disease is based on a violation of hormonal background, which leads to an increased proliferative activity of endometrial cells.
Given the histological structure of endometrial hype
- 1) Glandular - there is only a thickening of the inner layer of the uterus
- 2) glandulocystica - thickening of the inner layer of the uterus combined with the presence of cystic formations (clogged glands endometrium)
- 3) The atypical or adenomatosis (signs of atypia endometrial cells).
- 1) The atypical, which requires action on the part of the doctor, as it is a precancerous process
- 2) Neatipicheskaya.
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) 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) Excessive amounts of adipose tissue, which is now seen as an endocrine organ.It is synthesized estrone, causes inappropriate proliferation of the endometrium.
- uterine myoma
- ovarian cysts
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) Ultrasound diagnosis
- 2) Hysteroscopy
- 3) Histological examination of scraping the uterine lining, which allows to differentiate atypicalneatipicheskuyu and endometrial hyperplasia.
- 1) The increase in endometrial thickness of more than 10 mm
- 2) Uneven loop
- 3) When atypical hyperplasia there is an abundant blood flow in the mucous membrane of the uterus (neatipicheskaya hyperplasia is characterized by poor vascularization).
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) Surgical
- 2) Conservative.
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
- analogues gonadoliberines
- hemostat (used gemostatiki)
- iron therapy of anemia
- pain therapy, which is the use of nonsteroidal anti-inflammatory agents.
- scraping the uterine cavity
- endometrial ablation.
uterus removal shown in the following cases:
- 1) atypical hyperplasia of the endometrium in women who are not planning a pregnancy, as well as perimenopausal
- 2) The ineffectiveness of conservative therapy for 6-12 months
- 3) The presence of contraindications to hormone therapy.
- decompensated diseases of internal organs
- mental illness
- increased anesthetic risk.
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.
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.
diagnostic search is based on clinical examination and additional research methods.
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