence of abnormal cells, all hyperplastic processes of the endometrium are divided into groups:
- Glandular cystic hyperplasia of the endometrium
- Endometrial polyps (focal form of hyperplasia)
- Glandular cystic
- Glandular fibrous
- Atypical hyperplasia of the endometrium (adenomatosis)
Glandular forms of hyperplasia are characterized by a large number of glands, sometimes forming cysts. The structure of cells in such a focus is not broken. Symptoms of glandular hyperplasia of the endometrium and cystic forms are exactly the same. In the atypical form of hyperplasia (adenomatosis and adenomatous polyp), changes occur in the structure of cells, which begin to divide at high speed, as a result of which the number of glands grows very quickly.
Can hyperplasia turn into cancer?
Hyperplastic processes should always cause oncological vigilance, but only in a few cases are they malignant. There are certain conditions under which hyperplasia is considered a precancerous condition:
- atypical hyperplasia at any age. According to statistics, in 40 percent of cases without treatment, such hyperplasia is malignant, endometrial cancer occurs.
- frequent postmenopausal glandular hyperplasia
- glandular hyperplasia in disorders of the hypothalamus at any age, as well as in the metabolic syndrome.
Metabolic syndrome is a special condition of the body in which the ability of the immune system to infect cancer cells is sharply reduced, and the tendency to hyperplasia is great. It is characterized by anovulatory infertility, diabetes, obesity.
The most noticeable and frequent symptom of endometrial hyperplasia is uterine bleeding.
- More than half of patients report menstrual delays for 1–3 months, which are replaced by prolonged bleeding of varying intensity.
- In rare cases, bleeding can be cyclical, that is, manifested in the form of heavy and prolonged menstruation, painful periods (causes)
- Most often, patients note an unstable menstrual cycle for a long time, against the background of which bleeding occurs.
- In 5 percent of cases, bleeding occurs on the background of the absolute absence of menstruation.
An important companion of endometrial hyperplasia is metabolic syndrome. In such cases, the symptoms of bleeding join:
- Symptom complex of male traits - the appearance of increased hair growth, changes in the tone of voice and other signs of male hormones
Other common symptoms
Often women with hyperplasia also call other satellites of the disease:
- secondary infertility - the absence of pregnancy after a year of regular unprotected sex
- miscarriage - early miscarriages
- chronic inflammatory diseases of the genital organs
- mastopathy and fibroids
What research is needed to determine it?
- Anamnesis It is necessary to tell the doctor in detail about the peculiarities of the menstrual cycle: how old menstruation began, how long and how much it continues, whether there were any irregularities or delays. Anamnesis will allow a specialist to determine all the symptoms of endometrial hyperplasia of the uterus.
- Transvaginal ultrasound in the first phase of the cycle (for 5-7 days). The examination determines the thickness of the endometrium, its homogeneity and structure. Hyperplasia can be suspected at a thickness of more than 7 mm. If the endometrium is thicker than 20 mm, the doctor may suggest a malignant process. If the bleeding is prolonged, then an ultrasound scan is performed regardless of the day of the menstrual cycle.
- Hysteroscopy and separate diagnostic curettage (brushing) - at the same time play the role of research and treatment. Read about the state after hysteroscopy.
- Investigation of the level of hormones in the blood in suspected metabolic syndrome and polycystic ovary syndrome. Usually determine the level of FSH, LH, estradiol, testosterone, progesterone. And it is also possible the level of hormones of the adrenal and thyroid glands.
- Mammography - often the doctor prescribes an x-ray examination of the mammary glands to exclude proliferative processes.
With endometrial hyperplasia, the information content of an ultrasound with a vaginal sensor is estimated at 68%, and hysteroscopy at 94%.
Treatment of endometrial hyperplasia
Therapy of hyperplastic processes depends on the woman's age, the characteristics of the endometrium, and associated diseases. With endometrial hyperplasia, treatment can be carried out in several ways.
These include estrogen-progestin preparations, pure gestagens, gonadotropin releasing hormone agonists and antagonists, androgen derivatives. These drugs are prescribed only by a doctor, individually and strictly according to indications. The doctor takes into account all possible contraindications for hormonal drugs: rheumatism, thrombophlebitis, hypertension, diabetes, biliary tract and liver diseases, smoking and alcohol increase the risk of side effects. Before treatment and during treatment, the state of the immune system, vascular, endocrine glands, liver should be examined and blood tests should be performed.
- "Small" or conservative surgery
Removal of the endometrium (functional and basal layers) using a resectoscope. The controversial method, as it gives frequent recurrences of the disease and is contraindicated in case of suspicion of atypia.
This is the removal of the uterus with or without the ovaries. Indications for surgery:
- ineffectiveness of conservative treatment for precancerous forms of hyperplasia
- repeated cases of precancerous hyperplasia
- contraindications for hormone therapy
- atypical hyperplasia in peri and postmenopausal
I stage of treatment - curettage
The first stage is a medical-diagnostic curettage of the uterine mucosa under the control of a hysteroscope (cleaning) and the study of the material obtained in cytological laboratories.
Scraping - removal of the functional layer of the endometrium, along with its pathological formations. The study is conducted under general anesthesia, visualization of the contents of the uterine cavity is carried out using a special apparatus - a hysteroscope. It is an optical system equipped with a light source, having a channel for inserting surgical instruments into the uterus. Thanks to the hysteroscope, the curettage procedure is safe and effective.
The cleaning itself is carried out using a curette; sometimes a mechanism is used to stop the bleeding. The functional layer of the endometrium is removed completely, the contents of the uterine cavity are sent for histological examination, it will determine the nature of the process and tactics for further treatment of endometrial hyperplasia after curettage.
Causes of hyperplasia
There are a number of reasons for the proliferation of endometrium, which concern not only the pathological states of the vital systems of the body, but also the effects of external mechanical influences.
- Hormonal disbalance. Hyperplasia usually provokes excessive estrogen production or high levels of prolactin in the blood.
- Inflammatory diseases of the uterus, vagina, ovaries and fallopian tubes. Particularly dangerous are chronic infections, which for years have remained without treatment and become the cause of enhanced cell division of the inner mucous layer of the uterus.
- Age over 40 years. After menopause, the body begins to react more sensitively to the endocrine system malfunctions. Therefore, even if a woman is normal estradiol and prolactin, the growth of the endometrium can cause low or high levels of other hormones.
- Hereditary predisposition Some doctors say that a grandmother, mother, and daughter may have hyperplasia. Moreover, this problem will arise with age.
- Frequent scraping of the uterus.
Before embarking on the development of a treatment regimen, the doctor needs to find out what caused the appearance of the disease. Otherwise, an incorrectly chosen therapy will only aggravate it.
Symptoms and forms of endometrial hyperplasia in women
In most women, the growth of the endometrium does not cause any symptoms and they start treatment for hyperplasia only if the doctor explains to them that endometrial hyperplasia is a future cancer (especially the atypical form).
The disease begins to manifest itself brighter only when the thickness of the mucous layer exceeds 2 cm:
- There are violations of the menstrual cycle
- Marked intermenstrual bleeding (usually scanty brownish discharge)
- A woman can not conceive a child or has miscarriages in the early stages.
- Menstruation is accompanied by severe pain, which can sometimes be the cause of disability for 1 - 2 days.
With such complaints, the doctor sends the patient to an ultrasound to determine the exact diagnosis. Ultrasound examines the following signs of endometrial hyperplasia:
- The thickness of the mucous layer is 15 - 20 mm.
- The endometrium is thickened evenly on both walls of the uterus.
- Echogenicity of the mucosal structure is heterogeneous
- The contours of the uterus smooth
For more informative, in addition to ultrasound, hydrosonography can be prescribed, which involves the introduction of a contrast agent into the uterus.
Forms of the disease
Depending on the consistency and characteristics of the growth of the endometrium, gynecologists distinguish several types of hyperplasia.
Glandular hyperplasia of the endometrium
It is considered the safest, since it has the smallest percentage of malignancy (not more than 5 - 6%). It implies enhanced division of the glands, as well as the disappearance of the endometrial division of the basal and functional layer.
The glands themselves do not have a uniform arrangement, and a small part of them is presented in the form of cystic formations.
Glandular cystic form
Glandular hyperplasia of the endometrium can progress, with the result that all cells of the glandular tissue are transformed into cysts. The main reason for the formation of this form of the disease is an excess of estradiol in the blood, or diabetes.
Cells of the glandular tissue are presented in the form of cystic formations, however at the same time inside the cyst are not filled with fluid, but are lined with epithelial tissue. This type of hyperplasia has a high percentage of malignancy and the development of a cancer.
The mucous layer of the uterus grows unevenly, with ultrasound in the places of thickening observed small cysts. The risk of turning such a hyperplasia into a malignant tumor is estimated based on the structure of the cystic formations.
It suggests the presence of atypical endometrial hyperplasia, in which the risk of transforming a disease into a cancer tumor has the highest chances (more than 50%). It is focal and diffuse, depending on the location of the thickening of the mucous layer of the uterus.
Endometrial hyperplasia and pregnancy
The proliferation of the mucous layer of the uterus (in any form) is often an obstacle to pregnancy. At the same time, the egg cell can fertilize, and even reach the uterus, but cannot attach to its wall, since the endometrial layer, despite its thickness, is not capable of providing sufficiently good nutrition to the embryo.
In cases where the fetal egg still can be implanted in the wall of the uterus, there is a threat of abortion. The situation will be easier if the woman has focal hyperplasia and the embryo has managed to attach to a healthy part of the mucous membrane.
In any case, in the presence of such a disease, a pregnant woman should be under the close supervision of a gynecologist so that she can react in time to the onset of the detachment of the ovum.
The concept of pathology
Endometrial hyperplasia of the uterus occurs when the normal restoration of the functional layer is disturbed. The endometrium that lines the uterus consists of two different layers. The first one is functional, it is located outside; it grows in the process of maturation of the egg, and then (if fertilization has not occurred) is completely rejected and removed from the body during menstruation. The second one is basal, it fits under the first layer and is located inside, it is thinner, the structure at the cellular level is weakly expressed and serves as a “building material” when restoring the functional layer.
The normal physiological process is as follows:
- Proliferation (growth of the endometrium in the uterus): immediately after the onset of menstruation, the growth of the functional layer starts, so the body prepares for a potential pregnancy,
- Secretion (maturation): occurs at the time of ovulation,
- Desquamation (rejection): if fertilization does not occur, the overgrown layer is rejected, and together with the unfertilized egg cell is removed from the body, menstruation begins.
The whole cycle occurs as a result of hormonal effects, estrogens are responsible for the first stage, and progesterone is responsible for the second stage. The level of growth of the functional layer is regulated, the proliferation of the first phase of the menstrual cycle is accompanied by aptosis - the death of "extra" cells. Each stage is important in its own way, because such a consistent change in the endometrium maintains the normal thickness of the functional layer at different periods of the menstrual cycle. Any irregularities in the regulation lead to pathological thickening, and this is hyperplasia.
Is this disease dangerous? Yes, if it is not treated, then the pathological focus in about 40% of cases enters the stage of cancer, that is, it is a precancerous condition. In addition, hormonal disorders can lead to diabetes and obesity, and changes in the normal menstrual cycle can lead to infertility. Therefore, women should pay attention to their health and regularly visit a gynecologist. Обнаружение болезни в начале, в бессимптомном периоде поможет справиться с возникшей проблемой до того, как клиническая картина станет угрожающей.
Как часто и у кого возникает
Гиперплазия считается одним из наиболее распространенных заболеваний неинфекционной этиологии. В структуре всех гинекологических болезней она на 2 месте, по разным источникам – от 15%. If we analyze the age groups separately, we can note the following indicators:
- in adolescent girls: occurs as a result of hormonal physiological changes, hormonal disruptions or functional disorders of neurohumoral regulation during puberty,
- in women under 35 years of age: the least dangerous age, hormonal background in this group is usually stable, all processes go within the physiological norm,
- over 35 (before, after and during menopause): the most dangerous age is the main risk group for the occurrence of hormone-dependent gynecological diseases.
Recently, cases of detection of hyperplasia increased. If earlier it was about 5%, now endometrial diseases are recorded much more often. And in the latter group, according to some data, from 40 to 50% suffer, that is, every second woman of this age has a pathology at a particular stage of development.
How is the disease associated with the menstrual cycle
Hyperplasia of the mucous layer is directly dependent on the menstrual cycle. All stages (proliferation, secretion and desquamation) normally occur in a strictly defined period of the menstrual cycle.
From the first day of menstruation, the endometrium begins to grow, so the uterus prepares for a potential pregnancy. In the second, at the time of ovulation, the newly grown cells mature, and the “extra” die (natural aptosis). If fertilization has not occurred, rejection begins, the accumulated layer is destroyed, and together with the egg is removed from the body, menstruation begins. And at the same time the next cycle is “launched”.
The whole process is controlled by hormones, to which endometrial cells are very sensitive. Any violation of hormonal function at each stage can lead to abnormal tissue growth, suspend the death of over-developed cells or disrupt the process of rejection and lead to hyperplasia.
Causes and pathogenesis
The causes of hyperplasia are associated primarily with various changes in hormonal levels. But there are others that are not directly related to humoral regulation, provoking factors.
The main causes of the pathological growth of the endometrium are:
- disorders in hormonal regulation associated with an imbalance of estrogen and progesterone of any etiology (age-related changes in hormonal function, hypothalamic-pituitary syndrome, etc.),
- associated with other diseases of the female reproductive system (polypoid, polycystosis, hormone-producing tumors, etc.),
- the presence of concomitant diseases associated with hormonal imbalance: diabetes mellitus, adrenal hyperplasia dysfunction, obesity, thyroid and / or mammary gland diseases, hypertension,
- disorders caused by prolonged or improper use of hormonal drugs,
- pathologies provoked by injuries (during and after childbirth, abortion, diagnostic curettage, etc.),
- hyperplasia, which caused pathological processes associated with infections of the reproductive tract,
- genetic predisposition
- psychosomatic disorders that caused the disease.
Hyperplasia on the background of any hormonal problems occurs most often. The remaining causes of endometrial hyperfunction are not so common, but they can become disease-provoking factors. Separately, it is worth considering how hyperplasia and psychosomatics are interrelated. Diseases on the background of psychological problems often arise. In medicine, the connection between pathological changes in normal functions and psychological disorders has long been established.
In this case, in response to feelings, depression or prolonged stress, the body turns on defensive responses. They can lead to changes in hormonal levels, which will cause the development of hyperplasia. There are such data, cases have been recorded and a direct relationship has been established between the pathological growth of the endometrium and psychological problems and disorders.
Since the disease occurs in women of different age groups, it is also worth considering the etiology for each of them separately.
The causes of adolescent girls at maturity are anovulation, which at this age is caused by certain disorders of the function of the hypothalamic-pituitary system. They lead to impaired hormonal regulation of the maturation of follicles, which are controlled by the pituitary gland. The result is most often premature atresia of the follicles.
If the violations repeat many times during successive menstrual cycles, then the normal ratio of hormones is disturbed in the body. Estrogen accumulates in excess, and progesterone is not enough. Consequently, the normal sequence of proliferation - secretion - rejection is disrupted. As a result of the appearance of an excessive number of cells in the functional layer of the endometrium, hyperplasia develops (mainly due to the glandular epithelium). As a result, cystic or adenomatous forms of the disease are diagnosed.
In reproductive age
In the age category under 35 (reproductive age), hyperplasia may occur on the background of:
- dysfunctions of the hypothalamus-pituitary system, which may manifest as a result of hyperprolactinemia. Or against the background of problems with the work of the hypothalamus, chronic somatic diseases, stress, fasting, etc.
- Anovulation caused by a violation of the secretion of luteinizing hormone, the activity of which depends on the hormone feedback mechanism,
- diseases of the ovaries (polycystic, follicular cyst, pathological growth of the stroma, etc.).
In premenopause and perimenopause
During this period, hyperplasia may occur against the background of age-related changes. Reproductive loss is associated with a decrease in hormonal activity against the background of a decrease in the activity of the hypothalamic-pituitary system. The consequence of these physiological processes is anovulation on the background of estrogen deficiency.
An additional factor that stimulates the development of pathology is an increase in the activity of the adrenal cortex. As a result, diseases such as obesity (of the male type), IHD and GB, diabetes mellitus and other “age-related” diseases associated with hormonal changes in women of this age often occur.
Another risk factors for the development of hyperplasia are the consequences of pregnancy, childbirth and abortion (possible injuries). Reducing the number of hormone-sensitive receptors, dysfunction of aptosis at the gene level and other physiological changes associated with the aging process.
Endometrium responds to all of these effects:
- growth due to an imbalance of estrogen and progesterone,
- abnormal reaction from the glandular cells of the mucous membrane on the background of stable hormonal levels (at the level of the norm),
- an imbalance of insulin activity and resistance, which results in a number of pathological conditions (polycystic disease, diabetes, etc.), impaired normal growth, development and death of the endometrium.
Thus, the etiology and pathogenesis of hyperplasia differs in women of different age categories. But there are common reasons that led to the activation of the process itself.
Symptoms of hyperplasia may not appear immediately, at the beginning of the pathological process they may be poorly expressed, therefore women often do not pay attention to their appearance. The main and most important manifestation of this pathology of the endometrium is bleeding, which can be:
- in the form of long delays: monthly periods can be absent for 1–3 months, after which they resume, they are abundant and long or scanty. Such symptoms occur most often (almost half of the patients have corresponding complaints) and do not depend on age-related changes. However, most complaints are associated with heavy bleeding, scanty menstruation is not a frequent manifestation of hyperplasia,
- changes are associated with the nature of menstruation: the stability of the cycle is maintained, and the amount of discharge during hyperplasia increases (longer and more abundant), there are unpleasant or painful sensations,
- bleeding on the background of pre- and postmenopausal, when the cycle is unstable and the intervals between periods are long or absent.
That is, the symptoms associated with any bleeding (out of cycle or uncharacteristic for a woman in abundance during the period of a stable cycle) should be the reason for an immediate visit to the gynecologist. This is the main and often the only sign that characterizes hyperplasia.
In addition to the pathological processes of the endometrium may indicate:
- metabolic syndrome, which manifests itself in the form of various pathological conditions (increased insulin levels, obesity, the appearance of secondary male symptoms, etc.),
- chronic inflammatory and infectious diseases,
- infertility and miscarriages can also be seen as alarming signs of the development of pathology,
- fibroids and mastopathies are separate diseases, but can be caused by hormonal disorders, like endometrial pathologies,
- contact bleeding that is not associated with the menstrual cycle (during intercourse, using tampons, etc.) are not among the main complaints and are rare,
- Complaints of cramping pain are also not often, they are more likely to be a sign not of endometrial atypia, but indicate other pathological processes, such as polyps.
Since the delay in menstruation is the main symptom, any changes in the duration or nature of the cycle should alert the woman, regardless of age. What to do in such cases? It is necessary to immediately contact a gynecologist. The delay, of course, can be caused by completely different reasons (pregnancy, inflammatory process, hypothermia, etc.). But one should not neglect to check with a specialized specialist, even if the cycle failures are quite understandable (for example, menopause). Regular visits to a gynecologist are for women over 35, since they are at risk and asymptomatic during the initial stages of the development of the disease.
There are several classification systems that allow you to view the disease from different points of view. For example, it is customary to distinguish simple, medium (moderate hyperplasia) and severe forms in terms of pathology. And the prevalence is shared by focal (polypous hyperplasia) or diffuse. The standard system is based on cytology, i.e. types of pathology are divided into different groups according to the type of cells and tissues prevailing in the modified area. Currently emit:
- simple hyperplasia (glandular). It is characterized by the absence of cystic enlargement of the glands. But in the process of proliferation, such an expansion can be observed in certain parts of the mucous membrane, then they talk about the glandular-cystic form, but at the same time consider this case not as a separate species, but as a stage of the pathological process,
- glandular stromal. Mixed type, complex hyperplasia, which is characterized by the simultaneous proliferation of glandular and stromal structures, and can be in both active and resting form,
- The atypical glandular and adenomatous forms, which are combined into one group and are characterized by a variety of morphological picture and severity of proliferative processes, are considered to be especially dangerous.
According to the WHO classification, endometrial hyperplasia is divided into:
- NOT ATYPICAL. Hyperplasia without atypia is characterized by the absence of altered cells. It includes a simple and complex form (by complex means adenomatous).
- ATYPICAL, which can also be simple or complex. This group includes the stages of development in which the cells are modified and become atypical in their structure.
In describing any classification, a number of factors are taken into account. For example, the local form can be represented by polypoid outgrowths from different types of tissue.
The basal form of hyperplasia is considered separately. Since most often the pathological process does not affect the basal layer, but develops in the functional, it is usually implied that the outer layer is affected. Initially, the pathological process in the inner underlying tissue begins rarely, its damage is more characteristic already in the later stages, when the pathological focus goes beyond the functional layer and nearby tissues are involved in the process.
Diagnosis is currently a comprehensive examination using all the methods available in modern medicine. These include:
- RECEPTION OF A PROFILE SPECIALIST with a mandatory survey (anamnesis) and gynecological examination.
- LABORATORY ANALYSIS: blood is donated to determine the level of hormones, a smear is taken with concomitant gynecological diseases.
- HYSTEROSCOPY allows: to visualize the clinical picture, to study and evaluate in detail the condition of the endometrium, to identify all pathological processes and to obtain material for histological examination. Diagnostic curettage is the most informative method, its accuracy reaches 97%. On which day of the cycle do they perform hysteroscopy? If we are talking about a simple examination, then it is prescribed for 5-7 days, for diagnostic curettage, the day before menstruation is selected or the first, immediately after the onset of menstrual bleeding. The disease is diagnosed if the thickness of the endometrium with hyperplasia is more than 15 mm, surface and color changes are visible. When scraping, 2 goals are achieved at the same time: the material is taken for the study and the pathological focus is simultaneously removed. Histology allows you to get a reliable result on the presence of atypical cells.
- ULTRASOUND PROCEDURE. In gynecology, the best method is transvaginal ultrasound, which reveals the echographic signs of the disease. It is usually prescribed on the 5th - 7th day of the menstrual cycle. If the disease manifests itself as a violation of it, then with prolonged bleeding a day can be chosen arbitrarily. In this case, on what day of the cycle to do ultrasound, does not matter. The echo signs of hyperplasia make it possible to determine the structure, uniformity and thickness of the functional layer. The accuracy of this method is almost 70%, an additional advantage will be the ability to differentiate the pathological process. If the thickening is more than 7 mm, then the disease can be defined as hyperplasia, if it is more than 20 mm, suspect oncology.
- MAMMOGRAPHY - is used as an additional examination to exclude proliferative processes.
- RADIO ISSUE RESEARCH. The ability of radioactive phosphorus to accumulate in the affected tissues allows you to accurately determine the localization and volume of the focus.
Modern diagnostic methods used to identify hyperplasia, allow us to accurately determine the nature and extent of the pathological process. At its very beginning, scraping can be a diagnostic and therapeutic measure at the same time.
Is it possible to cure forever
The concept of endometrial pathology and the causes of its occurrence, we considered. Patients after diagnosis are usually interested in future prospects, how to treat and whether it is possible to permanently get rid of the disease. And both surgical and therapeutic methods. The choice of treatment depends on the clinical picture. Additionally prescribed course aimed at eliminating the causes of the disease. A complete cure is possible if the pathology was identified on time.
Prejudice, which concerns some methods of treatment, forces to look for alternative solutions to the issue. But it is better for patients to use traditional methods of medicine that allow them to preserve their reproductive function and be completely cured.
It should be understood that hyperplasia will not disappear by itself, complex treatment is necessary, and if the causes of the development of the disease remain, there is a risk of recurrence. But with early detection, chances for a full recovery are high, so after the diagnosis it is necessary to start treatment immediately.
Is relapse possible?
The diagnosis of recurrent hyperplasia is given to patients with repeated occurrences of the pathological focus. Since the main cause of the disease is considered a violation of the hormonal balance of estrogen and progesterone, the possibility of relapse exists, if not eliminate the imbalance.
If after treatment the recurrent form continues to disturb the patient, it is necessary to change the tactics of treatment. For example, instead of organ-sparing surgery (removal of the functional layer of the endometrium), surgical intervention with removal of the genital organ is prescribed. The absence of the uterus completely eliminates the possibility of resuming the pathological process.
Often the disease recurs if the cause of its occurrence remains unchanged. Patients are usually prescribed a comprehensive treatment aimed at eliminating the pathological focus and etiology. После курса пациентка остается на диспансерном наблюдении, что позволяет вовремя обнаружить любые признаки возобновления патологического процесса.
Лечение гиперплазии эндометрия может проводиться как терапевтическими, так и хирургическими методами. The basis for the choice of tactics will be the clinical picture: the type of pathology, its volume and localization, the results of cytological studies, etc. Since the symptoms of this disease are primarily bleeding, anemia may develop. Then in addition can be appointed the preparations containing iron. To improve the overall condition - vitamins to maintain immunity. Comprehensive treatment is carried out in stages, so you should clearly follow the recommendations and adhere to the general plan prescribed by the doctor.
Stages of treatment
The treatment usually goes as follows:
- Scraping by hysteroscopy. The procedure is therapeutic and diagnostic at the same time. During its implementation, the functional layer is completely removed, the resulting material and the contents of the uterus are sent for examination.
- The tactics of treatment is chosen in accordance with the results obtained, taking into account the patient's age, type of pathology, its volume and other important factors.
- Iron cystic hyperplasia: the treatment is usually therapeutic, special treatment regimens have been developed for patients of different ages,
-Atypical form in postmenopausal patients is treated surgically. In reproductive age, hormone therapy is first used with a control curettage after 6 months. For complications such as fibroids or metabolic syndrome, surgical intervention is recommended.
In case of hyperplasia, medications are prescribed according to special regimens, long treatment courses. Therapeutic drugs are selected in accordance with the form of the pathology and the age of the patient.
What hormones the disease treats depends on the age of the patient:
- in reproductive age, oral combination contraceptives are preferred, single-phase progesterone-containing drugs are most commonly used. Contraceptive are taken within 3 - 6 months, the prognosis with the right tactics is favorable, the risk of relapse is minimal,
- after 35 years and before menopause, it is recommended to take drugs with the gestagen,
- in postmenopausal patients, conservative treatment is allowed if there are no tumors.
Such is the tactic for the glandular-cystic form. If we are talking about atypical form, then it is recommended to take drugs containing gonadotropin releasing hormone agonists. It will be obligatory to monitor the state of the body (during the course they perform a mammogram, an ultrasound is done, blood tests are taken).
In addition, suppositories (suppositories can help reduce inflammation), physiotherapy, acupuncture can be prescribed during the period of therapy. Medications for anemia, as well as supportive drugs (for example, Karsil to improve liver function or vitamins) can be prescribed. Electrophoresis is used as physiotherapy, for obesity, exercise therapy and diets can be recommended for weight loss. The doctor determines whether it is possible to cope with the disease solely with therapeutic means and selects a scheme that will be aimed at eliminating the cause of the development of HPE and improving the patient’s general condition.
Surgical intervention is prescribed in several cases:
- therapeutic treatment did not produce the desired effect
- the patient has relapses,
- the operation is the only correct tactic: hyperplasia is atypical in nature, the patient has already entered the postmenopausal phase and hormone therapy will be ineffective, the pathology seriously endangers health (the disease progresses, there is a risk of transformation into oncology).
In surgery, an operation is performed:
- to remove the endometrium (curettage during hysteroscopy or with a resectoscope when you want to remove both layers),
- removal of reproductive organs (uterus, more complex - with the ovaries).
Hysteroresectoscopy is done in a hospital setting, the patient can queue up for free treatment or go to a private clinic. In case of hyperplasia, the price of surgical intervention depends on the degree of complexity, on average from 15 to 30 thousand rubles. The cost depends on the level of the medical institution, in the regions it is usually lower than in Moscow, St. Petersburg and some other cities.
Despite the positive reviews of various folk methods, hyperplasia is best treated if they complement conventional methods. Doctors often recommend a supplement in the form of herbal medicine. Such drugs help fight obesity, relieve local inflammation, restore hormones, etc. Medicinal herbs must be taken as prescribed by the treating doctor, who selects them individually.
As additional methods of treatment can be used:
- HOMEOPATHY. Acceptance of homeopathic remedies is aimed at reducing the volume of bleeding, restoring hormonal levels, the menstrual cycle, reproductive function, etc. The homeopathic physician should select the drugs, taking into account the general tactics of treatment in each case.
- HIRUDOTHERAPY. It helps to normalize the cycle, activate protective mechanisms, balance hormonal functions, etc. Treatment with leeches is quite effective (this is confirmed by reviews) and is actively used in gynecology,
- PHYTOTHERAPY. The attending doctor will help you choose an effective remedy based on medicinal herbs. He knows the clinical picture exactly and will be able to recommend the necessary remedy. Often used: celandine, nettle, burdock, Borovaya uterus, plantain, peony and other plants (alone or in the form of fees).
When choosing a treatment strategy, it should be understood that hyperplasia is completely cured if one strictly follows the recommendations of a specialist. Modern medicine offers great opportunities, some drugs are interchangeable (natural hormones can replace synthetic ones, for example, Utrogestan). For patients older than 50, surgical intervention is often prescribed as the main method, women of reproductive age are trying to preserve their reproductive function. Timely detected hyperplasia can be completely cured, while the risk of recurrence is reduced if provoking factors are eliminated.
What to do after diagnostic cleaning
Treatment of hyperplasia after curettage consists in the prevention of relapses (it is necessary to normalize the hormonal function), restoration of the normal cycle and the condition of the operated area. For this, hormonal preparations can be used in combination with local procedures, diets, and unconventional methods.
What threatens hyperplasia
What is dangerous gpatology? In the period of development of the disease without adequate treatment, the pathological process continues. As a result, it can affect the underlying basal layer, neighboring organs, go into oncology. Persistent bleeding can cause anemia, and the causes of the disease - associated diseases of similar etiology.
Is further development dangerous? Yes, first of all by the transition to the atypical form. In addition, pathology can cause infertility.
What consequences should be expected? In the absence of treatment - the further development of the pathological process. If the hyperplasia was not completely cured or the causes of its occurrence were not eliminated, the disease is dangerous to relapse.
No, in the initial stages the disease consists of normal cells that accumulate in excess and thicken the endometrium. Some forms of this pathology are considered precancerous, since cells are reborn into atypical.
What it is?
Endometrial hyperplasia is a gynecological pathology, during the development of which there is a benign growth of tissues that form the mucous membrane of the genital organ. As a result, the endometrium thickens and increases in volume.
The main phase of the pathological process is the proliferation of stromal and glandular components of the uterine endometrium.
Can I get pregnant with the development of this pathology?
If we take into account the etiology and features of the development of the pathological process, it can be said with confidence that the possibility of becoming pregnant with this pathological process occurring in the layers of the endometrium is minimal. And this is due not only to the presence of changes in the tissues of the mucous membrane of the reproductive organ, due to which the fertilized egg cannot attach to its wall. The reasons lie in the hormonal imbalance, which is one of the main factors predisposing to the development of infertility.
In addition to the natural pregnancy, a woman is unlikely to be able to successfully carry and give birth to a baby after the IVF procedure. But if you undergo a course of therapy in a timely manner, this will reduce the risk of miscarriage, whatever the process of conception - natural or artificial.
Uterine endometrial hyperplasia is rare in women who have given birth, of course, if at a young age they did not suffer from the atypical form of this disease. in such a situation, a relapse of the pathology after the birth process is possible. This type of disease, especially if it often recurs, can lead to the development of an oncological process. To prevent this, women who give birth at risk should undergo regular routine check-ups with a gynecologist.
Symptoms of endometrial hyperplasia
One of the most common symptoms of this disease is the opening of uterine bleeding. Besides him, patients often complain about:
- amenorrhea (delayed menstruation for several months), followed by copious bloody discharge from the genital tract,
- the presence of spotting - brown or brownish - vaginal discharge,
- painful and longer periods with heavy bleeding (rare),
- violation of the menstrual cycle, its displacement in one direction or the other.
A frequent companion of uterine endometrial hyperplasia is metabolic syndrome, which, in addition to intense bleeding, is accompanied by:
- increased insulin levels in the blood,
- hormonal disruption, leading to the symptom complex of male features (it is accompanied by the appearance of vegetation in those parts of the female body where it should not be, as well as a decrease in the tone of the voice, etc.).
In addition to the above abnormalities, women with endometrial hyperplasia complain of:
- development of secondary infertility
- inability to bear fruit
- the occurrence of chronic inflammatory processes in reproductive organs,
- development of mastopathy or myomatosis of the uterus.
The more rare associated symptoms of hyperplasia include:
- bleeding during intercourse or hygiene procedures
- in the presence of polyps in the genital organ, periodically, the occurrence of cramping pain in the lower abdominal segment.
To begin with, a visual gynecological examination is carried out, followed by a series of laboratory and instrumental diagnostic procedures, among which the most informative are:
- Ultrasonography of the uterus and appendages using a special intravaginal sensor,
- Hysteroscopy - a clinical examination of a sample of endometrial tissue,
- Aspiration biopsy is performed when it is necessary to differentiate one type of hyperplasia from others.
An important role is played by biochemical blood analysis to determine the level of sex hormones, as well as hormones produced by the thyroid and adrenal glands.
Gonadotropin releasing hormone agonists
This group of hormonal drugs is considered the most effective. Zoladex and Buserelin preparations are used for different types of hyperplasia in women over 35 years old and during the perimenopause. The course of therapy can last 3-6 months.
The downside to the use of this group of hormonal agents is their ability to cause the appearance of symptoms of early menopause (in particular, hot flashes). This is explained by the fact that gonadotropic releasing hormones have a negative effect on the functioning of the hypothalamic-pituitary system, which, in turn, causes a decrease in the production of sex hormones by the ovaries. Such a phenomenon is also called "drug castration." However, this deviation is reversible, and normal ovarian functions are restored within 2-3 weeks after discontinuation of the drug.
Drugs in this group are administered every 4 weeks. The course of treatment lasts from 3 months to six months. The dosage and duration of therapy is calculated and adjusted (if necessary) by the attending physician.
Women suffering from atypical forms of hyperplasia should be under the close supervision of a gynecologist. Preventive ultrasounds are performed every 3 months for a year after surgery and the start of hormone therapy. When adenomatosis recurs, a hysterectomy is indicated.
If there is a re-development of uterine polyposis or cystic glandular hyperplasia, and hormone therapy does not give any results, ablation of the endometrium is performed. This is a procedure that involves the complete destruction of the tissues of the mucous membrane of the reproductive organ. However, this is an extreme measure, because after resection a woman loses the ability to conceive and give birth to a child.
During the procedure, a special electrosurgical knife with a cutting loop is used. Different types of laser beams can also be used that have a detrimental effect on endometrial abnormal cells. The operation is performed under general intravenous anesthesia.
After surgery, in the absence of complications, the patient is discharged home the next day. For 3-10 days after surgery, the woman may experience bloody vaginal discharge of varying intensity. If the patient has undergone endometrial ablation, then parts of the resected tissues can be secreted from the genital tract along with blood. However, this is an absolutely normal phenomenon, which should not embarrass and cause panic.
In parallel with the hormones, the patient is prescribed and vitamin therapy. Especially important for the female body are ascorbic acid and B vitamins (in particular, folic acid).
With heavy bleeding that accompanies hyperplasia, women often develop iron deficiency anemia. To replenish iron reserves, the doctor prescribes special drugs - Gyno-Tardiferon, Sorbifer, Maltofer, etc. Sedatives are also prescribed (spirit tincture of valerian or motherwort roots, Sedavit, Beefren, Novopassit, etc.).
Physiotherapeutic procedures, in particular, electrophoresis, are also prescribed. Excellent results and acupuncture.
To speed up the recovery process, a woman must eat right. It is also necessary to maintain a balance between stress and rest. The average duration of the recovery course after surgery is 2-3 weeks.
Is it possible to cure endometrial hyperplasia with folk methods?
The use of alternative medicine in the fight against hyperplasia often does not give any results, and sometimes can even harm.
So many herbs can cause powerful allergic reactions, to predict the consequences of which is extremely problematic. In addition, some medicinal plants contain phytoestrogens, which can cause the beginning or progression of the growth process of the inner uterine layer.
Diet and nutrition
For endometrial hyperplasia, it is necessary to give preference to low-calorie fractional nutrition. The main components of the menu should be:
- fresh vegetables and fruits,
- white meat,
- milk and dairy products.
It is best to cook dishes by steaming, avoiding the use of large amounts of vegetable oils. Proper nutrition helps to restore the functions of the whole body and normalize hormonal levels. In addition, it eliminates the risk of gaining weight, because women with obesity of varying severity are most susceptible to endometrial hyperplasia.
Prognosis of endometrial hyperplasia
The prognosis of the disease is influenced by the age of the patient, the form of the pathology and the presence of associated diseases.
- If endometrial hyperplasia was diagnosed in a woman during menopause, the prognosis of treatment is unfavorable. However, the pathology of the patient’s life does not threaten, but the state of health may deteriorate significantly.
- Severe course or the presence of atypical forms of hyperplasia also has an unfavorable prognosis. In addition, this concerns not only health, but also the life of a woman.
- With a steady course of pathology requiring surgical intervention, the prognosis is also unfavorable. And although the life of a woman is not in danger, she will lose the opportunity to become a mother.
- Hypertensive heart disease accompanying hyperplasia worsens the prognosis of the disease, as it can cause relapses. The same applies to the presence of endocrine pathologies and failure in the process of metabolism.
Uterine endometrial hyperplasia is a disease that occurs in various forms and has various manifestations. And although today there are effective methods of its treatment, it is better to prevent its development. Регулярное прохождение профилактических осмотров у гинеколога, своевременное излечение патологий половых органов, а главное, ведение здорового образа жизни – вот основные правила, которые помогут избежать развития гиперплазии эндометрия, и, следовательно, избежать опасных для здоровья (а иногда и жизни) женщины последствий.
Endometrial hyperplasia - what is it?
Endometrial hyperplasia is a morpho-functional pathological condition of the uterine mucosa, consisting in diffuse or focal proliferation (proliferation) of glandular and stromal structures with a predominant lesion of the glandular component in the functional (surface), less often in the basal endometrium. The thickness of the endometrium with hyperplasia exceeds the norm of indicators that depend on the phase of the menstrual cycle - up to 2-4 mm in the phase of early proliferation and up to 10-15 mm during the secretory phase.
In recent decades, there has been a steady increase in the number of pathological hyperplastic processes in the mucous membrane of the uterus, due to an increase in the average age of the female population, unfavorable environment, an increase in the number of somatic chronic diseases, many of which are to some extent associated with the hormonal system or have on her influence.
The frequency of pathology is 10-30% and depends on its form and the age of women. It occurs in girls and women of childbearing age, but most often - at 35 - 55 years of age, and according to individual authors - at half of women who are in the late reproductive or in menopause.
Recent years have seen an increase in the number of cases. Moreover, this growth occurs in parallel with the increase in the number of cases of cancer of the body of the uterus, which among all malignant tumors in women takes the 4th place, and among the malignant neoplasms of the genital organs - the 1st place.
Various forms of hyperplasia of the uterine mucosa - is it cancer or not?
Pathological changes in the endometrium are benign, but, at the same time, it is noted that in their background, malignant tumors develop much more frequently. Thus, simple endometrial hyperplasia without atypia in the absence of treatment accompanies uterine cancer in 1% of cases, with atypia in 8–20%, complex atypical form in 29–57%. Atypical form is considered a precancerous condition.
What is the difference between endometrial hyperplasia and endometriosis?
If the first is localized only within the uterine mucosa, then endometriosis is a chronic progressive recurrent benign disease, which by its growth and spread resembles a malignant tumor.
The cells of the endometrial tissue are morphologically and functionally similar to the cells of the endometrium, but they grow into the wall of the uterus, spread and grow beyond its limits - in the fallopian tubes and ovaries. They can also affect adjacent organs (peritoneum, bladder, intestine) and be carried by blood flow (metastasize) to distant organs and tissues.
Causes of endometrial hyperplasia and its pathogenesis
Due to the presence of the receptor apparatus in the mucous membrane of the uterus of a specific nature, it is a tissue highly sensitive to changes in the endocrine status in the female body. The uterus is the “target organ” for exposure to sex hormones.
Periodic cyclic changes in the endometrium are due to a balanced hormonal effect on the receptors of the nuclei and the cytoplasm of cells. Menstruation results from the rejection of only the functional layer of the endometrium, and the restoration of glandular structures occurs due to the growth of the glands of the basal layer, which is not rejected.
Therefore, the occurrence of a hormonal imbalance in a woman's body can cause a violation of the differentiation and growth of endometrial cells, which leads to the development of their limited or widespread excessive growth, that is, a local or diffuse endometrial hyperplasia develops.
The risk factors for endometrial pathological processes of cell proliferation are:
- hypothalamic-pituitary syndrome or Itsenko-Cushing's disease,
- chronic anovulation
- the presence of hormonally active ovarian tumors,
- polycystic ovary syndrome,
- tamoxifen therapy (antitumor and anti-estrogen drug) and replacement therapy with estrogens,
- chronic inflammatory processes of internal genital organs, frequent abortions and diagnostic curettage (occur in 45-60% of women with hyperplasia),
- fasting and psycho-emotional stress,
- thyroid diseases, whose hormones modulate the influence of female sex hormones (estrogens) at the cellular level,
- violation of the metabolism of fats and carbohydrates, in particular diabetes and obesity,
- pathology of the liver and biliary system, which results in slowing down the utilization of estrogen in the liver, which leads to hyperplastic processes in the uterine mucosa,
- hypertonic disease,
- postmenopausal period - due to the increased hormonal activity of the adrenal cortex,
- immune changes that are especially pronounced in women with metabolic disturbances.
In the development of proliferation of endometrial tissue, hormones play a major role. Among them, the primary role belongs to estrogens, which by their participation in the metabolic processes of cells stimulate the division and growth of the latter. In different periods of life, absolute or relative hyperestrogenism is able to provoke one or another of the factors listed above.
Hyperplastic processes in this period are mainly caused by anovulation cycles, and they, in turn, are associated with a disorder of the activity of the hypothalamic-pituitary system. The latter is accompanied by persistent unstable frequency and amplitude of GnRH emissions (gonadotropin-releasing hormone), which is the reason for the inadequate secretion by the pituitary gland of follicle-stimulating hormone (FSH).
The result of all this is premature (before reaching the stage that corresponds to ovulation) atresia of the follicles in many menstrual cycles. When this occurs, a relative excess of estrogen (as a result of the monotony of its products) with the secretion of progesterone (deficiency), which does not correspond to the stages of the menstrual cycle, which leads to inadequate growth of the endometrium. The glandular epithelium grows predominantly with a lag in the growth of the stromal component. Thus, adenomatous, or cystic hyperplasia of the endometrium is formed.
In the reproductive period
Excessive estrogen levels during the reproductive period may result from:
- hypothalamic disorders, hyperprolactinemia, frequent stressful conditions, starvation, chronic somatic diseases, etc., leading to dysfunction of the hypothalamus-pituitary system,
- disturbances in the hormonal feedback mechanism, as a result of which, in the middle of the menstrual cycle, the secretion of luteinizing hormone is not activated, which means that ovulation is also absent,
- changes directly in the ovaries themselves with the growth of their stroma, follicular cysts, ovarian polycystic disease, etc.
In periods of premenopause and perimenopause
The cycles of lack of ovulation are due to age-related changes in the activity of the functioning of the hypothalamic-pituitary system, as a result of which the intensity and frequency of GnRH release are changed. According to these cycles, both pituitary FSH secretion and the effect of the latter on ovarian function change.
The lack of estrogen in the middle of the menstrual cycle, which causes a decrease in stimulation of the release of luteinizing hormone, as well as the depletion (by this age) of the ovarian follicular apparatus lead to anovulation. In the postmenopausal period, the activity of the adrenal cortex increases in women, which also plays a certain role in the development of endometrial hyperplasia.
In addition, studies in recent years indicate the primacy of tissue resistance to insulin, which is caused by hereditary or immune factors, such as insulin receptor deficiency in tissues, the presence of specific antibodies against insulin receptors or blockade of the latter by growth factors like insulin and inherited, etc.
These genetic and immune disorders can cause metabolic disturbances (carbohydrate metabolism and diabetes, male obesity, atherosclerosis, etc.), as well as functional and structural changes (hypertension, coronary heart disease, etc.). They are considered secondary to the immunity of tissues by the action of insulin, which automatically leads to its increasing secretion in the body.
Increased insulin concentration, acting on the corresponding ovarian receptors and growth factors, stimulates multiple follicles, causing the development of polycystic cytosis, excessive production in androgen cysts, which are transformed into estrogens. The latter cause the absence of ovulation and hyperplastic processes in the endometrium.
Along with this, the condition of uterine hormonal receptors is of no small importance, which is not least influenced by mechanical damage (abortion, curettage) and inflammatory processes. Due to the lack of receptors, very often the hormonal treatment of endometrial hyperplasia (30%) is ineffective, since its sensitivity to hormonal preparations is insufficient.
An important role in the development of pathological proliferation is played not only by the enhancement of the growth processes of the endometrial cells themselves, but also by gene dysregulation of the regulation of their apoptosis (programmed timely cell death).
Thus, the mechanism of proliferative processes in the uterine mucosa is due to the complex interaction of many factors of both a systemic (neuronocrine, metabolic, immune) and local (cellular receptor and genetic apparatus of the uterine mucosa) character.
This mechanism is implemented mainly as a result of:
- excessive effect of estrogen with insufficient counteraction to progesterone,
- abnormal reaction of the glandular structures of the uterine mucosa in response to normal levels of estrogen,
- due to the high activity of insulin growth factors with insulin resistance, accompanied by a high concentration of insulin (metabolic syndrome, type II diabetes, polycystic ovary syndrome).
In most cases, the main symptom in women of different ages is dysfunctional uterine bleeding and / or bleeding from the genital tract. The nature of menstrual disorders does not depend on the severity of proliferative processes in the endometrium.
Violations of the menstrual cycle are possible in the form of delayed menstruation up to 1 - 3 months, which is later replaced by bleeding or a bleeding disorder (60-70% of women with endometrial hyperplasia). Somewhat less likely are cyclic bleeding lasting more than 1 week, corresponding to the menstrual days. Most often they are found among women who have no metabolic disorders.
Monthly with endometrial hyperplasia, as a rule, long. Their intensity can be different - from moderately pronounced bleeding to heavy, with great blood loss (profuse). On average, 25% bleeding occurs on the background of anovulatory menstrual cycles or the absence of menstruation (5-10% of women with hyperplasia).
In menopausal women, menstruation is irregular, followed by continued bleeding or bloody discharge. During menopause, there may be short-term or long-term poor blood flow.
Other, less significant and uncharacteristic signs of endometrial hyperplasia of the uterus are pain in the lower abdomen and bleeding after sexual intercourse, lifting weights, long walking (contact bleeding).
In addition, there may be complaints of a general nature, which are caused both by blood loss over a long period of time, and by metabolic and / or neuroendocrine disorders. These may include headaches, thirst, palpitations, high blood pressure, sleep disturbance, decreased performance and fast fatigue, psycho-emotional instability, excessive weight gain, the appearance of pink streaks and pathological hair growth, the development of pelvic pain syndrome, psycho-emotional disorders, reduced quality of life.
An insignificant percentage of patients show a lack of any symptoms. Pathological changes of the mucous membrane they are detected by random examinations, sometimes not even related to gynecological diseases.
In adolescence, endometrial hyperplasia is treated without curettage. To stop the bleeding, symptomatic therapy is used first of all, for which drugs that increase the tone of the uterine muscle wall (uterotonic drugs) are prescribed for no more than 5 days. These include Oxytocin, Dinoprost, Methylergometrine.
In addition, pharmaceutical hemostatic drugs (Vikasol, aminocaproic acid), vitamin therapy (folic acid, vitamin “B1”, Pyridoxine, vitamin“ E ”, ascorbic acid) and additionally - traditional medicines that help stop bleeding (nettle, shepherd's purse, etc.).
In the absence of an effect, progesterone drugs are prescribed, and if necessary, their combination with estrogen (Regulon, Femoden, Marvelon, Regigevon, etc.). In some cases, progesterone drugs are prescribed in shock doses, which leads to the separation of the uterine mucosa, like curettage or menstruation (hormonal curettage). Further treatment in order to prevent recurrence is carried out by means of gestagenic or complex (estrogen-gestagenic) hormonal preparations.
Reproductive and climacteric period
In women of reproductive and climacteric periods, treatment of endometrial hyperplasia begins with separate therapeutic and diagnostic curettage. After histological examination of the mucous membrane drug, certain hormonal agents are selected in individually selected dosages in order to prevent recurrence of the pathology or surgical treatment.
In reproductive age, therapy is aimed at both eliminating hyperplasia of the uterine mucosa and restoring ovulation cycles, in perimenopausal - at restoring the regularity of menstrual-like reactions or at suppressing them.
For these purposes, such agents as Utrozhestan (micronized natural progesterone), the complex estrogen-progestin drug Janine, as well as Norkolut (norethisterone), Duphaston (didrogesterone), Depo-provera, antigonadotropic hormones, agonists (stimulants) GnRG (Gosererelin, gonserelin, antigonadotropic hormones, agonists (stimulants) GnRH (Gosererelin, stimulants), anti-gadotropic hormones, agonists (stimulants) GnRG (Gorerelyralin, antigonadotropic hormones, agonists (stimulants) GnRG (Gosererelin, stimulants), depo-Provera, antigonadotropic hormones, agonists (stimulants) , Luprid Depot, Zoladex, Diferelin), etc.
How to take Duphaston with endometrial hyperplasia?
Djufaston, as well as Norkolut, has to be accepted from the 16th to the 25th day of a menstrual cycle in a daily dose of 5-10 mg. The drug is prescribed for six months (at least 3 months) with subsequent follow-up ultrasound tests after six months and 1 year.
The greatest difficulty is the treatment of hyperplasia in women with the presence of metabolic disorders (overweight) and an increased content of insulin in serum. For such patients, annual monitoring of blood lipoproteins, glucose, testing for glucose tolerance and testing of insulin levels are necessary.
Great importance is the normalization of body weight through increased physical activity, especially in fresh air, which helps to reduce the concentration of lipids in the blood, and proper nutrition. A diet for endometrial hyperplasia should be balanced, but in such a way that its daily caloric content is limited to 1,800 kcal. This should be ensured by limiting the content of carbohydrates and fats in the food and increasing the amount of proteins.
Let us consider in more detail the inner lining of the uterus, which today interests us most. Its thickness varies from 5 mm after menstruation to 2 cm before the new critical days.
Endometrium consists of two layers: functional and basal.
On the surface is a layer called functional. He is very sensitive to sex hormones that control his changes. After menstruation, the thickness of this layer is 1 mm. By the end of the cycle, it increases to 6-8 mm and exfoliates during the next menstruation.
Functional layer performs many functions. Its surface is smooth, smooth, without folds. Cover it ciliated cells. Each of them has up to 500 thin cilia. Together they oscillate and create waves that help the fertilized egg move.
There are simple tubular glandsthat emit a special slimy secret. Это вещество обеспечивает нормальную работу матки и не дает слипаться ее внутренним стенкам.
Строма эндометрия – особый вид соединительных клеток, расположенных в виде сетки. Под влиянием гормонов они меняются и выполняют разные функции: обеспечивают питание, защищают от повреждений, вырабатывают коллаген и участвуют в отторжении верхнего слоя.
Vessels of the surface layer in different phases of the cycle vary greatly. At first they are straightened, and closer to the month they twist spirally. When pregnancy occurs, it is these vessels that form the placenta, which brings nutrients to the embryo.
Under the surface layer is located basal. The main function is to restore the endometrium after “critical” days. He is not so sensitive to hormonal changes and changes little throughout the cycle.
This layer contains “cell-bubbles”, from which the atrial cells of the surface layer are formed. The stromal layer of the basal layer consists of connective tissue cells.
What affects the growth of the endometrium?
Endometrial growth is regulated by hormones.
- Estrogen normally produced in the first half of the menstrual cycle - the first 2 weeks. They are responsible for the restoration of the endometrium after menstruation and its growth (proliferation).
- Progesterone appears in the second half of the cycle in the third week. It stops the growth of the mucous membrane, starts the secretion phase - prepares the soil for the embryo to attach.
If there are too many estrogens, then the sprouting happens all the time. And because of the deficiency of progesterone, the growth of endometrial cells does not stop.
Diet is aimed at normalizing hormonal levels. Healthy foods are those that help control estrogen (vegetables and fruits, nuts, cereals, legumes). Products containing omega-acids (fish) and vitamins are added to the diet.
Food for hyperplasia should be fractional, 4-5 times a day. Protein of animal origin, spicy, pickled and salty foods, alcohol, coffee, soda, confectionery are excluded (or significantly reduced) from the diet.
II stage of treatment
Depending on the results of histological examination, drug therapy is prescribed to prevent recurrence. For this purpose, hormonal drugs are used, taken in a specific dosage and according to appropriate schemes.
Treatment of glandular cystic hyperplasia
- In girls at puberty and in women under 35, preparations containing estrogen and progestogens, for example, combined oral contraceptives (for and against their use). Preference is given to single-phase drugs with progesterone, which have a continuous effect on the endometrium, preventing its growth. Treatment lasts from three months to six months. Endometrial glandular cystic hyperplasia usually does not recur with proper therapy.
- In women from 35 years to perimenopause (the process of stopping menstruation). In therapy, gestagens are used, without the use of estrogen-containing components. Assign hormones in the second phase of the menstrual cycle, from 14 to 26 days after scraping or from the beginning of menstruation. Usually, endometrial hyperplasia is treated with duphaston and utrogestan. Therapy also lasts 3-6 months.
- In postmenopausal women (after cessation of menstruation). Hyperplasia at this age is a rare occurrence, usually associated with hormone-producing ovarian formations. With endometrial hyperplasia in menopause, treatment should be prescribed only after a thorough examination of the ovaries (ultrasound and, if necessary, laparoscopic examination). If there are no tumors, then 17-hydroxyprogesterone caproate is prescribed at a dosage of 125 mg 2 times a week, for six months - eight months. After the end of therapy, it is necessary to perform an endometrial biopsy and examine the sample obtained in the laboratory.
Treatment of atypical hyperplasia
Women of reproductive age and perimenopause. Therapies of choice are gonadotropin releasing hormone agonists for six months. Some drugs must be taken every day (buserelin acetate), some have a prolonged effect and require taking 1 time in 28 days.
After 6 months from the start of treatment, re-curettage of the endometrium with histological examination is usually required. In addition, each month of treatment ends with an ultrasound study, which controls the thickness of the endometrium (less than 5 mm).
When combined with atypical hyperplasia with myoma or metabolic syndrome, surgical treatment with careful ovarian examination is necessary. Constant monitoring requires the state of the mammary glands.
Plan of follow-up atypical hyperplasia:
- Ultrasound of the endometrium 1 time per month
- curettage with histological examination every 3 months
- Ultrasound of the ovaries every 3 months (with doplerometry)
- Breast ultrasound and mammography every 6 months
- monitoring signs of metabolic syndrome (cholesterol and blood glucose)
Postmenopausal women are indicated for prompt treatment with a thorough ovarian revision.
Pathology of endometrial hyperplasia: causes, symptoms, treatment
Endometrial hyperplasia is one of the most common pathologies affecting the cavity of the female uterus. The particular danger of the disease is that it, in fact, has no age restrictions - endometrial hyperplasia of the uterus occurs in adolescents, in patients of mature reproductive age, and in postmenopausal women.
Consider in more detail the nature of the occurrence of endometrial hyperplasia, symptoms and treatment of the disease, methods of diagnosis, as well as the possibility of prevention.
The nature and dynamics of the course of the disease
First, it is necessary to understand the nature of the appearance of hyperplasia - what it is, why the disease in question arises, how it manifests itself at different stages.
Uterine hyperplasia is the appearance of benign changes in the inner layer of the organ cavity (endometrium), consisting in the hypertrophic growth of tissues and an increase in their volume. The basis of the process - hormonal disruptions in the body associated with excessive production of estrogen. As a result, the glandular and stromal elements of the uterine lining begin to multiply rapidly, which leads to the expansion of tissue.
It should be noted that for the endometrium in a normal state, it is peculiar to cyclically change its structure, correlating vital activity with the menstrual cycle. At the stage of waiting for fertilization of the mature egg, the endometrium grows within acceptable limits, and when
fertilization does not occur, the layer is separated from the wall of the uterus and displayed outside with menstrual secretions.
Hormonal changes occurring in the body can cause excessive tissue proliferation and the development of a lesion.
For example, there is a high possibility of occurrence of the disease in adolescent girls who are undergoing a hormonal adjustment of the body.
What is hyperplasia in the medical sense of the term, and how does it manifest itself? In most cases, the disease has pronounced symptoms, but can sometimes occur latently, without revealing anything. In such conditions, the only way to detect pathology is a medical examination and special laboratory tests.
If the biological material obtained from the examination of a diseased uterus is taken for laboratory analysis, the following changes can be noticed:
- thickening of the mucous membrane,
- the endometrium acquires a characteristic gray-pink hue,
- the consistency of the mucous membrane softens, becomes more elastic,
- the surface of the shell becomes grainy or, on the contrary, leveled,
- there are cystic formations filled with a transparent or bloody substance,
- in the endometrial epithelium, a pseudo-stratification process takes place, in which the cell nuclei are lined up in several rows, creating a false impression of the multi-layered structure of the epithelial tissue,
- iron and stromal cell nuclei are hyperchromic,
- the level of the nuclear-cytoplasmic ratio increases,
- mitosis is intense.
Particularly relevant is the study of cellular transformations of uterine tissues affected by pathology, due to the fact that hyperplasia of the uterus in recent times is very often asymptomatic, and there is almost no chance for women to detect the disease on their own. Characteristically, menstrual periods with endometrial hyperplasia can proceed without alarming complications and not cause unusual pain. Therefore, the only way to detect a lesion in time is to undergo regular medical examinations and consultations with a gynecologist.
Symptoms of pathology
In addition to the above changes at the cellular level, a pathological increase in the endometrium notes a number of manifestations that are detected without special examinations.
Symptoms of endometrial hyperplasia:
- dysfunctional (anovulatory) uterine bleeding,
- menstrual irregularities (long delays or, on the contrary, too frequent menstruation),
- atypical manifestations during menstrual bleeding (too intense pain, vaginal discharge, the presence of copious amounts of blood clots),
- pain, localized in the lower abdomen and in the lumbar region,
- inability to get pregnant,
- in some cases - a feeling of weakness, anemia, dizziness.
It is worth noting that different types of endometrial hyperplasia may be accompanied by the same symptoms, and to determine the presence of a lesion, guided only by external manifestations, is in no case recommended.
Excessive bleeding with endometrial hyperplasia may indicate the presence of concomitant pathologies. In the case of the development of endometritis hyperplasia, it is also possible to have a thin, viscous discharge with bloody fibers.
For a more thorough study of the manifestations disturbing the patient, histology is assigned - a laboratory study of the cellular structure of the biological material that was seized during the examination. When hyperplasia of the uterus symptoms may be absent in principle. Therefore, only the conduct of an accurate diagnosis allows you to timely detect the development of the disease and prevent a wide range of possible complications.
Prevention and recovery after illness
There is no special prophylaxis for endometritis of hyperplasia and other pathologies of the uterine cavity, but it is recommended to adhere to the basic rules dictated by elementary logic and the implementation of general preventive measures.
In case of endometrial hyperplasia, prophylaxis includes a set of traditional measures aimed at supporting and restoring the body, in particular the reproductive system, regular medical examinations, an active and healthy lifestyle.
At the same time, it is worth remembering that intense physical exertion is prohibited after undergoing surgical intervention.
Great importance for rapid and high-quality recovery of the body has proper nutrition. Endometrial pathology requires a diet rich in vitamins and minerals, intake of ascorbic acid, B vitamins, iron supplements is recommended. Physical therapy, drugs of the sedative spectrum (valerian or motherwort in tinctures) are prescribed as an additional restorative measure.
Regarding sexual intercourse, regular and active sex life is the key to the general gynecological well-being of the female body. It is important to remember to observe the rules of hygiene and contraception. If sexual intercourse does not bring painful feelings, then sex is not forbidden even during the period of the disease. It is necessary to limit contacts only during the preparation for an surgical intervention and for the period of postoperative recovery - up to 2 weeks.
If the recovery was successful, the woman is ready to return to normal life, but do not forget about regular gynecological examinations and consultations.
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Dec 26th, 2014 @ 04:02 pm ›admin
Endometrial hyperplasia- these are benign changes in the uterus in the form of excessive proliferation and thickening of the inner layer (endometrium) due to increased reproduction of stromal cells and / or the glandular component. Endometrial hyperplasia occurs in 5% of women with gynecological pathology. Endometrial hyperplasia in different age groups is uneven. In women of premenopausal age, the probability of its occurrence is significantly higher and varies from 2 to 10%.
The increased number of hyperplasias in recent years is associated with a change in the rhythm of life and an increase in its duration, with an increase in the number of neuroendocrine and hormonal disorders, a decrease in immunity and an increase in somatic pathology.
In the endometrium there are two layers - the inner (basal) and outer (functional). The basal layer is dense and elastic, differs in quantitative and qualitative constancy of the cellular composition, it is formed by connective tissue elements and collagen fibers. The basal layer has a very weak and unstable reaction to the effects of sex hormones. It serves as a "reserve" for the restoration of the functional layer after menstrual bleeding.
The inner (functional) layer of the endometrium is sensitive to the effects of sex hormones, it undergoes cyclic changes in thickness and structure. In the thickness of the functional layer there are many full blood vessels and glands. During the first half of the menstrual cycle, the functional layer is actively increasing in volume and preparing for a potential pregnancy. The second phase of the menstrual cycle is designed to ensure that all previous changes are eliminated. The culmination of these processes is the complete rejection of the functional layer, that is, menstruation. Then the cells of the basal layer help restore structural damage.
Endometrial hyperplasia is not an independent disease. The leading role in the formation of hyperplastic processes belongs to the abnormal hormonal regulation. All processes occurring in the uterus, are controlled by female sex hormones and depend on their proper ratio. If this ratio is violated, the processes of maturation and rejection in the endometrium occur in an altered rhythm, the menstrual cycle is distorted.
Endometrial hyperplasia is characterized by a variety of forms and clinical manifestations. Despite the benign process, with endometrial hyperplasia, there is a likelihood of atypical changes.
The phrase “endometrial hyperplasia of the uterus” is incorrect. The inner layer of the uterus is called the endometrium. In no other sense is it used, therefore, the process of endometrial hyperplasia can only be in the uterus and cannot be formulated as uterine endometrial hyperplasia.
Symptoms and signs of endometrial hyperplasia
Structural changes in the endometrium with hyperplasia do not always occur in the same way. Hyperplastic processes can be implemented due to the proliferation of various elements of the endometrium, so all hyperplastic processes are divided into four types:
1. Glandular hyperplasia of the endometrium. The growth of the endometrium occurs mainly due to an increase in the glandular component. The glands become sinuous and grow evenly.
2. Glandular-cystic hyperplasia of the endometrium. In some sources it is classified as simple endometrial hyperplasia and, in fact, is equivalent to the glandular type of hyperplasia, differing from it only in that the dilation of the endometrial glands occurs with the formation of cysts.
3. Atypical endometrial hyperplasia sometimes represents a threat to life and health, as it refers to precancerous diseases. It has a synonym for "adenomatosis". It is characterized by the appearance of atypical cells in the endometrium. Focal (adenomatous polyp) or diffuse forms are distinguished. It is believed that the oncological process is preceded by a long-existing simple endometrial hyperplasia. Dangerous cellular changes may occur in a limited area of the mucous membrane, for example, in polyps, or spread throughout the endometrium. Atypical endometrial hyperplasia is transformed into cancer in 10% of patients.
4. Focal endometrial hyperplasia (another name is endometrial polyp). The growth of endometrial cells occurs in certain areas (foci), which are most sensitive to hormonal changes. Endometrium grows in such areas intensively, but it cannot go beyond the boundaries of the focus, therefore it grows in height. Initially, a slight elevation is formed in the endometrium, and then an endometrial polyp is formed. Polyps are prone to recurrence and malignancy.
The clinical picture of endometrial hyperplasia is a consequence of hormonal disorders, namely hyperestrogenia. The severity of symptoms in patients is not the same, in some of them the process may be asymptomatic.
A characteristic symptom for patients with endometrial hyperplasia are anovulatory uterine bleeding. They begin after the delay of the next menstruation, usually abundant and long, in some cases with blood clots. Межменструальные маточные кровотечения встречаются реже, имеют умеренный характер. В постменопаузе чаще отмечаются мажущие кровянистые выделения.
Боль не является типичным симптомом гиперплазии эндометрия. Иногда у больных могут появиться умеренно выраженные боли внизу живота, в том числе во время менструации. In endometrial polyps, patients may complain of cramping pain associated with an increase in the size of the polyp or necrotic changes inside it.
Infertility is the most frequent companion of endometrial hyperplasia, and sometimes it can be its only symptom. However, infertility is not the direct cause of endometrial hyperplasia. It can be said that these are two concomitant symptoms accompanying one cause — the anovulatory menstrual cycle.
With heavy uterine bleeding, patients may develop anemia. Appears pallor of the skin, general weakness, dizziness.
Endometrial hyperplasia during pregnancy
The most frequent companion of endometrial hyperplasia is infertility. During the examination of patients with primary infertility, endometrial hyperplasia is diagnosed in every fifth of them. Pregnancy against the background of diffuse hyperplasia of the endometrium of a hormonal nature is impossible.
In order for a pregnancy to take place, two mandatory conditions are necessary:
- The presence of ovulation, meaning readiness for fertilization,
- “Prepared” for the development of a fertilized ovum endometrium. In the first phase of the cycle, under the control of estrogens, the functional layer of the endometrium grows, but, unlike hyperplasia, these changes are physiological. It is their patients who are sometimes mistakenly called endometrial hyperplasia.
Pregnancy will come only if there is a two-phase cycle with a physiological change of dominant hormones. Endometrial hyperplasia in the overwhelming number of cases develops with severe hyperestrogenism and gestagen deficiency, ovulation is absent, and in the endometrium pathological changes occur, precluding the development of pregnancy.
A rare exception is the situation when endometrial hyperplasia has non-hormonal causes and occurs against the background of a two-phase ovulatory cycle. This applies to cases of focal hyperplasia, when a center of abnormal growth of endometrial tissue - a polyp - occurs on an unchanged functional layer. The following scenario of events has two directions:
1. A fertilized egg enters the uterus and implants (takes root) in its healthy part. If a polyp is not large and does not interfere with the development of pregnancy, it is monitored, and after birth it must be removed. It is possible that a polyp threatens the normal course of a developing pregnancy, then a decision can be made to remove it. Such situations are extremely rare. Endometrial polyp can only be removed in early pregnancy.
2. If the polyp is located in the way of a fertilized egg in the uterus, pregnancy will not come. A similar ending will happen if the fertilized egg tries to “settle down” in the area of the polyp - implantation does not occur, and pregnancy does not come.
Large endometrial polyps can cause premature labor and uterine bleeding in pregnant women.
To avoid undesirable situations, it is necessary to undergo a gynecological examination before the onset of the desired pregnancy.
The diagnosis of endometrial hyperplasia does not mean a sentence of reproductive function, with timely adequate treatment and elimination of the causes, endometrial hyperplasia regresses.
Focal hyperplasia of the endometrium
Focal hyperplasia of the endometrium is represented by polypous processes inside the uterus. Uterine polyps are formed due to the proliferation of areas of the basal layer of the endometrium. The polyp consists of epithelial cells, has a leg and a body. Depending on the cellular composition of endometrial polyps are divided into:
- glandular polyps, in which the number of glands exceeds the number of other cells,
- glandular fibrous polyps formed by connective tissue, the glands in their composition are much smaller,
- fibrous polyps consisting exclusively of connective tissue.
Additionally, atypical focal hyperplasia is distinguished, which is an adenomatous polyp — a glandular polyp with signs of atypia (precancer).
The greatest number of cases of detection of endometrial polyps accounts for 35-50 years. In the reproductive age, glandular polyps appear more often, and in elderly patients - adenomatous and fibrous. Focal hyperplasia of the glandular-fibrous structure can be diagnosed at any age.
In the development of uterine polyps, the leading role is assigned to the same disorders as with diffuse endometrial hyperplasia: hormonal disorders and hyperestrogenism, as a result - anovulatory single-phase cycle.
A much smaller number of cases of focal hyperplasia develops on the background of a preserved two-phase cycle.
The pathological process in the endometrium in such cases lead to:
- trauma to the uterus during abortions, diagnostic curettage, prolonged presence of the intrauterine device,
- miscarriages, late pregnancy termination, abnormal labor,
Polyps can form on the background of unchanged endometrium or on the background of a diffuse hyperplastic process. Women with metabolic and endocrine diseases, hypertension. obesity is a risk group for the development of endometrial polyps. Polyps in these patients are more likely to undergo malignancy (they acquire signs of a malignant process).
The most frequent complaints of patients with endometrial polyps are menstrual irregularities, leucorrhea (with large polyp sizes), abdominal pain and infertility.
If a polyp develops against the background of an unchanged functional layer of the endometrium, young women experience scant serum discharge that is not associated with menstruation, and blood loss during menstruation increases. In the premenopausal age (from 45 years of age), endometrial polyps show intermenstrual bleeding. In postmenopausal women, occasional spotting of moderate or scanty character may occur.
If polyps reach a length of 2 cm, the uterus responds to them with contractions (like a reaction to a foreign body), in this case, the patients notice cramping pains mainly in the lower abdomen. Similar pains appear in case of development of necrotic processes in a polyp.
The uterus background processes (uterine fibroids, adenomyosis, inflammatory diseases), the state of hormonal function and the age of the patient have a significant influence on the course of the disease.
The symptoms of endometrial polyp are similar to those of uterine myoma and endometriosis. To establish a reliable diagnosis requires additional diagnostic methods.
The basis for the medical treatment of pathology is hormone therapy. For its use using contraceptives, progestins and gonadotropin releasing agonists - hormone or aGnRG.
This treatment is aimed at leveling hormonal levels by reducing estrogen and stopping the growth of the uterine lining.
Combined oral contraceptives. With the help of OC, treatment is given to nulliparous women and adolescent girls who have irregular and abundant periods against the background of glandular hyperplasia or glandular-cystic.
Such medicines can be prescribed in order to avoid emergency curettage. The course of therapy is long, at least 4 - 6 months. The medicine is taken according to a special scheme.
Synthetic analogue of progesterone. Women of any age category and forms of this pathology are prescribed gestogen drugs. It is possible to treat HE with these drugs for 3-6 months. Against the background of gestogen therapy, intercyclical secretions may appear.
Duphaston therapy. Duphaston is an effective drug in the treatment of endometrial hyperplasia. It is prescribed for long-term treatment - at least 4 months according to a special scheme with an increase and decrease in dose.
Narcolut is not an active progestogen, but has an anti-estrogenic effect. Drink it for six months in the middle of the menstrual cycle. If the patient has bleeding, then to stop Narkolut, they drink it once for 12 days.
Mirena is an intrauterine device. Used as a contraceptive and local hormonal treatment of hyperplasia.
GnRH is a modern and effective medication used to treat EH. The advantage of treatment with drugs of this class is a high percentage of positive results, a convenient schedule for taking the medicine, as well as the ability to adjust the dosage.
Gonadotropin releasing hormone agonists help in the treatment of infertility, and avoid surgery to excise the uterus.
Surgical intervention is carried out in various volumes and different methods.
Scraping. It is carried out in order to diagnose and therapy. With it, remove the abnormal layer of the endometrium, stop the bleeding. Uterine material is sent for histology.
Cryodestruction is used for the prevention and treatment of endometrial hyperplasia. With the help of low temperature, an effect on the anomalous layer occurs, which is subsequently rejected. Vessels, while not exposed to defeat.
Laser ablation With the help of special tools is carried out the impact of the laser on the affected area.
Hysterectomy or removal of the uterus is performed with a complex, atypical form of the disease in premenopausal women. During this operation, the ovaries do not touch, but they are carefully examined to clarify whether the type of pathology is malignant or not.
If there is endometrial hyperplasia and endometrial cancer is detected, then complete resection of the uterus and appendages is performed.
Combination therapy includes surgery with hormone therapy.
Traditional methods of treatment
Herbal medicine in the treatment of hyperplasia has a positive effect if you carry out a comprehensive treatment.
4 week course of therapy with celandine and juices
- The first month is to use carrot or beet juice, flaxseed oil and make syringing with celandine.
- The second month - Cagor and aloe, honey are added to daily therapy.
- The third month passes without douching.
- In the fourth month, weekly breaks are taken, and an infusion of a boron uterus is added.
Complications and Prevention
The prognosis of this pathology depends on its type. If the disease has a simple form, and the patient is at a young age, then promptly started therapy will fully restore health.
Late diagnosis and treatment not started on time lead to a number of complications:
- The occurrence of endometrial cancer,
- Recurrence of the disease
- Anemia on the background of bleeding can take a chronic form.
In order to prevent the following requirements should be observed:
- If possible, do not make an artificial abortion,
- Once every three months, perform scraping for histological examination,
- Regularly visit a gynecologist,
- Monitor blood pressure, blood glucose,
- Prevent obesity,
- Do yoga, fitness, eat healthy and wholesome food.
Important! It should be remembered that endometrial hyperplasia is not always a cancer. And in order to prevent the reincarnation of pathology in oncology, you should promptly seek the help of a specialist.
Questions to the gynecologist
Perhaps conceive a child with Go?
As a rule, pregnancy with this pathology does not occur, or is interrupted by early miscarriage.
Is it possible to postpone therapy for this disease?
It is not advisable to postpone a visit to the doctor if you suspect a disease. There is always a risk that the disease may turn into oncology, develop infertility or open bleeding.
Why endometrial hyperplasia occurs
The inner lining of the uterus undergoes permanent changes associated with the menstrual cycle. In the first half of the cycle, it swells, the vascular network develops, conditions are created for fixing and feeding the fertilized egg. If pregnancy does not occur, the epithelial layer of the membrane is rejected and removed from the body in the form of menstrual bleeding.
In hyperplasia, the connective and glandular tissues of the endometrium overgrow, the shell thickens and the uterus increases. The danger is that abnormal changes can lead to the formation of cancer.
Causes of abnormal development of endometrial cells are hormonal disorders that occur during puberty or menopause. In addition, the causes are various diseases associated with metabolic disorders and endocrine system, diseases of the external and internal genital organs.
Symptoms of endometrial hyperplasia are most often observed in violation of the content of estrogen and progesterone in the body. An imbalance of hormones occurs in the following cases:
- presence of mastopathy, uterine fibroids, polycystic ovary,
- inflammatory diseases of the uterus and ovaries,
- surgery on the uterus, scraping,
- diseases of the pancreas, digestive system associated with impaired fat metabolism, obesity,
- liver disease, diabetes,
- hormonal drugs, contraceptives.
Types of endometrial hyperplasia
Depending on the nature of changes in endometrial tissues, the following types of disease are distinguished:
- Glandular hyperplasia. Formed by reproduction of cells of the connective and glandular tissue of the endometrium. This is a benign process. The endometrial mucosa thickens, the tubular glands penetrate it. There is an acute form of the disease that occurs as a result of a sharp increase in estrogen levels, and also chronic - with a slight change in estrogen levels over a long period.
- Glandular cystic dysplasia. Occurs clogging glands. They overflow with mucus, swell, due to which cysts are formed.
- Atypical hyperplasia (adenomatosis). Not only is the pathological proliferation of cells, but the structure of the nucleus is changing, which is already characteristic of malignant diseases.
Forms of endometrial hyperplasia
According to the degree of damage to the inner surface of the uterus, there are diffuse and focal forms of hyperplasia. When the diffuse form affects the entire surface of the endometrium, its layer thickens evenly.
A focal form is characterized by a lesion of a separate surface area. An example of a focal form of the disease are endometrial polyps. They look like overgrown formations with connective (fibrous) tissue at the base.
The more complex the changes occurring in the structure of endometrial tissues, the greater the likelihood of the disease turning into a malignant form. In the case of small changes in the shape of the glands, the probability of cancer is 1-3%. In complex cases of atypical changes, it increases to 22-57%.
Signs of glandular hyperplasia
Hyperplasia with a change in the structure of the glands can easily become an atypical form, which has the highest probability of dangerous transformation. The most typical symptoms of glandular endometrial hyperplasia in women of reproductive age are:
- Violations of the menstruation cycle. Menstruation comes irregularly, the amount of discharge is uneven, more often there are heavy bleeding. Before menstruation and after them there is a clear discharge with blood.
- The appearance of bleeding between normal regular menstruation (metrorrhagia).
- The appearance of prolonged and heavy bleeding after a delayed menstruation.
- Long (lasting more than a week) and abundant (about 3 times more abundant than normal) menstruation (menorrhagia). Such menstruation is accompanied by severe pain in the lower abdomen, in the lower back. The woman has weakness, fatigue, fainting. Anemia may occur. Such symptoms are most characteristic of endometrial hyperplasia with the formation of polyps (glandular, fibrous).
- Infertility. It may occur as a result of underdevelopment of the egg due to hormonal disorders. Such symptoms of endometrial hyperplasia also appear because of the impossibility of attaching a fertilized cell to the wall of the uterus due to the violation of its structure.
One of the signs of the disease in adolescent girls is the appearance of blood clots in the menstrual flow.
Signs of focal endometrial hyperplasia
Lesions may have a diameter of 2 mm or more (up to several centimeters). Perhaps the emergence of two types of pathology. First, if the level of estrogen exceeds the norm, then the maturation of the egg cell slows down, the detachment of the mucous membrane is delayed, so it has time to grow. An important symptom of hyperplasia in this case are prolonged and severe bleeding, coinciding with the periods of menstruation, as well as minor spotting of blood between periods.
Secondly, with a shortage of progesterone, the eggs do not mature, ovulation does not occur. In this case, only a part of the mucous layer is rejected; polyps form from the remaining cells. Symptom focal hyperplasia of the endometrium are menstrual bleeding lasting 10-14 days.
Signs of hyperplasia during menopause
Symptoms of endometrial hyperplasia may manifest as early as premenopause. Менопауза - это период, для которого менструальные нарушения не являются чем-то необычным. Менструации становятся нерегулярными, может колебаться их интенсивность.
Если в это время у женщин появляются кровянистые или сукровичные выделения, они часто не придают этому особенного значения, принимая их за климакс.
Age-related hormonal changes, postponed abortions, chronic diseases of the genital organs, weakening of the immune system accelerate the occurrence of the disease. The likelihood of reincarnation in uterine cancer increases.
If persistent hypertension is observed, there is diabetes mellitus, there is a violation of fat metabolism in women older than 45-50 years old, then you need to pay special attention to signs such as prolonged and heavy bleeding or, conversely, meager bleeding. It is necessary to consult a doctor in a timely manner to increase the chance of a cure.
Signs of postmenopausal hyperplasia
During this period, the warning sign is the appearance of bleeding of any length and intensity, as well as pain in the lower abdomen, with a cramping character. Acyclic bleeding that is not associated with menstruation occurs both in polyps and uterine myoma. They are also characteristic of malignant diseases.
Note: Particularly attentive to the appearance of such symptoms should be women who have a late menopause (after 55 years). Symptoms of endometrial hyperplasia are easily confused with menstruation that occurs during a prolonged menopausal period.
Echographic signs of hyperplasia
One of the most important methods for detecting endometrial hyperplasia is ultrasound examination of the uterus. The method allows to measure the thickness of the mucous membrane, to detect polyps, as well as to estimate the size of the lesions. In this case, the indicators are compared with the norms characteristic of individual phases of the menstrual cycle.
In a healthy uterus, the thickness of the mucous membrane in the first phase of the cycle is 3-4 mm, and in the second 12-15 mm. The echogenicity (sound conduction) of the mucous is greater than the muscle layer. With hyperplasia, the thickness of the mucous does not change, the echo is homogeneous, and the outlines of the thickening are even. If malignant changes occur, the contours of the thickening become uneven, the echogenicity of different areas is heterogeneous.
Echographic symptoms of endometrial hyperplasia are considered to be the presence of polyps with a size of 16.1-17.5 mm with a muscle thickness of 14.6-15.4 mm. Thickening of the wall to 19-20 mm may indicate the presence of a cancer.
Can I have sex
Sex with endometrial hyperplasia will be contraindicated for heavy and / or contact bleeding.
I have hyperplasia, the doctor advises hormone therapy, reviews about the consequences first scared me, I began to look for how to treat with other methods. She felt worse, went to the doctor again. I have been drinking hormones for 3 months now. I feel great, the cycle is stable, I advise everyone not to delay treatment.
After being diagnosed, she refused the operation. After six months on the ultrasound, the doctors noticed an increase in the focus. After the operation, 3 years have passed, I was removed from the dispensary registration, the disease no longer returned.
I am outraged by reviews about the benefits of treatment with dietary supplements. I could not stand it, I called one number. A polite girl said that traditional medicine is nonsense, their supplements will cure everything. I am an intern doctor, started asking questions. Well, at least one answered correctly! Do not believe such specialists.
Is endometrial hyperplasia cancer?
Endometrial hyperplasia is not cancer, but its individual types are classified as precancerous pathology. This means that on the background of hyperplasia, an oncological disease can develop. During the proliferation of the endometrium, cells may sometimes appear that are structurally different from the normal elements of the uterine lining. Such cells are called atypical, and their appearance is called atypia. If there are many such cells, endometrial cancer begins to develop. To avoid a negative scenario, it is necessary to undergo timely treatment.
Endometrial hyperplasia of the uterus (endometrial hyperplastic processes) is an excessive proliferation of endometrial cells due to increased proliferation of stromal and glandular cells, during which the cells thicken, change, the uterus increases. New structures are found in the uterine lining. This disease is dangerous, therefore, requires compulsory treatment.
Depending on which elements prevail in the endometrium, hyperplasia is distinguished:
- glandular hyperplasia of the endometrium - proliferation of glandular tissue associated with the expansion of the lumen between the glands of the endometrium. The tissue is homogeneous and the thickness of the endometrium with glandular hyperplasia does not exceed 1.5 cm.
- glandular-cystic or cystic hyperplasia of the endometrium - associated with the growth of glandular tissue with the formation of cysts.
- atypical, which is also called adenomatosis - it is determined by structural changes in the tissues. Accompanied by the appearance of rapidly dividing atypical cells, and related to precancerous diseases. The thickness of the endometrium with such hyperplasia reaches 3 cm.
- focal hyperplasia of the endometrium, which involves the formation of polyps, germinating in the form of individual foci. Polyps are also glandular, fibrous, adenomatous. The size of focal hyperplasia of the endometrium can reach 6 cm.
Of all three forms of the most dangerous focal, which goes into cancer in 10% of cases. Otherwise, the treatment is fairly easy and fast. Therefore, great importance is attached to the early diagnosis.
Endometrial hyperplasia can develop in women at any age, but most often it occurs in transitional age, that is, at a time when hormonal changes occur in the body, for example, in adolescents or in women before menopause.
Causes of endometrial hyperplasia: metabolic disease,
late onset of menopause (after 50 years), hormonal imbalances (hormonal imbalance), excess estrogen on the background of acute progesterone deficiency, as well as other inflammatory diseases (hypertension, fibroids, endometriosis, polycystic ovary), history of abortion and diagnostic curettage, hereditary predisposition .
Endometrial hyperplasia is exacerbated by other endocrine disorders, such as diabetes and obesity. Most often, women over 50, overweight, after menopause, and high blood pressure complain of hyperplasia and related bleeding.
The occurrence of endometrial hyperplasia is associated with a malfunction of the hypothalamus and pituitary - brain centers regulating the functions of the sex glands in particular, and the endocrine system in general. At the same time, there is an increase in the formation of follicle-stimulating hormone responsible for the growth and maturation of the follicles in the ovaries of a woman. As a result of this increased influence, many follicles form simultaneously in the ovary, which “freeze” at a certain stage of their existence, continuing to secrete a large amount of estrogen into the blood of a woman, or undergo a reverse development, which, on the contrary, is accompanied by a decrease in the amount of estrogen. In any case, ovulation does not occur, and the mucous membrane of the uterus is under the prolonged action of estrogenic hormones, causing its excessive pathological growth, that is, hyperplasia.
Symptoms of endometrial hyperplasia: very heavy menstrual periods, disruptions and irregular menstruation, non-cyclical bleeding that may occur during the intermenstrual period or after a short delay in menstruation.
At an early stage, the disease has practically no manifestations. But after a while, the woman in the period between the menstruation begins bleeding, which patients often take for a small failure of the menstrual cycle and ignore this problem, triggering the disease.
Often, the symptoms of this disease are confused by women with miscarriages or symptoms of uterine fibroids.
If you do not start treatment in time, the discharge becomes more frequent and turn into prolonged heavy bleeding.
Diagnosticshyperplasia spend carefully to establish an accurate diagnosis and on the basis of it to appoint prompt and correct treatment. Diagnosis is performed using the following methods:
Examination of the gynecologist on the basis of the patient's complaint. On examination, an increase in the uterus may be detected, but for an accurate diagnosis of one examination is not enough, you must go through a number of studies.
Ultrasound of the pelvic organs allows to evaluate the structure and thickness of the mucous membrane.
Blood test for hormones.
Hysteroscopy - inspection using a special optical probe.
If the process is suspected to be malignant, a biopsy is performed - endometrial tissue is collected for examination.
Methods of treatment of endometrial hyperplasia depend on its type, the extent of the process and the age of the patient.
Drug treatment: hormonal therapy aimed at the regulation of hormonal metabolism. The course of treatment is individual and is usually 3-6 months. Properly prescribed hormonal agents stop the growth of the endometrium. But with significant hyperplasia and with relapses of the disease, surgical treatment is prescribed.
Uterus removal - the most radical method, which is carried out in the case of recurrence of the disease, severe forms of the disease. Surgical treatment of endometrial hyperplasia is to remove the overgrown layer of the uterine mucosa (ablation). It is necessary to remove the uterus with endometrial hyperplasia, complicated by myomas, multiple polyps and internal endometriosis.
If you decide to use some of the means of traditional medicine - be sure to consult with the gynecologist, because such treatment can harm, not help.
Treatment of endometrial hyperplasia folk remedies
- peach oil: chop fresh peach leaves, put them in a glass jar and cover with warm linseed oil (the levels of oil and leaves should be the same). Close the jar tightly, leave for 20 days, then strain the oil and squeeze the cake well. Take two tablespoons of oil twice a day, you can add in this quantity of oil in food.
- an infusion of herbs: nettle, celandine, boron queen, centaury, St. John's wort, thyme, calendula flowers, hawthorn fruit, shepherd's purse - take in equal parts. 2 tbsp. Spoon collection brew in a thermos 0.5 liters of boiling water, close and leave for 2 hours, then strain. Take 2 tbsp. spoon 3 times daily before meals for 6 months. In this case, the treatment should be coordinated with the phases of the female cycle: begin taking infusion every time on the eighth day from the beginning of the new cycle.
There are contraindications. Check with your doctor.
- decoction of the uterus of the uterus: one-sided ortilia (1 tbsp. Spoon) is filled with boiling water (0.5 l) and evaporated in a water bath for fifteen minutes. The resulting decoction is taken an hour before meals per day no more than three times. Herb grass is brewed in the same way, only the broth is taken after eating twenty minutes a day no more than 3 times.
- Aloe tincture: 0.4 kg of aloe juice, 0.4 kg of honey, 700 ml of Cagoras - mix everything in a jar, leave for 14 days.
- tincture of nettle: 200 g of nettle herb pour 0.5 liters of vodka, insist two weeks.
Take in the morning and before bedtime, 1 tsp.
- decoction of nettle: 2 tbsp. spoons of nettle grass is poured 200 ml of boiling water and boiled for 15 minutes in a water bath. Add boiled water to the original volume. Take 4-5 times ¼ cup.