Hyperplasia (pathological growth) of the endometrium is a benign process of an excessive increase in the volume and thickness of the inner lining of the uterus.
Endometrial hyperplasia occurs as a result of the proliferation of glandular and other tissue cells. It leads to a violation of the functional activity of the endometrium (menstruation disorder, problems with conception).
Under normal conditions, the endometrium grows in the first phase of the cycle under the action of estrogen, and is restrained in the second phase of the cycle under the action of progesterone. In pathology, the endometrium grows uncontrollably, it can capture certain areas (focal hyperplasia) or the entire inner membrane.
The main cause of endometrial hyperplasia today is considered the excess of the physiological level estrogen with relative deficit progesterone . This condition can lead to:
- taking estrogen-containing drugs without taking progesterone,
- period menopause,
- syndrome polycystic ovaries,
- female obesity
- transitional age with hormonal surges and hormonal metabolic disturbances.
Most often, endometrial hyperplasia occurs in young women who have not given birth or in premenopausal women.
Concomitant diseases that may exacerbate the manifestations of hyperplasia are hypertension, sugar diabetes both types, thyroid disease, problems with the breast and adrenal glands. Predispose to the development of hyperplasia:
- genital inflammation,
- production abortions and scraping,
- uterine fibroids,
- unfavorable heredity of genital diseases.
The predominance of certain elements in the growing endometrium, stands out:
- hyperplasia of the glandular type (endometrial glands proliferate),
- hyperplasia cystic glandular type (cysts and glands grow approximately the same),
- adenomatous hyperplasia with the presence of atypical cells, precancerous. The rebirth of such hyperplasia reaches 10%.
- polypous form of hyperplasia. This focal growth of the endometrium, which has the character of fibrous, fibro-glandular and glandular. May be on the leg, become rarely malignant, but may be an adverse background for various gynecological diseases.
Endometrial hyperplasia is mainly manifested by recurrent non-cyclical bleeding.
Blood discharge may be between menstruation or after menstruation, prolonged spotting secretions. They are of a moderate nature, smearing, blood coagulated.
In adolescence, there may be heavy bleeding with clots, leading to anemization. The menstrual cycle is anovulatory, due to the suppression of the maturation of the egg by an excess of estrogens. In rare cases, hyperplasia is asymptomatic, giving effect to infertility.
Endometrial hyperplasia during menopause manifests itself again after a period of menstruation. bleeding non-cyclical nature.
Hyperplasia is considered as a precancerous condition, in connection with which it requires special observation, according to doctors, up to 1% of cases of hyperplasia turn into uterine cancer.
The basis for the diagnosis of endometrial hyperplasia is the examination of a woman by a gynecologist, laboratory and instrumental examinations.
The main of them include:
- Ultrasound of the uterus and appendages with a vaginal sensor,
- hysteroscopy with material sampling for histological examination and possibly diagnostic curettage of the uterus,
- if it is necessary to clarify the type of hyperplasia, an aspiration biopsy is performed.
One of the most important laboratory tests is to determine the level of sex hormones in the blood serum, as well as the level of adrenal hormones and thyroid gland.
Treatment is carried out immediately after diagnosis, the method is chosen based on the age and manifestations of the disease.
The most effective method is hysteroscopic removal of polyps or separate diagnostic curettage of the endometrium during a diffuse process.
However, the treatment of endometrial hyperplasia is multi-stage.
First of all, scheduled or emergency scraping is performed. Emergency resorted to with bleeding and anemizatsii patients.
After obtaining the results of histology prescribe:
- combined oral contraception – Janine, Yarin, regulon, for six months according to the traditional regimen,
- with bleeding in girls at a young age, oral contraceptives can be used in several large doses for non-operative bleeding,
- progestin drugs (utrozhestan, djufaston) a second phase of the cycle,
- intramix spiral Mirena with gestagens,
- drugs gonadotropin antagonists ( buserelin ) after the age of 35 years.
These drugs create an effect similar to climax, but quite reversible.
After the curettage operation, the control is carried out within six months, but if the adenomatous form of endometrial hyperplasia recurs, the removal of the uterus is indicated. With other recurrent forms of the process and the ineffectiveness of other treatment methods, ablation of the endometrium, its artificial destruction is carried out.
The most dangerous complication of endometrial hyperplasia is the transformation into uterine cancer.
Not less dangerous relapses and persistent bleeding with the development of anemia, infertility.
The prognosis in most cases is favorable, the disease can be cured within 6-12 months of medication and surgery.