When a woman has uterine bleeding, this symptom should not be ignored. It can signal a serious problem - endometrial hyperplasia. Not timely assistance will lead to infertility, cause anemia, provoke the formation of cancer. Women's health during this period should be supervised by doctors.
What is endometrial hyperplasia
The inner surface of the uterus is lined with endometrium - mucous membrane. It consists of connective tissue, permeated with blood vessels and has two layers:
- Basal, which provides endometrium with strength and elasticity, has a constant structure, is not affected by hormones.
- Functional - changes the cellular composition, its size in accordance with the phases of the menstrual cycle. It depends on the content of hormones.
The increase in cells in the functional layer proceeds from the first days of the menstruation cycle under the action of estrogen. This leads to an increase in its thickness. The germination of the layer of vessels begins - the site is being prepared to receive the embryo of the child. At the same time, the egg leaves the ovary in the middle of the cycle. If she is not fertilized, the amount of estrogen decreases. The process ends with the rejection of the physiological layer - menstruation occurs.
Endometrial hyperplasia - what is this phenomenon? Due to various reasons hormonal failure occurs in the woman’s body. Estrogens continue to be produced, although the first phase of the cycle must end. The physiological layer instead of the rejection increases its thickness. This benign growth is endometrial hyperplasia, which can be located on the walls, bottom, cervix. There are such types of the disease:
- glandular cystic,
Glandular hyperplasia of the endometrium
The mucous layer of this form of the disease grows by increasing the number of glandular epithelium. In this case, both layers of the endometrium are combined into a common conglomerate. Glands have a different format, are uneven. Violent reproduction of cells can provoke the overgrowth of education into a malignant form, although this is rarely seen with this type of hyperplasia. The disease is accompanied by signs:
- violation of menstruation,
- severe bleeding
Glandular cystic hyperplasia of the endometrium
Diseases of this variety are characterized by the proliferation of glands, accompanied by the appearance of thickening. Cysts are formed - cavities that are filled with liquid contents. They can exist separately or entirely lining the endometrium, affecting the adjacent tissues. Cyst overgrowth:
- causes lower abdominal pain
- interferes with ovulation,
- makes pregnancy impossible,
- increases discharge between periods in those situations where the neoplasm bursts.
Endometrial adenomatous hyperplasia
Atypical endometrial hyperplasia - what is this form and what is its danger? This type of disease is also called adenomatous. Accompanied by the process of rapid growth and change of mucosal cells. It is considered a precancerous condition, requires surgical intervention. Especially dangerous during menopause. Wherein:
- active cell multiplication begins,
- glands of irregular shape, located close to each other,
- inside of them are formed compounds of the epithelium,
- develops into the form of a cancerous tumor.
Focal hyperplasia of the endometrium
The peculiarity of this type of disease is polypous growths that are very sensitive to hormones. It can be single or multiple formations, which are often located at the transition to the fallopian tubes or at the top of the uterus. Polyps have a rounded appearance with a smooth pink surface on the stem. At disturbance of blood circulation on a neoplasm ulcers appear. The size reaches 5 cm. There is a risk of a cancer on this place.
Why develop endometrial hyperplasia of the uterus
The disease begins at the time of hormonal changes that occur in the body during adolescence, with menopause. The process provokes an increase in the amount of estrogen and a decrease in progesterone. The reasons for this are:
- misuse of hormonal drugs
- frequent abortions,
- inflammation of the genitals
- dysfunction of the adrenal cortex,
- hormone-producing ovarian tumors,
- immunity disorders
- polycystic ovary syndrome,
- associated diseases - obesity, hypertension, diabetes.
Symptoms of endometrial hyperplasia of the uterus
Since the disease has serious consequences, it is important to know what signs accompany it. Endometrial hyperplasia - what kind of disease is it and how is it recognized? The main symptom is menstrual disorders. In adolescence, this can have far-reaching consequences - the inability to become pregnant in the future. In postmenopausal women, when menstruation has ceased, uterine bleeding is characteristic of endometrial hyperplasia. The peculiarity of this period is the increased likelihood of a neoplasm passing into a malignant form
One of the main signs of endometrial hyperplasia is uterine bleeding, which depends on the type of disease and takes place in different ways:
- follow in violation of the duration of menstruation,
- happen with small, smearing secretions,
- occur in the absence of menstruation,
- characterized by abundance during the cycle,
- accompanied by long - up to three months - delays, followed by severe blood loss.
Additional signs include metabolic syndrome, in which body weight increases, obesity occurs. Due to the growth of male sex hormones, body hair growth increases, the voice decreases. Symptoms of the disease:
- inflammatory processes of the genital organs,
- infertility when trying to get pregnant for a year
- colic pains,
- appearance of myomas
- development of mastopathy,
- bleeding during sex.
How to treat endometrial hyperplasia of the uterus
Is it possible to finally cure endometrial hyperplasia - what are these techniques and do they help a woman to become pregnant later? Since very young girls are at risk, it is important to preserve their reproductive function. One method of treatment is medication. Since the disease provokes a hormonal imbalance, it is restored with special drugs that help stop the growth of the endometrium. The treatment is carried out strictly under the supervision of a gynecologist due to the many contraindications.
Removal of polypoobraid single pathologies is performed by unscrewing the stem and cauterizing the growth site. In the future, after additional hormonal treatment, a woman is able to become pregnant. Things are more complicated with a strong proliferation of the endometrium. Requires surgery with complete removal of the ovaries, uterus in the case of adenomatous form of the disease, which can develop into cancer.
There is a surgical treatment method that allows you to suppress cell growth and restore hormonal balance. It includes two stages:
- diagnostic curettage, in which the overgrown layer is removed, tissues are sent for histological examination.
- According to the results of determining the type of hyperplasia, hormone therapy is prescribed according to the appropriate schemes.
What is focal glandular hyperplasia of the endometrium without atypia
1. What does endometrial glandular hyperplasia mean?
Endometrium consists of two plates:
- Connective tissue plate or stroma. This is the supporting tissue in which the vessels and uterine glands are immersed.
- The epithelial plate that covers the stroma. Growing into loose connective tissue, it forms many hollow tubes or uterine glands.
Excessive proliferation (reproduction, division, mitotic activity) of epithelial plate cells leads to abnormal growth, deformation and dysfunction of the uterine glands. This process is called endometrial glandular hyperplasia.
2. The term “without atypia” means that the proliferating cells of the endometrium are not changed, in other words, they are healthy.
Normally, the epithelium of the glands occupies about 20% of the total volume of the uterine lining. In the case of glandular hyperplasia, its content increases to 30% -70% or more percent, depending on the severity of the pathology.
There are many variants of typical endometrial hyperplasia: focal simple endometrial hyperplasia, complex or complex, cystic or glandular-cystic hyperplasia, adenomatosis. In fact, these are different stages of the same pathological process. To avoid confusion in the interpretation of the diagnosis, a new classification (WHO, 2014) combined all non-typical forms of hyperplasia into one type: endometrial hyperplasia without atypia.
Stages of development of typical endometrial hyperplasia Back to table of contents
Causes of focal hyperplasia of the endometrium without atypia
An important condition for the development of non-atypical glandular hyperplasia of the endometrium is hormonal imbalance, more precisely, estrogenia: excessive stimulation of the endometrium with estrogen against the background of insufficient progesterone action.
The center of abnormal growth of the epithelium occurs in the endometrium zone, which is most sensitive to the action of sex hormones. An important role in the formation of the proliferation locus is played by local immunity disorders and the production of bioactive substances.
In addition to local factors, systemic disorders are involved in the development of focal hyperplasia of the endometrium: hormonal imbalances, diseases of the reproductive system, somatic, vascular, neuroendocrine disorders.
The main mechanisms of development of typical endometrial hyperplasia
Mechanisms of development of typical endometrial hyperplasia
Hyperplasia often develops against the background of the following diseases:
- Disruption of the menstrual cycle: anovulation, insufficiency of the function of the corpus luteum.
- Polycystic ovary syndrome.
- Hormone-producing ovarian tumors.
- Hypertonic disease.
- Pathology of the thyroid gland, adrenal glands.
- Metabolic syndrome, obesity.
Local factors in the development of focal endometrial hyperplasia:
- Infectious-inflammatory process of the genitals, leading to a violation of the receptor apparatus of the endometrium.
- Acceleration of proliferation processes.
- Disruption of natural cell death (inhibition of apoptosis).
Causes of focal hyperplasia of the endometrium with atypia
In most cases, the atypical form of hyperplasia is focal. It can develop on the background of a non-atypical, as well as unchanged, atrophic mucosa, on (or in) an endometrial polyp.
Atypical epithelial cells are still very similar to healthy ones. But due to genetic transformation, they have already acquired the features characteristic of malignant cells: nuclear polymorphism, the ability for rapid uncontrolled division, etc. In fact, focal atypical endometrial hyperplasia is endometrial cancer of the 0th stage (non-invasive cancer).
Focal hyperplasia of the endometrium with atypia is the result of a progressive genetic mutation of cells, with local growth independent of the hormonal influence. This form of the disease is poorly amenable to hormone therapy and requires surgical treatment.
The appearance of atypical hyperplasia is not associated with metabolic disorders. But hormonal imbalances and somatic diseases (obesity, diabetes, hypertension, etc.) increase the risks of the rapid transformation of precancer into invasive cancer.
Factors for the development of atypical endometrial hyperplasia
Mechanisms of development of endometrial hyperplasia with atypia
Read more about the treatment of endometrial hyperplasia with atypia in the article: Atypical endometrial hyperplasia
Symptoms of focal hyperplasia of the endometrium
The clinical manifestations of any form of endometrial hyperplasia are the same:
- Dysfunctional uterine bleeding.
- Long abundant menstruation.
- Bloody spotting from the uterus, not associated with the menstrual cycle.
- Cramping abdominal pain (sometimes).
- Anemia (result of uterine bleeding).
Symptoms of focal hyperplasia of the endometrium
Asymptomatic focal hyperplasia of the uterine lining is not uncommon.
Ultrasound signs of the disease: uneven borders, echo heterogeneity of the endometrium, an increase in M-echo.
Diagnosis of focal hyperplasia of the endometrium
In cases of an obscure hysteroscopic picture or in the absence of endoscopic equipment for diagnosing the disease, separate therapeutic and diagnostic curettage of the uterine mucosa is performed, followed by histological examination of the tissue samples obtained.
Diagnosis of focal endometrial hyperplasia
Diagram of methods for diagnosing the disease Back to table of contents
Treatment of focal hyperplasia of the endometrium without atypia
This form of the disease responds well to hormone therapy.
Focal glandular hyperplasia of the endometrium: treatment in stages 1 stage
After scraping, young patients with simple focal endometrial hyperplasia without risk factors (no obesity, diabetes, hypertension, ovarian pathology, etc.) may be offered dynamic observation.
50% of cases of simple non-atypical endometrial hyperplasia after curettage are resolved independently (self-healing).
According to the results of a meta-analysis of hormone therapy of various forms of endometrial hyperplasia (in comparison with oral gestagens) in 2010, the intrauterine device LNG-Naval Forces Mirena was recognized.
Means of hormone therapy for the treatment of focal endometrial hyperplasia
Signs of focal endometrial hyperplasia
Despite the type of pathology, there is one symptom that is characteristic of each of its forms - blood discharge outside the menstrual cycle. A distinctive feature of this trait is a small amount of isolated blood, sometimes spotting.
This is typical for menopause, but for the puberty period there are more heavy bleeding with the presence of clots. As a result, a decrease in the level of erythrocytes and hemoglobin in the blood of a girl is observed - this is how chronic anemia develops in the absence of a sufficient therapeutic complex.
Signs of focal endometrial hyperplasia are infertility, since a woman cannot become pregnant due to the absence of ovulation in her menstrual cycle. This is due to an excess amount of estrogen in the blood. In some cases, the pathology may absolutely not have clinical manifestations, so the inability to become pregnant is the reason for visiting the doctor and further examination.
During hyperplasia, menstruation is characterized by strong secretions, not counting that a small amount of blood is also released outside the cycle. In the aggregate, the girl may feel weakness, dizziness, and the skin becomes pale.
When anovulatory cycle is most often found glandular cystic hyperplasia, which develops due to the processes of dystrophization and the death of the cells of the uterine layer.
Focal glandular hyperplasia of the endometrium
Depending on the structural changes in the internal uterine layer, it is customary to distinguish certain types. So, focal glandular hyperplasia of the endometrium is a local reproduction of cells of the glandular tissue, when at this site there is a thickening of the endometrium.
Endocrine, vascular pathology, which results in hormonal disorders, can become a background disease for the development of pathology. Increased estrogen levels and decreased progesterone stimulate the activation of glandular tissue proliferation.
In addition, diseases of the reproductive system (fibroids, genital endometriosis, inflammatory processes) are also involved in endometrial hyperplasia.
Focal glandular hyperplasia of the endometrium is most often detected when visiting a woman gynecologist for the lack of pregnancy. However, it is possible to change the menstruation cycle as a result of the formation of endometrial polyps, fibroids or endometriosis.
There may be a delay in the onset of menstruation with subsequent heavy bleeding, as a result of which the woman loses red blood cells, which leads to the development of anemia. Its manifestations are considered dizziness, pallor, weakness and appetite deterioration.
Medical tactics involve the use of drugs with substitution purposes. In addition to oral hormonal agents, injectables, patches and the intrauterine device are often used.
In the absence of a therapeutic effect, it is necessary to resort to surgical intervention when removal of the affected area of the endometrium is performed. In severe form, it is possible to extirpate (remove) the uterus. After surgical treatment, additional hormone preparations can be prescribed at a low dose.
Simple focal hyperplasia of the endometrium
Based on the presence of a large number of cells or additional structures in the endometrium, simple focal hyperplasia of the endometrium and complex is highlighted. It is the simple form that is most favorable in view of the presence of only a large cellular composition and the absence of atypia.
It refers to background pathology, as it is characterized by a slight risk of malignancy. In turn, simple hyperplasia may be glandular or cystic. The diagnosis is made after the discovery of cystic formations or the growth of glandular tissue.
In view of the fact that this pathology has hormonal genesis, the treatment of pathology should also be aimed at regulating the hormonal ratio and normalizing the qualitative and quantitative cellular composition of the endometrium.
To do this, you can use hormonal means tablet form. It must be remembered that the dosage, the frequency of intake and the duration of the therapeutic course should be set exclusively by the doctor. In the case of an incorrect selection of the dose of a hormonal drug, it is possible not only the absence of a positive effect on hyperplasia, but the progress of the accompanying pathology and the appearance of adverse reactions.
In addition to tablet means, you can use injecting hormones, shepherds or helix, installed intrauterine. Sometimes combined treatment is required. It consists in prescribing hormonal drugs after surgical removal of the endometrial site affected by hyperplasia.
Focal basal endometrial hyperplasia
This form of pathology is quite rare. It is characterized by an increase in the thickness of the endometrium, in particular the basal layer, as the glandular tissue grows. Pathological reproduction of cells occurs in a compact layer in parallel with stromal hyperplasia, as a result of which polymorphic nuclei of large stromal cells arise.
Focal basal endometrial hyperplasia is recorded mainly after 35 years, differing in a limited proliferation of cells. The basal layer, which undergoes hyperplasia, has coagulated blood vessels. Their walls are modified by sclerotic processes, resulting in an increase in their thickness.
The explanation of prolonged menstruation with severe bleeding and pain is the delayed rejection of areas of the basal layer that undergoes hyperplasia.
During examination and confirmation of diagnosis, diagnostic curettage is recommended for 6-7 days from the onset of menstruation.
This type is not considered a precancerous process, since the risk of transformation into a malignant form is minimal.
Focal atypical endometrial hyperplasia
In comparison with other forms of pathology, focal atypical endometrial hyperplasia is considered the most dangerous, since it has the greatest risk of malignant transformation. Endometrial cells lose their physiological structure and acquire a new characteristic.
In some cases, the cells look so different that they stand out clearly against the background of healthy ones. The degeneration of the cellular composition may be malignant, which requires a special therapeutic approach.
Focal atypical endometrial hyperplasia most often turns into a malignant form in women after 45 years, because the body's defenses weaken and the treatment has a not so positive effect than expected. At the same time, at a young age, the frequency of ozlokachestvleniya atypical type of pathology is practically not observed.
In addition, in older age, hormone therapy used to stabilize hormone levels is not always effective, which implies the use of a surgical treatment method.
In view of the fact that the endometrium consists of 2 layers, pathological changes in the cells can be observed both in the functional and in the basal layer. The first is able to reject during menstruation and gradually recover under the influence of estrogen, so it is more susceptible to hyperplastic processes.
As for the basal layer, the occurrence of atypia in its cells indicates a cancerous process. Most often, atypical cells result from an imbalance of hormones, as well as other related diseases that become a starting point for the start of transformation.
Focal glandular-cystic hyperplasia of the endometrium
Hormonal disorders can serve as a background process or a major cause of glandular cystic hyperplasia. An insufficient amount of progesterone and, conversely, an excess of estrogen stimulate the thickening of the uterus layer due to the proliferation of glandular tissue with the formation of cystic formations.
Hormonal fluctuations are possible at different ages, but the majority of reported cases occur during puberty and menopause.
Focal glandular-cystic hyperplasia of the endometrium at a young age can be the result of frequent abortions, late pregnancy and prolonged use of oral contraceptives.
In addition to this disorder in the endocrine system, for example, dysfunction of the thyroid, pancreas, adrenal glands and metabolic processes also provoke the development of pathology in the endometrium.
Do not forget that surgical intervention in the uterus has a direct traumatic effect on its layers, which in the presence of background diseases threatens the emergence of uncontrolled cell multiplication.
Clinical symptoms manifest as changes in the menstrual cycle with the appearance of bleeding between periods. In addition, there are strong and prolonged discharge, as a result of which the woman feels weakness, loss of appetite, and the skin becomes pale.
Another manifestation is infertility, resulting from the lack of ovulation.
Prevention of focal endometrial hyperplasia
In order to avoid the development of the pathological process, some recommendations should be followed. They will help reduce the likelihood of atypia and cell proliferation.
Prevention of focal endometrial hyperplasia consist in regular examination by a gynecologist, at least 2 times a year. This will allow not only to prevent the progression of the pathology in case of its presence, but also to start treatment in a timely manner, which increases the chances of recovery.
In addition, abortions should be avoided, as frequent injury to the endothelium can cause the activation of the pathological process. It is necessary to use protective equipment during intercourse to prevent or reduce the likelihood of unwanted pregnancy and, accordingly, abortion.
It is necessary to control the activity of chronic inflammation of the genital organs and try to carry out the necessary treatment in order to avoid provoking its progression and the appearance of complications.
Since the accompanying pathology also affects the development of the pathology through hormonal background, it is therefore necessary to carry out their full treatment and further prevention of relapse.
Moderate exercise and a minimal amount of stressful situations also contribute to the normalization of the hormonal ratio and prevent the appearance of hyperplasia.
Depending on the form of the manifestation of the pathological process, one should distinguish the prognosis for life. The atypical hyperplasia is considered the most dangerous, since they are characterized by the appearance of altered cells, which possibly means a transformation into a malignant form. In view of this, early diagnosis of atypical forms and treatment reduces the risk of malignancy.
The prognosis of focal hyperplasia of the endometrium in the presence of a glandular-cystic component is relatively unfavorable. Such a form is not a threat to life, but it worsens the standard of living. This is due to the lack of ovulation in the menstrual cycle, which in turn significantly reduces the chances of getting pregnant.
In most cases, it is infertility that is the reason for a woman to go to a gynecologist. If the cystic formations are not promptly removed, there is a possibility of their degeneration into malignant tumors.
The prognosis also depends on comorbidities, because hypertension reduces the chances of recovery, since the treatment will not have the desired result in full. This is especially true for diseases that affect the hormones, such as thyroid dysfunction, adrenal glands and ovaries.
Focal hyperplasia of the endometrium is not a cause for disorders, because modern medical methods allow you to control the pathological process and gradually contribute to its regression. To avoid the occurrence of this pathology, you should follow these recommendations, and in case of detection of the disease during a gynecological examination, start treatment as soon as possible.
Focal hyperplasia - what is it?
Under the action of estrogen, the functional layer of the uterus normally thickens, the glands germinate. It creates the conditions for the attachment of a fertilized egg. If this does not happen, then the endometrium is exfoliated, but in case of pathology it will always be enlarged.
What is endometrial focal hyperplasia? The term refers to the proliferation of the functional layer of the uterus across its surface. Under the influence of various factors, the disease persists for a long time.
Frequency of occurrence
The disease is registered in 5% of women from the total number of gynecological pathology. The number of cases is increasing every year. This is associated with an increase in patients with metabolic syndrome or a violation of the environment.
Hyperplasia occurs in premenopausal women or adolescent girls. Changes in the uterus are associated with hormonal changes in the body.
Specific signs of focal endometrial hyperplasia do not appear in all women. The disease also has an asymptomatic course, which becomes an accidental find during a medical examination. The manifestations are as follows:
- Violation of the menstrual cycle with a delay of several months. Menstruation after it is plentiful and long.
- Sometimes the disease proceeds without the discharge of a pathological nature.
- Increased insulin concentration in the blood.
- Chronic inflammatory diseases.
- Discharges with red streaks after intercourse are scarce in quantity.
- In rare situations, pain occurs in endometrial hyperplasia.
- Endometrial polyps are often manifested by painful cramping sensations in the lower abdomen.
These symptoms occur in many gynecological diseases. To confirm the diagnosis is carried out a comprehensive examination.
With endometrial hyperplasia in the uterus, hormonal imbalance is considered the main factor. This happens for a number of reasons:
- curettage of the inner layer in the uterus with a diagnostic or therapeutic purpose,
- change of secretion in the gonads,
- cysts in the ovaries,
- diseases of the glands - dysfunction of the adrenal glands, diabetes,
- non-compliance with the rules of hormonal drugs,
- change in pituitary function,
- burdened heredity.
Factors that create the conditions for a disease are hypothermia, bad habits and infections.
Probability of transition to cancer
According to statistics, malignancy occurs in 20% of women (for 10 people 2 patients) with a modified endometrium. If atypical cells are found in the material that was sent to the laboratory, then there is a risk of hyperplasia turning into cancer.
The risk of developing endometrial malignancy in menopause increases. The presence of a predisposition to it is a reason for constant observation by a doctor.
Classification of focal hyperplasia
The system contains all types and forms of the disease. This allows you to prescribe a specific treatment for each of them. The types of hyperplasia include:
Focal simple endometrial hyperplasia is considered the safest. Cells proliferate, but the structure of the tissue is almost unchanged. When there is a complex thickening of the functional layer, the individual glands in the study are detected in an enlarged form. The structure of cells inside remains unchanged. The proliferative endometrium starts these processes. The structure under the microscope looks heterogeneous, the glands are displaced.
When there is no atypia in the material, this indicates a low probability of developing cancer. A woman with hyperplasia is prescribed hormone therapy, to which the endometrium responds well. After menopause, the disease will recede.
Atypical cells in the analysis indicate a modified internal structure. They are not cancerous, but due to the increased risk of transition to a malignant process, this type refers to precancer.
The classification includes the following forms of the disease:
- glandular cystic.
The listed options are divided into simple and complex.
Glandular focal hyperplasia
There is no pathology in the cell structure. Microglastic hyperplasia is characterized by an increase in the number of elements and their change in size. They have a different arrangement, which blurs the boundaries between the elements of the basal layer of the endometrium and the functional cells.
What does glandular hyperplasia mean in the material? Overgrown cells are rejected after death. This is manifested by acyclic bleeding with the appearance of any day, regardless of menstruation. Discharges are usually abundant.
Proliferative hyperplasia with a focal structure in the tissues has a favorable course. In this form, there are no cells that can cause cancer.
The most common hyperplasia with the formation of polyps. It is based on glandular and fibrous tissue. Structures are presented by various configurations.
Glandular cystic hyperplasia
The presented option becomes the next stage after the focal. Cysts are formed from cells of the enlarged glands in the epithelium of the uterine cavity. Inside is a fluid rich in estrogen.
This form of disturbance appears when it is impossible to absorb the amount of estrogen secreted by the body. The excess goes into the intercellular space and accumulates there.
Basal focal hyperplasia
This form refers to rare options. Focal basal endometrial hyperplasia occurs at the age of 30 years.
Cells enlarged in size have coil-shaped vessels. Their walls are modified by sclerotherapy, which makes them thicker. Hyperplasia of the basal layer occurs with long and abundant menses. There is a violation of the cycle in the form of delays (weeks, months) or the appearance ahead of time.
Pain in endometrial hyperplasia due to the slow separation of the basal layer. Scraping to confirm the diagnosis is carried out only on the 7th day from the first day of menstruation. Basal layer hyperplasia is characterized by a low probability of degeneration into cancer.
Atypical focal hyperplasia
The form of the disease is among the most dangerous due to the high risk of malignancy. Normal cells lose their function, structure, and acquire features that are not typical of these structures.
Focal atypical endometrial hyperplasia occurs in the basal and functional cell layer. The latter is rejected, which increases the risk of a hyperplastic process. Due to the invariance when atypia occurs, the basal layer has a high probability of transformation into cancer.
How to diagnose a disease
The diagnosis of this pathology, such as focal hyperplasia of the endometrium, takes into account the complaints of a woman. The physician must be aware of the flow and regularity of menstruation, the volume of blood lost, the presence of pain or discharge between menstruation.
Externally, pale skin is revealed due to anemia, which develops on the background of prolonged blood loss, as well as breast tumors, such as fibroadenoma, which indicates a hormonal imbalance. During the initial examination, the uterus, vaginal walls, the color and consistency of the endometrium, the presence of polyps and other structures are visualized.
But the result of the diagnosis is modern methods of visualization of internal organs - ultrasound, hysteroscopy, curettage, as well as the study of blood for hormone levels.
Diagnostic curettage procedure - curettage
Diagnosis using curettage allows you to study directly the particles of the endometrium, which has undergone hyperplasia. The procedure is an invasive intervention that requires testing and particularly thorough preparation. Scraping with hyperplasia is carried out in a hospital under general anesthesia using intravenous anesthesia. The use of anesthetics is not required only if manipulation is performed immediately after a miscarriage or childbirth, when the cervix is dilated.
Scraping of the inner layer is carried out with an expander that opens the cervical canal. A small portion of the endometrium from different areas is scraped gently with a surgical spoon (curette). Less commonly used vacuum aspirator.
Manipulation is almost blind, rarely with the purpose of control using a hysteroscope. It allows you to display the image on the monitor, where the areas of tissue collection are clearly visualized.
При очаговом варианте гиперплазии выскабливание не является желательным, поскольку во время манипуляции остается риск забора частичек эндометрия со здоровых участков. Если поражена вся поверхность, сбор тканей с любой ее части позволит точно провести исследование материала.
Manipulation is considered not only diagnostic, but also used in the treatment of various diseases, including endometrial hyperplasia. During the procedure, the upper affected layer of the uterus is removed, which allows you to quickly stop the bleeding.
The emergence of pathologies
Prerequisites for the development of pathology are the following factors:
- Age fluctuations of hormones. The defeat of the endometrium can occur at any age after the first menstruation and before full menopause, but more often in the pubertal and premenopausal periods. This is due to the fact that during these phases of a woman’s life, there is a maximum fluctuation in the background of hormones, an increase in the concentration of estrogens, which causes hyperplasia. Also, the risk of pathology increases after abortion, childbirth, miscarriage.
- Progesterone deficiency and / or increased estrogen concentration. Such a failure of the hormonal background can occur with endocrine pathologies, severe stress, various gynecological diseases, including inflammatory, high blood pressure, metabolic disorders, diabetes, vascular and heart disease, breast and adrenal glands.
- Heredity. The connection of the development of focal hyperplasia of the basal layer or endometrium in maternal relatives has been proven.
- Chronic inflammatory foci, uterine myoma, adenomatosis, polycystic ovarian cancer (PCOS) also cause hormonal failure and, as a result, hyperplasia.
It is often possible to establish the exact cause of the pathology only after removal (curettage) of the endometrial cells and subsequent histological examination.
Focal hyperplasia is simple
A simple form of hyperplasia is characterized by thickening of the endometrium with the presence of healthy cells without signs of atypia. It develops more frequently in women over the age of 30–35, the maximum number of cases registered during the period of pre-climax.
Changes in the uterine wall in this case have no signs of rebirth. The disease belongs to the background pathology, the risk of malignancy is minimal.
In the modified intrauterine layer, tissue is thickened, a local benign lesion - endometrial polyp - grows. He responds well to hormone therapy.
With a simple form of pathology, fertilization is possible, but the attachment of the ovum and gestation are difficult, the risk of spontaneous interruption is increased in the early stages.
Changes in the structure of the endometrium with significant glandular proliferation is a complex form of hyperplasia. Structural disorders of the gland form, balance between stromal and glandular components of the uterine layer occur.
Complicated hyperplasia can be with or without atypia. The absence of atypical changes means that the risk of cancer is absent. The presence of altered cells indicates the possibility of the transformation of tissues into malignant ones (according to various sources in 10–40% of cases).
It is not only the structure of the glands that changes, the number of connective tissue elements, uterus vessels decreases. In the presence of atypia, an uncontrolled rapid transformation of cells occurs, which covers not only the endometrium, but also the myometrium with further spread throughout the body.
The main treatment for any form of hyperplasia is hormonal. With proper selection of drugs, inhibition of the stage of proliferation of endometrial cells, stopping bleeding and stabilization of hormonal levels are possible.
When using contraceptive methods as a therapy for hyperplasia, ovulatory cycles are restored, the ratio of progesterones and estrogens stabilizes, and the thickness of the uterine layer decreases.
After the use of hormones is assigned:
- laser ablation - removal of hyperplasia foci with a laser pulse,
- cryodestruction - cauterization of areas of thickened endometrium.
Radical treatment - hysterectomy. Removal of the uterus together with the appendages (less often without them) is carried out only after prior therapy with hormones and in the absence of effect.
Treatment of hyperplasia folk remedies is permissible only in conjunction with hormone therapy. Apply these herbs and natural ingredients:
- Linseed oil - used in the acute phase of hyperplasia, taken orally for one month,
- Aloe tincture with honey - is used both for ingestion, and for douching, preparation of suppositories,
- peony extract, burdock juice, tincture of nettle or cucumber lash,
- Borovaya uterus - is considered the most effective means, reduces the active growth of the endometrium, improves immunity, suppresses the center of inflammation.
An important condition in the treatment of the disease is adherence to the principles of diet therapy. The diet includes foods rich in fiber, fatty acids, vitamins. Consumption of sweets, fatty foods, use of spices is reduced. To maintain water balance, the daily fluid rate is at least 2 liters.
Any form of hyperplasia requires an integrated approach and the correct selection of hormone-containing drugs. According to various sources, uterine extirpation as a method of therapy is used in no more than 5% of cases. In women up to 40–45 years old, during the operation, appendages are left to delay the onset of menopause.
How to understand the term "focal hyperplasia"?
The uterus is a three-layer organ. Inside the endometrium is located - the layer in which the embryo should develop, in the middle - a strong muscular layer, whose task is to help the baby to be born. Above the uterus covers the thin outer layer.
Endometrium consists of two layers: functional and basal. The functional layer is constantly changing: in the first half of the cycle it expands, which occurs under the action of estrogen. After the release of the egg from the ovary, it becomes rich in glands, which produces mucus, whose function is to create favorable conditions for the delivery of the spermatozoon. When fertilization does not occur, the internal endometrial layer exfoliates and exits along with the blood.
If ovulation does not occur, a large amount of estrogen continues to circulate in the body. Under the influence of which the proliferation of the functional layer of the endometrium happens - its hyperplasia. A similar increase in the volume of this endometrium can be caused by other conditions and diseases that cause an increase in the level of estrogen.
If the functional layer does not grow over the entire surface, but in a separate area, this is called endometrial focal hyperplasia. Pathology can be of several different types.
It may happen that a functional layer does not grow, but the one from which it is restored from scratch every time - sprout or basal. This condition is called basal hyperplasia.
What is dangerous disease?
Hyperplasia without atypia may be complicated by heavy bleeding, which can lead to a decrease in hemoglobin levels, weakness, fatigue, and increased respiration.
Pregnancy with focal endometrial hyperplasia is unlikely. This is due to the fact that the disease develops mainly due to an excess of estrogens. These hormones do not allow ovulation to occur. And without the release of an egg, conception cannot come. Glandular forms of pathology especially often lead to infertility.
If the pregnancy is still developing against the background of focal hyperplasia, it increases the risk of miscarriage in the early stages. In addition, during this period, due to hormonal adjustment, the chance is increased that the hyperplastic hearth will grow even more or even acquire signs of atypia. On the other hand, there is a chance that the pathological area will decrease in size under the influence of increased progesterone during pregnancy.
The disease can also become the basis on which it is “convenient” for cancer to develop. This particularly applies to the adenomatous (or atypical) form of endometrial proliferation, which, when not treated, becomes cancer in 40% of cases.
Causes of pathology
The main reasons for the development of focal hyperplasia are an imbalance of sex hormones, especially an excess of estrogens. Therefore, this disease most often develops at the age when the menstrual cycle is only being established, and also when they stop, in women over 45 years of age.
Predisposed to the development of this pathology of a woman with such diseases as:
- breast diseases,
- polycystic or sclerocystic ovaries,
- ovarian tumors,
- adrenal pathology,
- miscarriage or termination of pregnancy in the later periods,
- insufficient production of thyroid hormones,
- hypertonic disease.
The risk group also includes women with a history of:
- late pregnancies
- frequent abortions or scraping,
- long-term use of oral contraceptives.
Inheritance can be transmitted increased production of estrogen in the body, which leads to the formation of hyperplastic processes in the inner lining of the uterus. So, if the mother had endometriosis, uterine fibroids or endometrial polyps, the likelihood that the daughter will develop endometrial hyperplasia is very high.
How does focal hyperplasia appear?
Symptoms that can be suspected of having a disease are mostly vaginal bleeding. They appear between menstruation and during menstruation, making it more abundant.
Mezhmenstrualnye bleeding is not necessarily abundant, it may even be bleeding or bleeding. If hyperplasia develops in a postmenopausal woman, it will manifest as moderate or scanty bleeding.
Growing more than 2 cm in length, the hyperplastic area becomes similar to a foreign body, and the uterus will contract to “expel” it from its own cavity. This is manifested by cramping pain in hypogastria.
The most abundant, prolonged and painful menstruation occurs with focal growth of the basal layer, which normally should not exfoliate in the absence of fertilization.
Due to the fact that for the development of any, even mild endometrial hyperplasia, you need a high content of estrogens, which impede the onset of ovulation, the menstrual cycle is disturbed: there are constant delays of menstruation until they are completely absent for 2-3 months.
How is the diagnosis?
The diagnosis is made according to studies such as ultrasound, performed by a vaginal sensor, hysteroscopy, in which the hyperplastic focus is removed for further research under a microscope. Manipulation should be performed immediately before menstruation, when the thickness of the endometrium is maximum.
If hysteroscopy is impossible, an aspiration biopsy is performed, during which the necessary cells are taken out of the required area using a vacuum.
Treatment of focal hyperplasia of the endometrium depends on the form of the disease, the age of the woman, her chronic diseases. If atypia is not found under the microscope and there are no contraindications, treatment with hormonal preparations with different directions can be carried out. So, in the therapy they use both agents that cause artificial menopause (after they are canceled, menstruation is resumed), tableted contraceptives, or an intrauterine device Mirena is inserted, releasing progesterone.
If such treatment is ineffective, the foci of growth of the functional layer of the uterus are removed under the control of a hysteroscope. If there is atypia, semi-annual treatment is prescribed with drugs that cause artificial menopause, then repeated curettage is performed. If atypical cells remain, the volume of the operation expands.
In some cases, especially with atypia, found in a woman in menopause or after it, a woman with uterine myoma or metabolic syndrome can be hysterectomy.
Treatment after removal consists in taking medications based on female hormones. This is necessary to prevent the recurrence of the disease. If a woman is planning a pregnancy, and this becomes impossible within a year after the intervention, she is asked to perform IVF.
Focal hyperplasia difficult
Cells accumulate non-uniformly and secrete variants of hyperplasia with and without atypia. In the first case, the possibility of rebirth into cancer is 29%.
The structure of the endometrium is represented by foci scattered over the entire surface. The sizes of educations make no more than 6 cm.
Hyperplasia on ultrasound
What doctor treats?
At occurrence of reproductive disorders, the woman should initially undergo a gynecologist consultation. If the diagnosis is confirmed, the patient is referred to an endocrinologist and an oncologist.
Depending on the accompanying pathology, the treatment of other diseases is carried out simultaneously. The need for surgery is considered individually, depending on the form of hyperplasia.
Depending on the severity of the course and the type of the disease, a treatment plan is individually drawn up for each patient. It can be medication and surgery with further medication. The main means are:
- oral contraceptives,
- progestin drugs,
- releasing hormone agonists.
The initial stage of treatment is endometrial curettage. After the procedure, the gynecologist prescribes drugs. If a focal glandular hyperplasia of the endometrium is found in a woman, the treatment is performed with oral contraceptives (“Janine”, “Yarin”).
Gestagens without estrogen components are prescribed if they are older than 30 years. In postmenopause - “Oxyprogesterone”.
Focal atypical endometrial hyperplasia is susceptible to the action of drugs from the group of agonists ("Buserelin"). In postmenopausal women, when establishing such a diagnosis, an ovarian revision is performed.
In the absence of therapy from drug treatment or a neglected form of the course, the patient is sent for surgery. Applied to:
- laser ablation
Treatment after removal of the uterus is hormone replacement therapy. After surgery, they are assigned for the recovery period. You can learn more about the stages of patient management in the article “Treatment of endometrial hyperplasia”.
Impact on pregnancy
With focal hyperplasia, pregnancy is practically excluded. Women do not have ovulation. The main reason - changes in the uterine wall and hormonal failure.
In some rare cases, the egg can attach to the endometrium. This increases the risk of spontaneous interruption. During pregnancy, the risk of cancer is greatly increased.
Complications and consequences
When a woman is diagnosed, anemia develops due to heavy and prolonged bleeding. Many do not have the opportunity to have a baby, which is associated with the peculiarities of the modified structure of the endometrium. Tissues are rebuilt and do not allow the egg to attach. The most dangerous is the rebirth of hyperplasia. Especially high is the risk of malignancy for the atypical form of the disease.
How does the disease manifest itself
At the onset of the disease, the symptoms are practically absent. After it can be noted bloody discharge that occurs outside of menstruation. The excretions are smearing and slim. If you do not pay attention to this symptom for a long time, the discharge can develop into heavy bleeding, leading to anemia, a decrease in hemoglobin and a decrease in red blood cell cells.
Infertility can be the most dangerous consequence of this disease, as the level of estrogen in the blood increases in the blood. In such a situation, a mature egg remains for some time in the ovary, since other hormones (progesterone) are needed to release it (ovulation). Other hormones are not enough and this is the reason that the first phase of the menstrual cycle takes a long time, the uterus mucosa grows. In the menstrual cycle does not occur ovulation, so the conception of the child does not occur. However, infertility is manifested only if the disease is neglected and thickening of the large endometrial space occurs. If the thickening is focal, the egg can develop in the healthy part of the endometrial layer.
In the next phase, the mucosa does not change its size, and by the end of the cycle it is removed from the body with heavy bleeding. Together with him, not all mucous membrane is rejected. Some of its remains stuck on the walls of the uterus. After the end of the menstruation, they will create bloody spotting. Also, these residues can lead to germination of polyps.
Menstruation are very abundant with the release of clots and are accompanied by dizziness, weakness, pale skin.
With a lack of estrogen action develops the opposite way. There are no conditions for the maturation of the egg, it does not leave the ovary, menstruation takes a long time, in waves. It is not too strong, but because of the duration, the woman also loses a lot of blood. As a result, the mucosa is removed gradually, which can lead to incomplete removal of all areas.
The appearance of pain in hyperplasia is the fact that the disease is progressing. This should be a signal for a prompt visit to the doctor.
With focal hyperplasia of the wall of the mucous membrane of the uterus in some places can reach a thickness of 5-10 cm
With polyposis, the discharge is smearing, with glandular hyperplasia and adenomatosis - bleeding discharge.
Focal hyperplasia of the endometrium is familiar to women of different ages. Until now, the causes of the disease are not fully understood. Strong growth of endometrial cells can be observed both during the formation of the menstrual cycle and during its decline. This happens because of hormonal fluctuations.
The woman begins to increase the amount of estrogen, and significantly decrease the number of progesterones. This imbalance is becoming the main cause of focal endometrial hyperplasia.
In fact, the causes of the development of pathology are many. For example, this occurs when there is a disturbance in the endocrine system, in diabetes mellitus. Other factors may indirectly or directly affect the occurrence of the disease:
- Vascular and heart diseases,
- Excess weight,
- Diseases of the mammary glands and adrenal glands,
- Chronic inflammation of the sexual sphere,
- Polycystic ovary,
- Disorders in thyroid hormones,
- Uterine fibroids.
All the above diseases affect the endocrine system of women, therefore, can provoke the development of the disease.
At risk are women who in the family were relatives with similar sores. And also those who gave birth at a mature age. The dangers of a past scraping and abortion. These processes also provoke failures in the female immune system.
Uterus during the illness
Manifesting in different forms, the disease becomes a consequence of the formation of polyps. They are formed by increasing the mucous membrane of the uterus and underlying tissue. Polyps contain fibrous and glandular cells. In appearance, they represent the body of an elongated round shape with a leg. As for the number of polyps, they can be one, several or many. They occur most often at the bottom of the uterus or in places of exit of the fallopian tubes.
On top of the polyps are pink and smooth. Inside, they can be distinguished glands of different sizes, which sometimes reach the muscular middle layer of the uterus. But this can only be done under a microscope. They also include blood vessels and connective tissue elements.
Simple endometrial hyperplasia was isolated separately as a variant of the hyperplastic process in 1994. In other words, doctors call it glandular or glandular cystic hyperplasia. This pathology rarely turns into a cancer, and therefore is not relatively dangerous. However, it creates a prosperous environment for the development of cancer cells in the future. In addition, focal hyperplasia, which first appeared during menopause, is very dangerous for a woman.
Simple hyperplasia leads to an increase in stromal and glandular structures. At the same time, the active glands cystic expands.
With this disease, the nuclei of the cells of the glands are also displaced. The cells themselves modify their shape, becoming round with nuclei.
Traditional methods of treatment
To relieve symptoms of focal endometrial hyperplasia, patients often resort to traditional medicine, falsely believing that the disease itself is cured. Indeed, some herbs, such as nettle, help restore hemoglobin and iron levels in the blood after blood loss. It also has a tonic and tonic effect. But it must be remembered that the plants do not have medicinal properties for this disease, and can be used in the rehabilitation period after curettage.
A simple withdrawal of symptoms can lead to further progression of the disease and the appearance of complications.
What is it, focal endometrial hyperplasia? So called a disease in which there is a benign growth of the inner layer of the uterus - the endometrium. When focal form of hyperplasia tissue grows unevenly, and small foci, forming polyps.
To understand the mechanism of development of the disease, it is necessary to imagine how the growth of the endometrium occurs every month. Normally, each woman in the process of the menstrual cycle, the upper functional layer of the uterine lining grows and rejects, leaves the body along with the menstruation.
This happens because the embryo attaches to the endometrium after fertilization. When this layer is thick enough, the germ can easily attach to this loose layer, penetrated by blood vessels, and begin to feed and develop.
The whole process of growth and rejection of the endometrium is regulated by the hormonal background of the woman. If any hormonal disorders occur in the body, the endometrium may not grow in the right amount (hypoplasia), or, conversely, grow excessively. In the latter case, hyperplasia occurs, that is, an excessive increase in the thickness of the endometrium.
The exact cause of the development of hyperplasia has not yet been established. But it is known that the disease is associated with the hormones of a woman. If the patient has an overestimated level of estrogen in the body, then the likelihood of endometrial growth increases significantly.
The fact of the matter is that it is under the influence of estrogen that the endometrium grows monthly. After ovulation, progesterone levels increase, and the estrogen concentration drops. If the pregnancy does not come, then hormonal changes lead to the rejection of the endometrium. But if estrogen is overestimated, normal rejection does not occur and tissues begin to randomly expand.
There are also a number of conditions in which the risk of focal endometrial hyperplasia increases significantly:
- Endocrine diseases, diabetes,
- Polycystic ovary syndrome,
- Abortions, miscarriages in history, especially in late pregnancy, curettage,
- Late pregnancy
- Oncological diseases of the ovaries,
- Long-term or uncontrolled hormonal contraceptives,
- Genetic predisposition
- Various diseases of the genital organs: inflammation, tumors.
It is worth noting that focal hyperplasia may be associated with hereditary predisposition. The fact is that in some families, women have consistently observed transmission of elevated levels of estrogen in the body. Of course, this fact does not guarantee the development of pathology, but the risk increases.
If in the family one of the women suffered from focal hyperplasia (uterine polyps), endometriosis, uterine fibroids, cancer of the uterus and appendages, mammary glands, then the risk is very great. In this case, you must be attentive to your health, take preventive measures and be regularly examined in the antenatal clinic from the moment of puberty.
Apply the following methods of surgical treatment:
- Hysteroscopic removal of a polyp.
- With multiple polyps, therapeutic scraping is performed.
- Ablation of a polyp with the help of a laser, electricity, cryodestruction.
- Uterus removal.
Women of reproductive age who are planning a child, usually carry out the removal of polyps using hysteroscopy or ablation method. This method allows you to gently remove the foci of hyperplasia, leaving no adhesions. At the same time, the operation is low-impact and already in the next cycle a woman can start trying to conceive.
The disadvantage of this method is that if the patient does not quickly become pregnant, the hyperplasia will begin to grow again and will interfere with further conception. Then you have to carry out the operation again. But if it was possible to conceive, then under the influence of progesterones in the period of gestation, the disease will disappear.
Removal of the uterus or hysterectomy is prescribed to patients with adenomatous hyperplasia, which can transform into cancer. The operation also shows a woman of menopausal age who does not plan to give birth in order to reduce the risk of cancer. In severe cases, the uterus is removed along with the appendages.
Focal hyperplasia of the endometrium is a hormone-dependent pathology. Accordingly, the treatment is carried out by hormonal drugs. If you do not normalize the hormones after surgery, the disease soon recurs.
Combined oral contraceptives, for example, Janine, Diane-35, etc., are prescribed to restore the hormonal background and the menstrual cycle. The function of the uterus and ovaries is restored during the period of taking such drugs, but the woman cannot become pregnant.
After 36 years, the administration of progesterone drugs, such as Duphaston, is indicated. And if conception is not planned, then the intrauterine system (spiral) Mirena can be recommended.
Many patients are interested in whether it is possible to treat endometrial focal hyperplasia with traditional methods. Doctors categorically do not recommend self-treatment with this type of hyperplasia, it can lead to severe complications.
To cure uterine polyposis, you need to consult a gynecologist and undergo therapy, which he will prescribe. Do not use herbs with phytohormones, warm the lower abdomen and conduct douching.