Endometrial hyperplasia : symptoms, treatment , causes of

What is it - endometrial hyperplasia (endometrial hyperplasia) is a pathological condition in which there is an increase in the thickness of the inner layer and changes in the structure.

disease is based on a violation of hormonal background, which leads to an increased proliferative activity of endometrial cells.

Classification


Given the histological structure of endometrial hype
rplasia is divided into the following types:

  1. 1) Glandular - there is only a thickening of the inner layer of the uterus
  2. 2) glandulocystica - thickening of the inner layer of the uterus combined with the presence of cystic formations (clogged glands endometrium)
  3. 3) The atypical or adenomatosis (signs of atypia endometrial cells).
in practical gynecology basically distinguish between two basic types of hyperplasia of the internal layer of the uterus:

  1. 1) The atypical, which requires action on the part of the doctor, as it is a precancerous process
  2. 2) Neatipicheskaya.

Causes


The cause of endometrial hyperplastic processes associated with the violation of the hormonal regulation of the menstrual cycle.This leads to hyperestrogenemia that is both relative and absolute.Relative hyperestrogenemia say in the case where the synthesis of estrogen is in the normal range, and reduced production of progesterone.

hyperestrogenemia absolute in the case of reducing the production of estrogen, regardless of the level of progesterone.These conditions give the following pathogenetic mechanisms:

  1. 1) follicle atresia, in which there is no ovulation.Atrezirovanny follicle produces a monotonous low levels of estrogen, which can not determine the onset of ovulation.Therefore, the endometrium remains in the proliferative phase, without going into secretory, which precedes menstruation.
  2. 2) Excessive amounts of adipose tissue, which is now seen as an endocrine organ.It is synthesized estrone, causes inappropriate proliferation of the endometrium.
Given the generality of the pathogenesis of endometrial hyperplastic processes with other gynecological diseases, there is a combined pathology.So, hyperplasia may be associated with:

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

symptoms of endometrial hyperplasia


long time, endometrial hyperplasia is clinically does not manifest itself.Over time, however, when disrupted the process of separating the functional layer of the mucous membrane of the uterus, there are abundant menstruation.They can last longer than usual.Gradually move menstruation in uterine bleeding.

other clinical signs of endometrial hyperplasia has not.However, the clinical picture can be supplemented, and other symptoms that are associated with the presence of background pathology.Thus, in the case of uterine fibroids may bother abdominal pain, frequent urination, constipation and others.

Endometriosis is characterized by the appearance of painful menstruation, and pain during sexual intercourse.Against this background, gradually developed a nervous breakdown.Thus, the clinical picture of endometrial hyperplasia can not be a fundamental in establishing a definitive diagnosis.It can only bring a doctor to think about this pathology.

diagnosis of endometrial hyperplasia


Endometrial hyperplasia is clinically manifested by the presence of uterine bleeding.At the time of occurrence, they may coincide with menstrual periods (menorrhagia) or do not match (metrorrhagia).

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

  1. 1) Ultrasound diagnosis
  2. 2) Hysteroscopy
  3. 3) Histological examination of scraping the uterine lining, which allows to differentiate atypicalneatipicheskuyu and endometrial hyperplasia.
ultrasound criteria hyperplasia are as follows:

  1. 1) The increase in endometrial thickness of more than 10 mm
  2. 2) Uneven loop
  3. 3) When atypical hyperplasia there is an abundant blood flow in the mucous membrane of the uterus (neatipicheskaya hyperplasia is characterized by poor vascularization).
Hysteroscopy allows visualization of the uterine cavity using a endoscopic technique under magnification.As a result, it fails to consider the most suspicious areas and make the fence the impact of the biological material.It is also possible to remove under the control of endometrial polyps as a variant of the local hyperplasia.

material for histological study obtained by scraping the uterine cavity and cervical canal, which operate separately.This procedure is a medical diagnostic and putting an end to the establishment of the final diagnosis.

Treatment of endometrial hyperplasia


Treatment of endometrial hyperplasia is divided into two main types:

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

Conservative treatment of endometrial hyperplasia basically consists in the application of hormones that are pathogenic agents treatment.To this end, the following groups of drugs are used:

  • combined estrogen-progestin preparations
  • progestins
  • antigonadotropiny
  • analogues gonadoliberines
  • antiestrogens.
duration of hormone replacement therapy should be at least 3 months.On average, it is equal to 6 months.In addition to it being symptomatic therapy:

  • hemostat (used gemostatiki)
  • iron therapy of anemia
  • pain therapy, which is the use of nonsteroidal anti-inflammatory agents.
Surgical treatment depending on the clinical situation can be represented by several species:

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


uterus removal shown in the following cases:

  1. 1) atypical hyperplasia of the endometrium in women who are not planning a pregnancy, as well as perimenopausal
  2. 2) The ineffectiveness of conservative therapy for 6-12 months
  3. 3) The presence of contraindications to hormone therapy.
hysteroresectoscopy and endometrial ablation performed in cases where the removal of the uterus is shown, but for reasons of health, it can not be carried out.We are talking about the following situations:

  • decompensated diseases of internal organs
  • mental illness
  • increased anesthetic risk.

Complications


main serious complication of endometrial hyperplasia is the possibility of malignancy (her risk of 10%), ie the development of the internal layer of the uterus of a malignant process.This particularly high risk for atypical hyperplasia.

addition, hyperplasia of the endometrium may result in the following states:

  • heavy and prolonged menstruation
  • uterine bleeding
  • iron-deficiency anemia.

Prevention


preventive measures against endometrial hyperplasia is a normalization of the hypothalamic-pituitary-ovarian relationships.To this end, a woman must adhere to the following guidelines:

  • use contraceptive methods to prevent abortions
  • rejection of intrauterine devices
  • give preference to hormonal contraceptive methods
  • regular visits to the gynecologist (at least 1 time per year)
  • normalization of body weight, etc.
In conclusion, it should be noted that endometrial hyperplasia is a background for the pathological process of developing endometrial cancer.Therefore, a timely diagnosis and treatment of this disease.

diagnostic search is based on clinical examination and additional research methods.


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