Sex hormones estrogen and progesterone control the menstrual cycle. When imbalance problems arise.
Estrogens promote the growth of the endometrium at the beginning of the cycle, and progesterones stop their growth before menstruation. When the level of both hormones falls, menstruation occurs. If the hormonal background is disturbed, hyperplasia appears and, accordingly, monthly or absent, or do not go on time. Delayed menstrual hyperplasia is a common phenomenon.
The thickness of the endometrium during its growth may exceed 18 mm.
How are menstruation with hyperplasia?
The proliferation of the inner layer of the uterus - not a harmless state. For a long time, the pathology can proceed without pronounced symptoms, until the woman feels the deterioration of well-being. First of all, the disease can cause menstrual disorders. It is because of this symptom that a woman goes to the hospital, where pathology is detected.
With the growth of the endometrium in the uterine cavity, the disturbances are more pronounced.
- profuse bleeding, sometimes with clots,
- delay or absence of menstruation,
- violation of the duration of the menstrual cycle,
- spotting in the middle of the cycle or before the beginning of the month,
- pulling or severe cramping in the lower abdomen.
Scanty periods with hyperplasia - a rarity, often the selection is always abundant and not regular.
Spotting outside the cycle, especially during intercourse, can also be a sign of illness. This condition is connected with the fact that a thickened endometrium on the cervix is injured.
Copious bloody discharge
Disorders of the menstrual cycle manifest themselves in different ways. It all depends on the individual characteristics of the woman’s body.
Abundant menstruation with endometrial hyperplasia are in two cases:
- The cycle is regular, but long. It lasts more than 7 days, and the selection is abundant. Enzymes do not allow the uterus to contract, so uterine bleeding may open without treatment. What to do in this case? Scraping will only help.
- Delay of menstruation. With endometrial hyperplasia, it happens that menstruation does not begin on time, but it may take a week, a month or a few months before the menstrual periods go. During this time, the cells expand more and more. When the level of hormones drops sharply, the entire layer of the endometrium must come out with the blood. Bleeding opens, sometimes with clots and severe pain.
A prolonged delay indicates endometrial hyperplasia (unless the woman is pregnant). This condition is dangerous, because during the period of absence of menstruation, malignant cells can grow, and the woman will not know about her illness.
The consistency of discharge after a delay in endometrial hyperplasia is fluid, with many clots, the blood is bright.
Can endometrial hyperplasia develop into a tumor? Yes, in 50% of cases this is what happens. The more the endometrium grows, the thicker its layer, the greater the likelihood of replacing healthy cells with malignant tumors.
Glandular hyperplasia turns to cancer for 2-18 years. Often this disease is a precursor of fibroma, and then uterine fibroids, which occur against the background of heavy bleeding.
With complex atypical hyperplasia, the probability of transformation into cancer reaches 58%.
The risk of developing malignant tumors increases in women during menopause. The fact of the matter is that hormone levels change dramatically during the cliteric period, namely the imbalance of sex hormones leads to hyperplasia. If the disease is not treated, a tumor appears.
Abundant uterine bleeding should be a reason to go to the hospital.
Lean and abnormal bleeding
A sign of proliferation of cells are also scanty discharge. With menstruation, severe pains come as the pressure inside the uterus increases.
Scanty periods are when the endometrium thickens irregularly. In some places, the layer is very large, so on critical days these cells are not separated and do not leave. Accordingly, the allocation of scarce.
But scanty menstruation is often replaced by pathological bleeding in the middle of the cycle. Discharge can be abundant or smearing, like after sex. This is due to the fragility of blood vessels. Any excessive physical activity with hyperplasia can cause blood smearing or blood discharge.
Menstruation after scraping
Scraping is one of the procedures to restore the lining of the uterus. Its essence is that the upper part of the uterine mucosa is removed. This procedure is often used when medicamentally stop abundant or meager prolonged uterine bleeding fails.
More often used hysteroscopic curettage, after which there are fewer complications.
Begin menstruation after scraping in different ways. The onset of the first menstruation may be as follows:
- if they were absent for a long time due to the proliferation of cells, they can begin immediately after the procedure. Normally, they are painlessly, poorly and last 3-5 days,
- if the woman was bleeding, then after the procedure, the periods should begin after 1.5 months. A few days after scraping brown spotting is possible,
- if the procedure was carried out 3 weeks before the start of the cycle due to uterine bleeding, then menstruation will begin exactly after 3 weeks,
- with a strong hormonal imbalance after cleansing, the monthly periods may be absent for more than 35 days,
- If the work of the ovaries is not disturbed by scraping, then the periods can begin on time.
Sometimes menstruation begins only 7 weeks after curettage.
The cycle is restored after 3 months after cleaning. If the monthly does not begin, it is necessary to undergo an examination. In this case, the development of a pathological process is possible.
The nature and amount of discharge after scraping
There should be no scanty or heavy discharge after cleansing, but the first three cycles are painful, so doctors attribute painkillers to this period.
Discharge after the procedure are as follows:
- brown is normal discharge
- bloody and abundant indicate pathology, possibly the endometrium is not completely removed,
- yellow indicate infection of the uterus.
Hyperplasia needs timely treatment. Do not think that the entire endometrium will be released along with the monthly. Abundant discharge does not indicate the cleaning of the uterus from it, but signaling serious health problems.
Each time during the menstrual cycle, the endometrium increases by a few millimeters, this is a normal physiological condition. Pathological condition implies significant thickening and growth of tissues.
What can cause the development of endometrial hyperplasia:
- imbalance of female sex hormones
- chronic genital diseases
- previous abortion
- surgery on the uterus or appendages
- gynecological diseases: endometriosis, endometritis, ovarian polyposis, uterine polyposis, uterine myoma
- lack of childbirth
- genetic predisposition
The problem is benign and treatable. If you start the disease, it can become malignant and lead to infertility.
The uterus changes monthly. The mucous membrane grows, is updated. If the egg has not been fertilized, then menstruation occurs and the mucous membrane acquires its original size. In place of the endometrium, which came out, a new layer is formed and this happens every month.
Endometrial hyperplasia has the following classification:
- glandular cystic
- focal (polyps)
Judging by the name, one can differentiate subtypes of hyperplasia. Atypical is a precancerous condition, in 10% of cases adenomatosis turns into a malignant state.
Glandular and fibrous polyps do not turn into malignant tumors, but are a prerequisite for the development of atypical hyperplasia.
The second classification allows to determine the severity of the disease, the choice of treatment regimen and further prognosis.
- Simple glandular hyperplasia. The structure of the glands remains the same, only their number increases. The risk of cancer is 1%.
- Complicated hyperplasia. Glands accumulate on the surface. The risk of cancer is 3%.
- Simple hyperplasia with signs of atypia. The risk of cancer is 8%.
- Atypical hyperplasia. Cancer risk 29%.
Symptoms and signs
The main symptom that should serve as a signal for going to a doctor is bleeding within a month. Allocations are either in the intermenstrual period, or after a delay in menstruation. In a healthy state, menstruation should be moderate, can be smearing. With hyperplasia, the month is profuse, with blood clots. Such secretions can lead to anemia.
If the cause is a hormonal failure and an increased level of estrogen, then in addition to the growth of the mucous membrane, there is no ovulation and, as a result, infertility.
The reason for the examination is the non-occurrence of pregnancy within six months, spotting.
Symptoms of hyperplasia are often confused with signs of uterine fibroids, the threat of miscarriage.
Patients who are diagnosed with endometrial hyperplasia refer to the gynecologist with the following signs of endometrial hyperplasia:
- irregular menstrual cycle
- prolonged heavy menstruation
- blood discharge
- uterine bleeding
- painful periods
- mid cycle selections
- inability to get pregnant for more than 6 months
The excess endometrium cannot accumulate and periodically exfoliate, hence the discharge. Endometrium cannot hold an egg cell, so infertility happens. Sometimes the female germ cell does not even form.
Hyperplasia does not affect the comfort of life, there is no discomfort and pain during sex. After intercourse, there are also spotting.
If a woman has already reached climacteric, then the bleeding resembles menstruation, occurring at the same frequency. After bleeding, spotting appears, after a month everything repeats.
Cyclic bleeding lasts up to 3 weeks and starts on the first day of menstruation. Acyclic more than two weeks and begin between menstruation. Girls of reproductive age notice blood clots during menstruation.
If the disease has a complex neglected form, pain is felt in the area of the groin and ovaries.
The doctor may, at the time of the initial visual examination, assume that the woman has endometrial hyperplasia. For the final diagnosis you need to undergo ultrasound.
An ultrasound of the pelvic organs. It allows to obtain the following data:
- localization of nodules
- endometrial thickness in millimeters
- presence of polyps
If the endometrium is unchanged, then its thickness will be approximately 9.8 mm, if there is hyperplasia, the thickness of the endometrium rises to 15.4 mm, with glandular cancer, the thickness exceeds 20 mm.
The second research method is hysteroscopy. A special optical device is introduced that allows you to see the uterine cavity. Scraping is done to diagnose content. The resulting mucous membrane is sent for histological examination. This will determine the form of the disease and the method of further treatment. The sampling material for laboratory research is carried out before the onset of menstruation.
The third diagnostic method is aspiration biopsy. For the reliability of the result, you need to be sure that the tissue is taken from the center of hyperplasia, and not on a healthy site. The fence is a special tool in the second half of the cycle.
Diagnostics of hormonal background. The level of female sex hormones, thyroid gland and adrenal glands is investigated.
Routine examination, in which the doctor can detect endometrial hyperplasia, makes it possible to exclude precancerous conditions and infertility.
If glandular hyperplasia reappears after hormone therapy and curettage, then it has a negative prognosis. This condition requires constant monitoring and timely treatment.
The accuracy of ultrasound is 60%, the accuracy of hysteroscopy is 95%.
To determine the patency of the fallopian tubes and at the same time the state of the uterine cavity, you can use the method of echoseralpingography. Less commonly used radioisotope research. Active ingredient - radioactive phosphorus is injected into the vein. Through blood, the chemical element is spread throughout the body and penetrates only into the affected endometrial tissues.
Treatment of endometrial hyperplasia
Even if the hyperplasia is asymptomatic and does not bother the patient, it requires urgent treatment at any age. The most effective method is surgical (curettage). The operation is planned, carried out in a hospital.
At the initial stages of the disease, it is possible to refuse the operation in favor of a comprehensive medical treatment. Treatment lasts from 3 to 6 months. After the end of therapy, a control biopsy is performed.
The doctor assesses the form and neglect of the disease, the patient's age and general health. Duration and method of treatment is selected individually. Polyps are not treated, they can only be removed.
Prescribe the following medications:
- birth control pills
- gonadotropin releasing hormone agonists
To stop the mucous membrane to grow, you need to adjust the hormonal balance. With the help of drugs can increase progesterone levels and lower estrogen.
AGNRG (gonadotropin releasing hormone agonists) is the best drug in this field. Depending on the evidence, the pill is taken only once every few weeks, the dosage may vary. Sex hormones cease to be produced, atrophy of the uterus walls stops. The medicine helps even in the most serious cases when the removal of the uterus is indicated.
Oral contraceptives provide efficacy in adolescents and nulliparous girls. Tablets will allow you to adjust the menstrual cycle, eliminate pain, make menstrual flow less abundant. The duration of treatment is not less than six months.
Synthetic analogs of progesterone are prescribed for all forms of the disease at any age. The course of treatment from 3 to 6 months. To get rid of the bleeding will help progestin drug Duphaston. The minimum duration of treatment is 3 months. Tablets are taken monthly from 16 to 25 day of the menstrual cycle. The dose depends on the symptoms and indications.
Norkolut has anti-estrogenic effect. The scheme of application is similar to Duphaston. Tablets can stop bleeding.
At the same time, the hormonal intrauterine device Mirena (local progestins) has a therapeutic and contraceptive effect. Duration of treatment is 5 years. At the beginning of treatment, there may be bleeding, menstruation may become more painful. The spiral constantly has a hormonal effect on the walls of the uterus.
Treatment by surgical methods
Operations are also different. The first method is scraping. Scraping is also used for diagnosis. The method allows you to remove the overgrown layer, stop the bleeding. Part of the removed material is sent to the laboratory for research. If atypical cells are detected, the patient will need more careful monitoring to prevent recurrence of the disease.
Cryodestruction is used to prevent and treat mild stages. Unhealthy lesions are removed under the influence of low temperatures. The overgrown layer is removed, normal vessels are not affected.
The affected area can be removed with a laser or cauterized with high temperatures with a surgical instrument. Only pathological foci are eliminated, followed by the natural restoration of the mucous membrane.
In extreme cases, resorted to removal of the uterus. If the girl did not give birth or plans to have more children, then the uterus will be saved until the last. If a woman is of premenopausal age, then there is no more effective treatment. If the ovaries are healthy, they are retained. Surgery is cancer prevention.
The nature of menstruation with hyperplasia
The normal menstrual cycle lasts 21-35 days. This process is controlled by hormones - estrogen and progesterone.
While these substances in the blood are at a high level, the endometrium grows, as soon as the hormone indicator falls, menstruation occurs. The proliferation of hyperplastic cells causes hormonal imbalance, and menstruation does not occur on time, ovarian function is disrupted, progesterone drops, estrogen is off scale.
Menstruation is the only, and not always obvious, sign of hyperplasia. The higher the rate of pathology, the clearer the symptoms become.
With endometrial hyperplasia, menstruation of one of two types is observed. It can be:
- Scanty periods. Such secretions are characteristic of focal hyperplasia, when the inner layer grows unevenly. When menstruation occurs, only a part of the endometrium is rejected, so the amount of blood is much less. Однако в середине цикла у женщины могут наблюдаться кровотечения. Связаны они с истончением и хрупкостью кровеносных сосудов.
- Обильные кровянистые выделения. Такой вариант встречается чаще при гиперплазии. Обычно, месячные наступают после задержки.The consistency of the secretions changes, they become more liquid, dark clots appear. You may experience acute menstrual pain.
- Monthly with pieces of endometrium: photo, causes
Menstruation in women should be uniform. If any abnormalities are observed - bleeding or delay, pain, the duration and intensity of the discharge changes, this is a reason for seeking medical help. Untreated pathology often causes infertility.
Bleeding with endometrial hyperplasia - A common phenomenon among young women. They can be cyclic or acyclic. In the first case, copious uterine bleeding coincides with the days of menstruation, but differs in duration, which can exceed 20 days. Acyclic bleeding also lasts for weeks, but occurs between the days of menstruation. Leave uterine bleeding can only doctor.
Scraping with hyperplasia is performed under anesthesia. In order not to disrupt the endocrine system even more, the procedure is prescribed for the day on which the expected monthly periods should occur. The first two weeks after the procedure, the patient may experience scant, odorless spotting. This is due to damage to the inner walls and blood vessels. If there is pain in the lower abdomen, and the woman has a fever, this indicates inflammation or infection. Get medical attention right away.
Wait for these menstruation after scraping is worth a month. Their volume and duration may vary, but should not go beyond the permissible limits and norms. This period may be extended by taking hormonal drugs. When they should be canceled, the doctor decides. Also delay the period of menstruation can stress, taking antibacterial drugs.
When hysteroscopy the risk of injury is minimal, because the gynecologist with the help of an optical device and a computer monitor controls all processes and manipulations. During the rehabilitation period, which lasts 30-60 days, it is better for a woman to refuse sexual contact.
Hyperplasia adversely affects the reproductive system of a woman, causes infertility, and sometimes degenerates into a malignant neoplasm. To protect yourself from such an outcome, be careful about your health, pay attention to the alarming bells that the body gives, visit your gynecologist for a routine inspection every six months.
Opinions of doctors and patients
In order to understand whether hyperplasia is dangerous, and how to treat it, what consequences the disease causes, you need to read the reviews of women who are confronted with the pathology, as well as the opinion of doctors prescribing treatment:
Angelina 30 years
“I am 30 years old, trying to get pregnant with my husband for 3 years. No results. I felt good, only the cycle was irregular. After the examination, endometrial hyperplasia was detected. Scraping was done, a course of hormones and vitamins was prescribed. A friend also recommended recourse to folk remedies, namely alcoholic nettle tincture. After three months, the doctor said that visible improvements are noticeable, so hormones can be discarded. I continued to drink vitamins and nettles. Six months later, she was able to get pregnant. ”
Sofia, 56 years old
“My daughter was given endometrial hyperplasia of the uterus when she was 29 years old. She went to a doctor because of heavy periods, which lasted 2 weeks. At first, the gynecologist said that we would try a conservative treatment. She began taking hormones, enzymes and antibiotics. After a month on the planned ultrasound changes were not. Then they decided to remove the accretion layer and repeat the therapy. After the procedure, she had been bleeding for almost three weeks. Then they stopped, the cycle fully recovered in 3-4 months. ”
Irina 43 years old
“I was diagnosed with hyperplasia at the age of 42, before IVF. The procedure had to be postponed for six months. Spent endometrium removal (curettage), then saw hormones. I had to go on a diet, take a vitamin complex. Then followed a series of tests and surveys. IVF succeeded at the second attempt. Now I am 7 months old. And I want to advise everyone - do not despair, always fight for your health and happiness. ”
Anton 45 years
“I am a gynecologist with 20 years of experience. Endometrial hyperplasia occurs in 60% of women who have difficulty conceiving. It is not easy to notice the pathology, the main signal that the body is able to give is irregular monthly or some changes in the cycle. If menstruation has become shorter or longer, more abundant or more scarce, changed, color and smell, do not postpone a visit to the hospital. The sooner we notice a deviation, the easier it will be to restore the hormones, the menstrual cycle and the reproductive function. ”
Hyperplasia is a dangerous disease that requires immediate treatment. Its complications include infertility and a high risk of developing oncology. If time does not take action, the tissue of the uterus can turn into malignant tumors. A woman should pay attention to the signals that the body sends.
To facilitate cycle control, it is advisable to keep a special calendar.
ICD 10 is the international classification of diseases of the tenth revision. That is, ICD 10 is a single regulatory document for morbidity accounting, which simplifies the process of diagnosis.
According to the international classification of diseases, it refers to diseases of the genitourinary system (N00-N99). Under N85.0, there is endometrial glandular hyperplasia, and under N85.1 there is endometrial adenomatous hyperplasia. This section includes other pathologies and diseases of the female genital organs, such as: uterine hypertrophy, uterine inversion, abnormal position and subinvolution of the uterus.
Causes of endometrial hyperplasia
The causes of endometrial hyperplasia are varied. There are many factors that trigger the appearance of the disease. As a rule, the pathology develops against the background of hormonal disorders and disruptions, with diseases of the endocrine system, arterial hypertension and obesity.
Hyperplasia can occur simultaneously with chronic inflammatory diseases of the reproductive organs. Accurately determine the cause and prescribe treatment can only gynecologist, after examination and study of the results of tests.
Symptoms of endometrial hyperplasia
Symptoms of endometrial hyperplasia do not always appear. So, in some women, the disease is asymptomatic, and it can be identified only after examination. The main clinical symptoms manifest as anovulatory bleeding, bleeding from the vagina between menstruation, a violation of the cycle.
Women have heterogeneous bleeding and blood clots, that is, particles of overgrown mucous membranes, which exfoliated, menstruation become painful. And the most dangerous symptom of endometrial hyperplasia is infertility.
Discharges in endometrial hyperplasia
Discharges in endometrial hyperplasia manifest as non-cyclical spot bleeding. This is the main symptom of pathology. The disease is accompanied by delayed menstruation. Hyperplasia does not cause pain during sex, but after sexual intimacy there is a spotting.
As a rule, women rarely turn to a gynecologist because of the incomprehensible nature of the discharge. But it is on the routine examination that the doctor can determine the presence of the disease. In some cases, discharge is accompanied by pain in the groin and in the ovaries. In any case, bleeding in the middle of the menstrual cycle is considered a pathology. The task of the woman is to pass all the necessary tests to diagnose the disease and undergo proper treatment.
Bleeding with endometrial hyperplasia
Bleeding with endometrial hyperplasia is quite common. As a rule, instead of bleeding appear spotting. But the presence of bleeding can indicate not only the pathology, but also other, associated diseases. The nature of the bleeding depends on the age of the woman and the proliferative process.
- Cyclic hemorrhages appear in the period of menstruation and have a prolonged course, from 2-3 weeks. This type of bleeding in endometrial hyperplasia occurs in women of reproductive age.
- Acyclic hemorrhages are not associated with the menstrual cycle, begin during the period between menstruations, have a different duration and intensity (from 2-3 weeks to several months). Characterized by women in reproductive age.
- During menopause, bleeding caused by endometrial hyperplasia of the uterus manifests as abundant and irregular menstruation. After such periods, spotting is bloody.
- After menopause with endometrial hyperplasia, bleeding becomes scarce, but has a prolonged nature.
- Severe bleeding with clots characters for young girls in the period of the formation of the ovulatory and menstrual cycles.
Note that spotting indicates polyposis, and bleeding - glandular hyperplasia and adenomatosis.
Monthly with endometrial hyperplasia
Monthly with endometrial hyperplasia can be both regular and irregular. It depends on the hyperplastic process of the endometrium and periods of extinction-formation of menstrual functions. As a rule, irregular periods, women are over 40 years old and young girls 15-16 years old. If the disease appears in women of reproductive age, then this may not disturb the cyclical nature of menstruation. It all depends on the type and severity of endocrine-metabolic disorders (diabetes, hypertension, obesity).
If the pathology is combined with metabolic and endocrine disorders, then menstruation becomes irregular. If there are no violations, then the menstrual cycle is regular. Monthly depends on the type of pathology. So, with some types of the disease, menstruation disappears altogether or becomes irregular with smearing secretions. And with other types, menstruation becomes abundant with blood clots. That is to say unequivocally whether the regularity of menstruation depends on endometrial hyperplasia is difficult, since it is necessary to determine the type of the disease and consider other variants of pathological lesions.
Endometrial hyperplasia pain
Pain in endometrial hyperplasia - this is the first signal for a woman to urgently go for a visit to a gynecologist. As a rule, pain occurs when a certain period of time the disease is asymptomatic. In this case, the appearance of pain indicates the progression of the disease.
To identify the cause of pain and diagnose endometrial hyperplasia, the gynecologist conducts a histological examination of endometrial tissue. The procedure is painless and is performed in an outpatient clinic. If the study did not give a positive result, then the woman is sent to the ultrasound. Based on the indications of histology and ultrasound, the gynecologist diagnoses the cause of the pain and gives an accurate assessment of the endometrium in the female body.
Endometrial hyperplasia and pregnancy
Endometrial hyperplasia and pregnancy are phenomena that are extremely rarely observed at the same time. This is due to the fact that this pathology provokes female infertility, since the embryo cannot attach to the modified walls of the uterus. That is, talking about pregnancy and endometrial hyperplasia at the same time is not often necessary. Modern medicine considers hyperplasia as a precancerous condition. Infertility and an increase in the thickness of the endometrium lead to the fact that a benign tumor is transformed into oncology.
Pregnancy with endometrial hyperplasia occurs very rarely. If this happens, then, as a rule, women are diagnosed with a focal form of pathology. This allows the egg to grow in the healthy part of the mucous membrane. It is focal hyperplasia that is the type of disease that is the exception to the rule and allows a woman to become pregnant. But such cases are rare, therefore, require observation by a gynecologist and gentle treatment.
The most dangerous form of pathology for women's health is atypical. This type of disease belongs to malignant tumors and is a precancerous condition. Atypical hyperplasia can be reborn from the focal form of the disease. Any form is an indication of infertility. The task of the woman is to regularly undergo preventive examinations at the gynecologist to prevent the disease.
Pregnancy after endometrial hyperplasia
Pregnancy after endometrial hyperplasia is a matter of interest for many women who have had this disease and want a child. Infertility and endometrial hyperplasia run in parallel, so a woman cannot become pregnant at the time of the illness. But after successful treatment and a certain rehabilitation period, there is every chance to conceive and bear a healthy baby.
Pregnancy and endometrial hyperplasia have two options for development. In the first variant, a woman who does not plan pregnancy in the near future treats with the help of hormonal drugs (oral contraceptives). In the second variant, when the woman is ready to become pregnant, the doctor carries out gentle treatment and prevention of infertility. This allows you to prevent the pathological complication of the disease - infertility, and after the rehabilitation period, make a healthy baby.
Despite the fact that endometrial hyperplasia precludes the possibility of having children during the period of the disease. Full recovery, which involves timely diagnosis and treatment - allows you to become pregnant after endometrial hyperplasia.
Endometrial hyperplasia after delivery
Endometrial hyperplasia after birth, is not common, but in some cases, the disease begins to recur after childbirth. This happens with focal and atypical pathology.
The possibility of a relapse after delivery is possible, but not so dangerous. So, as the woman has already endured and gave birth to a healthy baby, so minor ailments fade into the background. Recurrent hyperplasia is recommended to be treated with surgical curettage and hormone therapy. In particularly difficult cases, radical surgery is possible, which involves the complete removal of the uterus.
Classification of endometrial hyperplasia
Classification of endometrial hyperplasia is a system into which all types and forms are collected. Using the classification, the gynecologist can easily determine the shape of the results of the tests and the manifesting symptoms. Thanks to this, it is possible to prescribe an effective and timely treatment. Let's look at the main types of pathology.
- Simple - a feature of this species is that there is a significant increase in the glands, but their architecture is preserved.
- Difficult - heterogeneous accumulations of glands in the endometrium appear.
- Simple and complex with atypia - in addition to the enlargement of the glands, signs of atypia of the nuclei appear in the endometrium.
The atypia processes are structural damage to the cell nucleus. Such a division into types has clinical and prognostic significance. Thus, a simple account for 1% of all cases of transition of the disease to uterine cancer, to a complex one - 3%. In cases of simple hyperplasia with atypia, uterine cancer is found in 8% of cases, with complex atypia - in 29%. According to research data, in 42.6% of cases, the atypical form develops into uterine cancer.
There are several forms of endometrial hypertrophy, which are also included in the classification. Let's look at the main ones:
- The glandular form is the easiest and benign form. The probability of developing cancer is 2-6%. In this form, the cells actively divide, and the endometrium thickens. The glands are unevenly arranged, they can be pressed together, but there is no stroma between them. From the straight, tubular glands turn into sinuous and significantly expand. But, despite such changes, the contents of the glands comes out freely.
- Glandular cystic form - the cells expand strongly and block the outflow of mucus. Because of this, the mouth of the gland takes the form of a cyst - a bubble with liquid. As a rule, such changes are due to the action of estrogen.
- Cystic form - glandular cells expand and grow in size, which makes them look like bubbles. At the same time, the inner part of the gland has a normal epithelium, therefore this form does not degenerate into a cancerous tumor.
- Focal form - endometrial cells do not expand uniformly, but separate foci. Foci are sensitive to the action of hormones. Elevations appear on the endometrium with altered cyst glands. If the cells are divided into a polyp, then it grows in size, from a few millimeters to 2-5 centimeters. There is a risk of developing a cancer at the site of the lesion. If the changes are not uniform, then this form is called diffuse.
- Atypical form or adenomatosis is the most dangerous form of endometrial hyperplasia, which leads to cancer. The only treatment for atypical forms is the removal of the uterus.
The choice of treatment depends entirely on the form of the disease. Так при простой железистой гиперплазии, в лечебных целях используют гормональные препараты, а при атипической – удаление матки.
Железистая гиперплазия эндометрия
Железистая гиперплазия эндометрия – представляет собой патологический процесс отклонения строения ткани эндометрия от нормы. Железистые клетки разрастаются, увеличиваются в объеме и способствуют утолщению ткани эндометрия. Основа такого нарушения в интенсивных процессах пролиферации в железистом маточном слое. Опасность данного нарушения в том, что есть риск перерождения патологии в онкологию. Timely diagnosis and treatment, allow to preserve the reproductive functions of the female reproductive system.
Cystic hyperplasia of the endometrium
Endometrial cystic hyperplasia is a form of lesion, which is a change in the endometrium at the cellular level. Cystic and glandular-cystic forms are practically the same. Cystic hyperplasia is the process of the formation of cysts due to abnormalities in the endometrial layer. In addition to cysts, large stromal nuclei begin to form in the endometrial layer. When the basal cystic form increases the thickness of the basal layer of the endometrium.
To diagnose the disease, except for examination, the doctor takes the tissue for histological analysis. In some cases, use biopsy, which gives more accurate results. Another method for diagnosing a cystic form is ultrasound.
Cystic hyperplasia can have recurrent forms, that is, recurrent. As a rule, for treatment use hormonal drugs that do not cure the disease until the end and give relapses. In such cases, resection is used for treatment, that is, endometrial excision, which is carried out using a laser. The doctor removes the inner surface of the endometrium. Because of this, the wound heals, and the disease does not recur. Damage to the endometrium can occur in women who have suffered from inflammation of the appendages in their youth.
Glandular cystic hyperplasia of the endometrium
Glandular cystic hyperplasia of the endometrium appears due to disturbances and disruptions at the hormonal level. Lack of progesterone and excess estrogen that occur during puberty, cause endometrial hyperplasia in young girls. Hormonal disruptions can also occur due to the misuse of progestogen contraceptives. Genital infections can also be the cause of the growth of the endometrium, as well as unprotected diseases of the female genital organs. Treatment depends on the woman's age, weight, endocrine disorders, chronic diseases and the desire to have children in the future.
Focal hyperplasia of the endometrium
Endometrial focal hyperplasia is a disease that is caused by hormonal disorders. Pathology leads to changes in the uterus and causes disruptions of the menstrual cycle. Focal form occurs due to the fact that endometrial cells expand unevenly, causing an increase in polyps. Polyps develop into cysts, which, without proper treatment, can degenerate into malignant neoplasms. In this case, we are talking about atypical form, the treatment of which can be complete removal of the uterus.
Simple endometrial hyperplasia
Simple endometrial hyperplasia is accompanied by a characteristic increase in the number of glands. Despite the pathological processes, the architecture of the structure of the endometrium is preserved. This form accounts for about 1% of the disease developing into uterine cancer.
- Simple typical causes an increase in stromal and glandular structures. This leads to the fact that the endometrium increases in volume, cystic expansion of the active glands occurs. In this case, the vessels in the stroma are evenly spaced, there is no atypia of the nuclei.
- A simple typical causes changes in the normal location of the nuclei of gland cells. It also contributes to the modification of the shape of cells, forming round cells with nuclei, causing expansion of vacuoles and anisicytosis. In 20 out of 100 cases, the disease takes on a malignant form.
Atypical hyperplasia of the endometrium
Atypical endometrial hyperplasia is the most dangerous form of this disease. Atypicality indicates a malignant process in the endometrium. The cause of the disease can be regular hormonal disruptions, neglected diseases, endocrine disruption, inflammatory diseases, infectious diseases of the genital organs, and more.
The treatment is long and, as a rule, radical. Surgical removal of the uterus prevents the recurrence of the disease and does not allow for the metastasis of a malignant neoplasm.
Complicated endometrial hyperplasia
Complicated endometrial hyperplasia is a disease that is characterized by profound impairment of the structure and architectonics of the endometrium, which leads to the growth of mucosal elements along its entire surface. Complicated pathology can be with or without atypia.
- A complex form without atypia suggests that a woman in the endometrium does not have degenerated cells that can transform into cancer cells and actively proliferate.
- Complicated with atypia is a disease in which cells transform and turn into cancer cells. Atypical cells in 40% of cases form malignant tumors.
Complicated endometrial hyperplasia involves several treatments. If the disease is without complications, then medical treatment uses hormonal treatment. If hyperplasia with atypia, then carry out curettage, and in severe cases - surgical removal of the uterus.
Polypous hyperplasia of the endometrium
Polypous hyperplasia of the endometrium is a pathological process, which is characterized by an accelerated growth of the endometrium, which adopts a pathological structure. Polyps are bunches of endometriotic tissue with pale pink blisters. For the diagnosis using ultrasound, in which the polypoid form is an uneven surface with multiple cysts, grooves and pits. Polyps differ in size and shape. In this case, the deeper to the bottom of the uterus they are located, the more they increase in size. For a detailed diagnosis of polyps can use hysteroscopy.
Polypous hyperplasia in the early stages may be asymptomatic. But with the appearance of painful symptoms, it is necessary to contact a gynecologist. For treatment, the doctor may prescribe hormone therapy and cure. In rare cases, the disease recurs.
Endometrial adenomatous hyperplasia
Endometrial adenomatous hyperplasia is a disease whose second name is adenomatosis, that is, a synonym for atypical hyperplasia. The disease belongs to precancerous pathologies, as there is a high risk of developing oncology. According to the results of the research, this type of pathology in 30% of cases is reborn into cancer.
The main clinical symptom is dysfunctional uterine bleeding. In addition to bleeding, menstrual, reproductive and sexual dysfunctions are noted in women. Diagnose the disease using histological examination. To do this, the gynecologist makes the collection of endometrial tissue from different parts of the uterus and examines them under a microscope. Characteristic features on histological examination are:
- Improper location of the endometrial glands and their large number.
- Between the glands there are no epithelial cells, the glands are located close to each other.
- The endometrial glands instead of tubular, acquire a branchy appearance.
- Structures of iron appear in the gland, protrusions, bridges of epithelial cells can form inside the glands.
All the above symptoms may have varying degrees of severity and are evidence of atypical adenomatous hyperplasia of the endometrium. Hyperplasia can be considered adenomatous and due to the large number of glands, which are located closely to each other. Atypia cells in that they rejuvenate, that is susceptible to anaplasia. This leads to the fact that such cells actively proliferate and develop into cancer.
Basal hyperplasia of the endometrium
Basal endometrial hyperplasia is very rare. A characteristic feature of this disease is a thickening of the basal layer of the endometrium due to the proliferation of the glands of the compact layer, the appearance of polymorphic nuclei of stromal cells of a rather large size. Pathology of the basal layer is an extremely rare variant of the pathology, which is most common in women over 35 years of age and has a focal character.
The thickened hyperplastic layer, as a rule, has a thick stroma with tangles of blood vessels that have thickened walls. This pathology is characterized by long, painful and heavy menstruation. This is due to the fact that the hyperplassed parts of the basal layer are rejected very slowly. For the treatment using a combined method, make scraping and conduct hormonal therapy.
Diffuse hyperplasia of the endometrium
Diffuse hyperplasia of the endometrium is a pathology that involves proliferative processes. Diffusion covers the entire surface of the endometrial tissue. That is, evidence of a pathological process throughout the mucous membrane of the uterus. Diffusion may take the form of attic, that is, adenomatous or glandular-cystic hyperplasia. It depends on the type of pathological growths.
- Diffuse glandular-cystic form of hyperplasia manifests itself as an overgrowth and appearance of cysts and glands that spread and expand throughout the entire mucous membrane of the uterus.
- Adenomatous diffuse form is a pathological proliferation of glandular cells and epithelium cells in the entire surface of the uterine mucosa. This form can grow into the muscle layer of the uterus. Atypical diffuse hyperplasia is a precancerous condition.
As a rule, the diffuse type of pathology appears due to chronic inflammatory processes in the uterine cavity. The factor provoking the disease can be multiple abortions, elevated levels of estrogen in the blood, inflammatory diseases of the genital organs, endocrine disorders. In 70% of cases, the disease is accompanied by obesity, diabetes mellitus, liver disease or hypertension.
Local endometrial hyperplasia
Local endometrial hyperplasia is a limited form of a disease called a polyp. According to histological studies, there are several forms that depend on the cells that prevail in their structure: fibrous polyps, glandular, glandular-fibrous.
Polyposis is characterized by rapid proliferation of endometrial cells in the uterus. Polyps can have a leg or be attached directly to the endometrium. Local hyperplasia may consist of one or more polyps, which are benign tumors. This species often recurs, especially with the age of the woman.
Symptomatology manifests itself in the form of cramping pain, which intensifies at the time of growth of the next polyp. In women, there are glitches in the menstrual cycle, heavy discharge of whiter and heavy bleeding. Timely diagnosis is the key to successful treatment and a favorable outcome of the disease.
Endometrial hyperplasia in menopause
Endometrial hyperplasia in menopause is one of those problems that lies in wait for a woman. Arises due to hormonal changes in the body. It is during menopause that a woman should be especially attentive to her state of health. Since during the period of menopause, the danger of the development of many diseases, both benign and malignant, lies in wait.
Endometrial hyperplasia in menopause, develops due to excessive proliferation of the uterine mucosa. During this period, women may experience heavy uterine bleeding. The appearance of the pathology contributes to overweight, diseases of the endocrine system, hypertension. The danger of the disease is that during menopause, it can degenerate into malignant tumors and lead to uterine cancer.
Regular examinations at the gynecologist can prevent the development of the disease. Normally, the endometrium should not exceed a thickness of 5 mm. Any magnification is a prerequisite for an ultrasound. If the thickness of the endometrium reaches 8 mm, then this pathology and the woman carry out diagnostic curettage. If during the period of menopause, the endometrium has reached the size of 10-15 mm, then the gynecologist performs separate curettage and histology of the material obtained. With regard to treatment for menopause, there are several methods, let's consider them:
- Hormone therapy - drugs contribute to a positive outcome of the disease and are an excellent prevention of oncology.
- Surgical intervention - the gynecologist conducts curettage of the uterus mucous membrane, removes the lesions of the pathology, stops bleeding and diagnoses the resulting tissues. For surgical treatment using laser cauterization (ablation). With atypical endometrial hyperplasia during menopause, a woman is having a uterus removed.
- Combined treatment - this type of treatment involves a combination of hormone therapy and surgical intervention. In some cases, it prevents the recurrence of the disease.
Postmenopausal endometrial hyperplasia
Postmenopausal endometrial hyperplasia is a frequent occurrence. It is during this period that involutional changes begin in the female organism, and especially in the reproductive system. The secretion of the hormone estrogen is sharply reduced, which leads to pathogenetic disorders.
The main symptom is bloody discharge. This is the first alarm that should force a woman to see a gynecologist. Late diagnosis and treatment can cause a precancerous condition, which, under favorable conditions, will quickly take the form of cancer.
For treatment use hormonal therapy, surgical treatment or a combined method.
- Hormone therapy - since pathology is a hormone-dependent disease, hormone therapy is not only one of the effective methods of treatment, but also the prevention of oncology.
- Surgical treatment - most often, patients are scraped, that is, the removal of endometrial growth foci. After curettage, the resulting tissue is sent for cytology. Laser cauterization is popular and effective. This method involves the destruction of foci of pathologies and is completely bloodless, since blood vessels are cauterized. Radical surgery, is the removal of the uterus. Removal is carried out in the case when all the above methods did not give a positive effect.
- Combined treatment is a comprehensive approach that allows you to significantly reduce the volume of enlarged endometrium before surgery and to carry out preventive treatment of the disease.
What is dangerous endometrial hyperplasia?
What is dangerous endometrial hyperplasia - the first question women who have been diagnosed with this disease. The most important and very deplorable consequence of the disease is infertility, that is, the impossibility of having children. Due to its pathology, the fetus cannot attach to the walls of the altered mucous membrane of the uterus. But hyperplasia is dangerous not only for those who want to feel the beauty of motherhood. Without proper treatment, the disease takes the form of a malignant neoplasm, the treatment of which negatively affects the work of the whole organism.
As a rule, it is possible to diagnose with an ultrasound (transvaginal or abdominal). In some cases, a gynecologist will refer you to a biopsy of the uterus or an echo sterrosalpingography. The most accurate method that can accurately determine hyperplasia is hysteroscopy. This method is a biopsy under the control of optical systems.
Endometrial hyperplasia recurrence
Relapse of endometrial hyperplasia is one of the clinical problems that needs to be resolved during the choice of the type of treatment for the disease. As a rule, to prevent recurrence, use surgical tactics. But even this type of treatment does not guarantee that endometrial hyperplasia does not recur.
The course of the disease depends on the type of pathology and the age of the patient. So, in the treatment of simple endometrial hyperplasia, that is, polyps, conservative treatment methods are used, which in 40% of cases give a relapse of the disease. If the pathology takes an atypical form, then hormone therapy and surgical intervention are used to treat it. But it also does not guarantee that the disease will no longer recur.
- When recurrent atypical endometrial hyperplasia, the woman is sent to an ultrasound to determine the extent of the lesion. The patient is scraped and prescribed hormone therapy. But if after such a therapeutic process, hyperplasia recurs, then the woman is shown to have a uterus removed.
- When relapses are simple, glandular, cystic or glandular-cystic form, hormone therapy is used. If a woman plans to give birth in the near future, then for treatment and normal conception, ablation is used, that is, resection of the endometrium (the procedure of complete destruction). For these purposes, electrosurgical and laser methods are used. The treatment is carried out under general anesthesia and under the control of a hysteroscope.
That is, the recurrence of complex forms of endometrial hyperplasia is a direct indication for performing the removal of the uterus. With the recurrence of other forms of the disease, women are given hormone therapy and regular curettage.
Endometrial hyperplasia on ultrasound
Гиперплазия эндометрия на УЗИ – позволяет визуально проследить изменения в полости матки, определить их масштабы и выраженность. Ультразвуковое исследование позволяет определить утолщения эндометрия, наличие полипов, кист, узлов и других новообразований, которые появились. Преимущество данного диагностического метода в том, что по результатам УЗИ можно делать преждевременные выводы о процедуре лечения и составлять прогноз на течение заболевания.
Ультразвуковое исследование выявляет характерные эхопризнаки, которые соответствуют тому или иному виду. То есть УЗИ не только определяет наличие заболевания, но и форму гиперплазии. Ultrasound examination makes it possible to assess the condition of neighboring organs, which may be the cause of the pathology.
Little bit about hyperplasia
Excessive growth of the endometrium of a benign nature is called hyperplasia. Under the influence of hormonal imbalance, his cells begin to quickly divide. This process occurs during normal development. But in this case, the division is rather than regular elimination of the end-of-life tissues. Therefore, the endometrium thickens and remains enlarged at all stages of the cycle. Its growth can take a lot of time, so the usual omen is the delay of menstruation with endometrial hyperplasia. Change the parameters of menstruation.
Hyperplasia is of four types:
- Ferruginous. When it grows the corresponding components of the body. Glands not only increase in size, but also bend,
- Cystic. Thickening occurs due to the formation of cavities in the glands with fluid,
- Atypical. Differs in the appearance of cells unusual for a healthy organism in an organ,
- Focal or polypous, characterized by abnormal thickening on certain parts of the endometrium.
Hyperplasia and cycle length
Ordinary manifestation - delayed menstruation with hyperplasia. Normally, the menstrual cycle is controlled by estrogen and progesterone. The first provides a thickening of the endometrium at its beginning, the second helps to stop the growth of the organ and loosening for the adoption of the ovum. When the volume of both substances decreases, menstruation comes.
The disease in question is caused by various reasons. But they are all associated with the imbalance of sex (and not only) hormones. This explains the absence of menstruation with endometrial hyperplasia. The layer grows, the cell growth continues, and this can take dozens of weeks. Almost always disrupted ovarian function. There is a shortage of progesterone, which prevents the maturation of the egg. Estrogen, on the contrary, is an abnormally high amount.
In most cases, glandular hyperplasia of the endometrium is diagnosed if there is no menstruation. Estrogen promotes the expansion of tubular areas. Endometrial thickening is also provided by increasing the number of stromal, that is, constituting connective tissue, cells. Gestagens are already guilty of this.
Abundant periods with hyperplasia occur after a prolonged delay. During their absence, the functional part of the mucous is thickened several times in comparison with the norm and has a width of 2-3 cm. Consequently, the number of tissues excreted will be significantly more. The consistency of the discharge also does not indicate health: it is more liquid, but with clots. The first sign is explained by a large volume of blood, which also has a reduced viscosity. Clots appear due to the fact that there are a lot of unseparated mucous membranes in the secretions.
Menstruation of this nature with hyperplasia are almost always painful. The main role in this has increased pressure inside the uterus. Due to the expansion of its tissues, the vessels are squeezed and spasms occur. This symptom should be taken into account when the pain manifested unexpectedly, after many months of menstruation, not accompanied by such sensations.
Monthly hyperplasia of the endocervix also makes it more intense and painful. Thick discharge observed in the intervals between them. The body normally produces mucus, but the proliferation of tissues in the area multiplies its volume many times. Another sign of abnormal thickening of the endometrium in this area is contact bleeding. During sex, the outer edge of the neck is injured, which causes the separation of excess tissue.
Scanty menstrual hyperplasia causes if the endometrium changes unevenly. That is, on the mucous membrane appear foci in which there is an increase in tissue. On critical days, their contents are not separated. There are only fabrics that remain unchanged. The area of the endometrium involved in menstruation has decreased, and the amount of discharge will decrease.
Focal glandular hyperplasia and scanty menstruation are complemented by mid-cycle bleeding. The contents of a polyp grown on a mucous membrane goes with them. Allocation can be a form of daub, and quite large in volume. They can provoke physical activity or sex. But hemorrhages appear and in addition to such effects, as the vascular walls are made fragile, easily damaged.
How to get rid of hyperplasia
In a significant part of the cases, curettage, which is done using hysteroscopy, is imperative. This is the possibility of a more precise effect on the mucous membrane and sending tissue for study. The hysteroscope allows the specialist to see the working field and the course of the surgical intervention.
With a diagnosis of endometrial hyperplasia, the treatment should stabilize the hormonal background. The goal of therapy is to reduce the amount of estrogen in the blood and normalize the amount of progesterone.
Patients under 35 years are shown a choice of drugs:
This hormonal contraceptive, they begin to take in the second half of the cycle.
The important point is how to cause menstruation with endometrial hyperplasia. Help reduce the delay can:
Hormonal drugs contain progesterone analogues, designed to fill its deficiency and to establish production by the body. Their impact is directed to the endometrium in order to stabilize the secretory phase of the cycle. These drugs are prescribed after curettage, usually for 3-6 months. Menstruation comes after their cancellation.
For the treatment of atypical hyperplasia, as well as women aged 35 years and older, gonadotropic drugs are indicated:
These are gonadotropin releasing hormone agonists, which make it possible to “rest” the ovaries by acting on the pituitary gland and leading the reproductive system to the corresponding menopause state.
After a month of taking them, curettage and cytological examination of endometrial tissues is carried out.
The choice of drugs can not be arbitrary, the doctor prescribes them in accordance with the results of the examination and the clinical picture.
The role of scraping in the treatment of hyperplasia
For a specialist, the combination of endometrial hyperplasia - curettage - menstruation has an obvious meaning. The fact is that this is an important component of treatment that rarely can be avoided. Scraping is the separation of the functional part of the endometrium with medical instruments. In order not to disturb even the functioning of the reproductive system, not to intervene roughly in the synthesis of hormones by the body, manipulation is done immediately before the menstrual periods. For accuracy of impact and a clearer picture of what is happening in the uterus, hysteroscopy is used. It also gives an undeniable chance to establish an accurate diagnosis. Actually, the process of scraping goes through a process similar to menstruation, but in a shorter period of time - up to half an hour. Anesthesia is given to the patient intravenously. Especially carefully cleaned out the foci of hyperplasia.
What after scraping
Scraping is the removal of a layer of mucous on the entire area inside the uterus. The cavity after the manipulation represents an open wound, therefore, the appearance of small, odorless bloody discharge in the next 10-12 days is acceptable. If they are not there, but there is pain, this is a negative circumstance, meaning a stagnation of blood in the uterus. This requires treatment, as it happens because of the narrowing of the canal of her neck.
Monthly after scraping, hyperplasia begins about 30 days later. The term is sufficient to restore the functional layer of the endometrium. At all times, women are prescribed hormones that regulate the functioning of the ovaries. Usually, these are progestins and drugs that lower the synthesis of estrogens, the names of which were cited. But against the background of their long use of critical days, it’s not worth waiting until the drugs are canceled. How long it should last, the specialist decides.
Monthly after curettage of endometrial hyperplasia may linger and for a longer period, then come in a very scant volume. This would mean too diligent cleaning, in which the basal layer of the uterus may also have been damaged. Antibiotics taken after the intervention, as well as stress related to the illness and treatment can play a role in the delay.
Monthly after hysteroscopy with hyperplasia come approximately at the same time, that is, according to the calendar. Since the doctor is able to see the operative field during the manipulation, the likelihood of any damage is minimal. Menstruation may last longer than usual, but not go beyond the permissible. If its characteristics have changed significantly, added temperature, odor and pain, this should be known to the doctor. All the symptoms in this case speak of an infection that has entered the organ cavity. To avoid postoperative difficulties, at the time of rehabilitation should be abandoned sex.
Monthly, going with hyperplasia, are a signal of the body about the disease. Control over the process will help to catch the changes with which you should definitely visit a doctor. Hyperplasia is dangerous because it leads to serious disorders in the reproductive system, including at the cellular level. Some of its species can degenerate into a malignant tumor. With hyperplasia, the probability of infertility is high, since the disease often leads to anovulation and impossibility of carrying. At the late stage of the disease, the uterus has to be removed, while at the beginning it is managed with less radical methods of therapy.
Depending on the predominance of certain elements, there are several types of endometrial hyperplasia:
- glandular (with proliferation of glandular tissue),
- glandular - cystic (glandular tissue in combination with cysts),
- atypical (synonym “adenomatosis”) with atypical cells. This type of hyperplasia is referred to as precancerous diseases. The risk of adenomatosis degeneration into endometrial cancer is approximately 10%,
- glandular, glandular-fibrous and fibrous endometrial polyps (focal growths of the endometrium consisting of glands, in combination of glandular tissue with connective tissue stroma or only from connective tissue). This type of hyperplasia is more common than the others.
Glandular and glandular fibrous polyps rarely undergo malignancy, but can serve as a favorable background for the development of endometrial cancer.
Possible causes leading to the development of endometrial hyperplasia include:
- hormonal disorders - estrogen excess in the background of progesterone deficiency,
- associated extragenital diseases - diabetes mellitus, high blood pressure, obesity, diseases of the thyroid gland, mammary glands and adrenal glands,
- inflammatory diseases of the genital organs,
- abortion and diagnostic curettage,
- adenomyosis and uterine myoma,
- polycystic ovary syndrome,
Doctors use several classifications. Among the most common, you can specify such as:
Classification of endometrial hyperplasia according to the presence in the composition of the tissue of various structural elements:
• Ferrous. At the same time in the tissues marked proliferation of the layer of glands.
• Glandular cystic. In this case, the glandular tissue actively expands in the endometrium and minor cystic formations are diagnosed.
• Atypical or adenomatous form. One of the most dangerous for women's health varieties of hyperplasia. A feature of this type of pathology is the presence in the tissues of atypical cells that have a tendency to degenerate into a malignant tumor.
• Endometrial hyperplasia of the glandular, cystic, glandular-cystic forms with the formation of polyps consisting of connective tissue. This species is much more common than other forms of the disease.
Experts identify the following types of hyperplasia on the mechanism of development of the pathological process:
• Working hyperplasia. In this case, an increase in an organ or a specific tissue occurs as a result of prolonged exertion when performing certain functions. This pathology is noted in the bladder, with a diagnosed violation of urine outflow. This is due to an enlarged prostate gland.
• Humoral hyperplasia. It occurs when cells have been exposed to chemical factors for a long time. As a result, there is an increase in the number of tissue cells during their intensive reproduction. For example, an excess of adrenocorticotropic hormone in the blood leads to adrenal hyperplasia. Hyperplasia of the thyroid gland in the case of a disease such as Graves' disease is also a vivid example of humoral hyperplasia.
• Replaceable hyperplasia tissue or a specific organ occurs if the body has completely lost part of the parenchyma. An example of such a pathological process is the loss of the renal glomeruli, with diagnosed hyalinosis. In this case, compensatory hyperplasia is an increase in one kidney when the second is underdeveloped. This is a clear example of vicar hyperplasia, manifested in paired organs.
Previously, experts have identified another type of hyperplasia, called disharmonious. Subsequently, it was found that it is one of the most common and studied forms of humoral hyperplasia.
There is also another type of classification of hyperplasia:
• Generalized. It occurs as a result of exposure to an organ or organ system of growth hormone secreted into the bloodstream by somatotropinoma (this is a tumor of the anterior pituitary gland). The patient has an increase in the bones of the skeleton and skull. Also in size increases the language or some internal organs.
• Systemic. A prominent example would be sebaceous gland hyperplasia, diagnosed in adolescents and young people during puberty.
• Local. Celebrated in a specific body. For example, in the stomach, with increased production of gastrin, a thickening of the mucous membrane is diagnosed.
Experts also subdivide hyperplasia into:
• Physiological. It manifests itself in the breasts during pregnancy and lactation.
• Pathological. All of the above states of the body can be attributed to it.
Doctors often talk about this classification of hyperplasia, such as:
• Focal. Damage to the endometrium or epithelial layer occurs in the form of clearly defined areas. Focal foveolar hyperplasia, which in other sources may be called the regenerative or hyperplastic polyp.
• Diffuse form. Pathological process completely affects the entire surface of the layer. At the same time, there is marked thickening of the endometrium or the layer that has undergone this disease. This form is the most difficult to treat.
• Polyps. They are formed with an uneven growth of connective tissue elements and can cause the development, in the future, of substandard or cystic formations.
Congenital adrenal hyperplasia
In addition, doctors distinguish congenital hyperplasia. as well as several degrees of each of the above types of pathologies. Among the many different diagnoses, one can see such a definition of hyperplasia as: moderate, chronic, typical, etc.
The lack of timely treatment of hyperplasia is directly related to the number of complications arising in the development of the pathological process. Consider endometrial hyperplasia and those complications that often accompany this disease:
• Crayfish. Transition of an atypical or, in other words, adenomatous form into a substandard disease occurs quite often.
• Relapse. One of the most common complications accompanying hyperplasia.
• Chronic anemia that occurs during menorrhagia and metrorrhagia.
• Infertility. In the reproductive age, doctors register an increasing number of patients whose infertility is based on uterine endometrial hyperplasia.
In the case when the patient is diagnosed with hyperplasia of other organs, then the development of such complications as, for example, urinary retention during prostatic hyperplasia, is possible. Assisting the patient is directly related to the need for bladder catheterization.
Causes of endometrial hyperplasia
Among the most common reasons for the development of this pathology, experts point out:
• Violations of the hormonal background. Hyperplasia is a hormone-dependent disease that is directly related to changes in the amount of various hormones. Endometrial hyperplasia develops in violation of the ratio of FSH, prolactin and hormone drugs.
• Various mucosal injuries, abortions, difficult childbirth can also lead to the development of endometrial hyperplasia.
• The presence of comorbidities such as obesity, diabetes mellitus or high blood pressure significantly increases the risk of developing pathology.
• Arbitrary use of contraceptives without prior consultation with a specialist leads to hormonal disturbances and, as a result, endometrial hyperplasia of the uterus.
• Синдром поликистозных яичников.
• Генетический фактор, оказывающий сильное влияние на развитие не только гиперплазии эндометрия, но и гиперплазии остальных органов.
• Миома матки, эндометриоз, аденомиоз и другие заболевания могут стать причиной развития патологического процесса.
Traditional methods of treatment
Среди народных средств лечения наибольшее признание получили:
• Отвары и настои крапивы. Она обладает кровоостанавливающим действием, поэтому широко используется для лечения кровотечений. 200г растения на 0,5литра спирта. Настаивается средство в течении 14-15 суток, а затем принимать по 1 чайной ложке двукратно в сутки.
• Сок корня лопуха и золотого уса. Приготовить по 1 литру сока каждого растения, а затем принимать смешанный состав по 1 столовой ложке дважды в сутки на протяжении 6 месяцев.
• Экстракт пиона, разведенный в соотношении 1:2. The dosage of peony is 2 ml. It is taken with water three times a day.
Endometrial hyperplasia is a benign proliferation of the endometrium (inner layer of the uterus). Let's consider the types, hazards of this pathology, methods of treatment and prevention.
There are several types of pathology: glandular, glandular-cystic, focal or polyps, as well as atypical. Very often the disease is asymptomatic. Therefore, it is possible to recognize hyperplasia only after a routine examination or ultrasound examination. In some cases, the disease is manifested by anovulatory uterine bleeding that occurs after a delayed menstruation or on the background of an irregular cycle. Many women get a diagnosis after the examination because of the inability to conceive a child. The disease causes infertility.
The causes of the disease are varied. Endometrial hyperplasia of the uterus may appear on the background of hormonal disorders, lipid, carbohydrate and other metabolic pathologies, due to gynecological diseases and surgical intervention. Very often, the disease appears in women with impaired fat metabolism, hypertension, high blood sugar, uterine myoma and liver disease.
Causes of disease
This disease has a hormonal nature. It starts due to an increase in the hormone estrogen in the blood.
Concomitant diseases are considered obesity, diabetes. as well as hypertension, diseases of the breast, thyroid pathology.
The main symptom that should cause anxiety is non-cyclical bleeding.
They, unlike the menstrual flow, do not have regularity. They also differ from menstruation by their moderation, are smearing .
Breakthrough bleeding also occurs.. which accompany blood clots, but this is most likely characteristic of the adolescent period — the time when the cycle is just set.
It is safe to say that it's time to see a doctor :
If, after a long absence of menstruation, sudden uterine bleeding occurs - this is a sure sign of endometrial hyperplasia. especially if we are talking about a woman in the menopause period.
Some external signs in conjunction with the main symptoms may indicate a disease. Symptoms of hyperplasia:
Of course, it is impossible to speak of hyperplasia solely on these grounds, but if there is a cycle malfunction and uterine bleeding at the same time, it is most likely hyperplasia.
What is dangerous diagnosis?
Endometrial hyperplasia fraught with sterility. The lining of the uterus with this diagnosis is so changed that the fetus can not attach to its wall.
Because of this, women with hyperplasia cannot become pregnant.
But not only the inability to give birth makes hyperplasia a dangerous disease. In some cases hyperplastic process can be the basis for malignant tumors.
In particular, this risk increases for women over forty with a diagnosis of hyperplasia.
In addition, if you do not treat hyperplasia, against its background such diseases may occur :
- ovarian cyst,
- polyp of the cervical canal,
- uterine polyp
- myoma node
This is due to the fact that endometrial hyperplasia is a disease of a hormonal nature. and hormonal disorders are a catalyst for many other diseases of the reproductive system.
Treatment and Prevention
Typically, the treatment of hyperplasia consists of several stages:
- Stop bleeding, if necessary.
- Hormone therapy, the purpose of which is to suppress the endometrium.
- Optimization of hormonal status.
- Dispensary observation 5 years after hormonal treatment, 6 years after operative measures.
If conservative therapy did not produce an effect, surgery is required.
Women of childbearing age are more commonly used. hysteroscopic resection. in menopausal women, in some cases, the uterus is extirpated (removal) - if we are talking about atypical forms of hyperplasia.
Prevention of hyperplasia lies in very simple things that will be true for the prevention of other diseases of the reproductive system:
It is easier to treat timely revealed pathology, so delaying the visit to the doctor may not only be unreasonable, but very dangerous.
The possibility of pregnancy with endometrial hyperplasia
If it is about glandular hyperplasia. the possibility of conception is nearing zero.
The fact is that hormonal failure leads to a lack of ovulation, and if ovulation has happened, the mucosa will not be able to accept the fetus.
With successful conception, further development of the fetus is very difficult.. developmental pathologies are possible, in most cases miscarriage occurs.
But after treatment hyperplasia a woman can naturally conceive, especially if treatment is started in a timely manner.
The effect of pregnancy on the course of the disease
If pregnancy occurs with hyperplasia. This happens with focal form. That is, the egg has adhered and develops on the whole, intact part of the uterine cavity.
These cases are still sporadic, and women who become pregnant in this way require constant medical supervision throughout the entire gestation period.
Rumors that during pregnancy, hyperplasia is reduced, can be called arrogant reasoning.
It will not decrease. moreover, hyperplasia makes pregnancy problematic, requiring special medical attention.
Endometrial hyperplasia is a serious disease of the uterus. which requires timely complex treatment.
Otherwise, a woman may acquire a subsequent diagnosis of "infertility", and in some cases hyperplasia can trigger the formation of a malignant tumor.
Regular visits to the gynecologist and control cycle will not allow the disease to develop further.
Mushroom Lyudmila Nikolaevna
Psychologist. Specialist from the website b17.ru
 - September 12, 2008, 22:53
Hormonal disbalance. Most likely on the background of severe stress, just a couple of months ago everything was fine with ultrasound. What further aggravate the disease crying. Scraping is done under general anesthesia, and then it is examined to prevent all sorts of other unpleasant sores, including oncology.
 - September 12, 2008, 10:58 pm
Hyperplasia. Doctors can offer nothing consolatory except hormones. scraping did 2 times. Then he bleeds anyway.
 - September 12, 2008, 10:59 pm
and then doctors predict what for you?
 - September 12, 2008, 23:47
I had a sister 20 years old, persuaded a doctor without an operation, regividon sawed according to the scheme, there at first several pieces at once, then another couple of hours and so on to stop, even cefozalin pricked something else, she went through the day, they said decreased something there What pills helped
 - September 13, 2008, 02:59
I also have this diagnosis. But they can’t decide whether to scrap or not. When I do an ultrasound at the beginning of the cycle, everything is normal, for 20-21 days, bad readings. The cuts prescribed by the doctor Duphaston are now waiting for 20-21 days and results. If all the same you have to do scraping promised after planting on hormones-minimum for six months. And do not cry - it's not so scary. Right you said - this is a hormonal failure. I had a pituitary macroadenoma against the background of this failure — I was also crying, it was scary — I took myself in hand — and was cured. And with this cope. Calm down and most importantly do not give up!
 - September 13, 2008 07:49
I, too, was seriously scared, before that I had a cycle violation, for 22 days, then 50 days after that, I showed an ultrasound scan of 15 mm, and 14 month periods, but this is no longer menstruation, but bleeding, something that is more than a week, but I scraping drove the fear of oncology, my mom had adenocarcinoma, I needed to know what kind of analysis I had, who was forearmed armed. Here at the forum I was prompted to make a hysteroscopy, the most informative and non-traumatic method, I did it without anesthesia, I am also afraid of it, it acts on the brain, anesthetized with canal, everything is tolerable. after drinking narkolut 3 months and again a delay of 3 weeks, but the ultrasound showed normal endometrium, so I am going to the gynecologist endocrinologist. I am 44 years old, maybe this is the beginning of menopause, up to 42 my periods were like hours.
And about the reasons they can be many, they have already written above. If the monthly went into the bleeding, you need to make a hysteroscopy, we have it paid prices range from 1,700 rubles to 8,000 rubles.
 - September 13, 2008, 07:51
But please do not self-medicate.
 - September 13, 2008, 15:37
Bitch also told me that then drink hormones. And yet the fact is that the lower abdomen aches a bit lower, too, the discharge is now brown and mixed with water. Now, this is the weekend and I cannot get blood on the RV anywhere, today I passed the result only on Tuesday. In short, everything is stretched. And no one will clean without tests. The gynecologist yesterday said she said that you can wait, but I am very scared. The hormone test is also not very low. I fear, as it were, for these days the inflammation has not stuck. And the fact is that I am not in my own country now, but with my husband on a business trip. If it would be easier in Moscow now. Leaving is not possible.
 - September 13, 2008, 15:46
It all began with the daub of black and brown on August 26, 28 came normal monthly, and so far everything continues so bloody and daub brown. I'm just in shock, I'm afraid of everything now. They looked at the cervix yesterday, they said that everything was fine, they took smears, 10–16 white blood cells. She said that it was not much. Vobschem just wait now.
 - September 13, 2008, 19:42
Scraping for hyperplasia is ALWAYS done so that the histology shows that it is part of a hyper-thickened endometrium. Diagnosis of hyperplasia is made by ultrasound - strictly on 5-7 d.ts. (this is ideal). How it happens: I personally did in a paid clinic, in the center of Moscow. She came in the morning on an empty stomach (strictly.) - the doctor looked, did an ultrasound, took a smear on the flora (the laboratory assistant checked everything right away) and into the operating room (before that, the conversation with the anesthesiologist). The softest anesthesia (Diprivan), smooth and soft falling asleep, the procedure itself, together with hysteroscopy, takes 10-15 minutes. Then you wake up, you are taken to the ward (a very nice and nice room), laid down and put cold on the lower abdomen. A little pulls, as during menstruation. Lie down from half an hour to an hour. Then you dress, go to the doctor again - she does a control (superficial) ultrasound and go home (essno, without accompanying you, they will not let go). Three days later - a res. Histology. Based on the data, treatment is prescribed. All this today costs 10,500 p. If you want, I will tell you the address and the name of the doctor.
 - September 13, 2008, 20:02
Guest 1455637142 the fact is that I am temporarily not in Moscow, this is a problem. Here, too, I want to apply here to a private clinic, but until they are ready, no one will put me on the scraping. But Uzi I did not in the first phase and in the second. But in my case, I think it does not matter because I am roofing.
 - September 13, 2008, 21:56
10- Did you get your hormones to drink after scraping?
How long have you had hyperplasia? how to treat?
 - September 14, 2008, 10:54
Bitch and you on hormones zdavali?
 - September 14, 2008, 11:59
12, yes, I took Utrozhestan. Hyperplasia is gone. Its causes - hormonal failure after death (stress) of a loved one. Now it is not. I go constantly checked, still in the unit at risk (.
 - September 14, 2008, 12:01
11, I did not have any analyzes on my hands. What did I have to wait two weeks for a re-com what was needed? Cow flow went for three weeks - this is not a joke. This is after the procedure, the doctor insisted on hormone and other tests. By the way, there was no divorce for money - she said do where you want. I need a cut.
 - September 15, 2008, 06:09
They did the same thing to me without tests, because this is bleeding, I later brought the tests, and if they brought you in soon, they would demand tests.
 - September 15, 2008, 19:51
I went to the hospital to know what it was like, they told me that you were not bleeding, but you could just wait to bleed and you could wait, they told you what to do. Tomorrow, they will be ready for tests and will go to the doctor to send me.
 - September 16, 2008, 16:02
hormone tests I gave. They were "normal", which really surprised me.
 - September 16, 2008, 16:11
I also had, did scraping and then put Mirena, already a year old, recently examined, ugh, everything is fine.
 - September 16, 2008, 16:21
Guest 10, please give the address and name of the doctor:
e-mail: [email protected]
 - September 19, 2008, 15:52
In general, I did the cleaning today, now the blood goes like during menstruation, so it should be?
 - September 19, 2008, 5:31 pm
After scraping, I was advised to drink the broth of the shepherd's purse during the sword, while the uterus cleared better and the growth of the endometrium ceased.
 - September 20, 2008, 14:03
Yes, the same problem. the second week is monthly, and before that, it is also not clear what.
ten! send coordinates please.
 - September 20, 2008, 15:48
And how much after scraping the selection should be, or it is monthly I do not understand anything, I will go to the doctor on Monday only. Here I sit and think whether it is normal.
 - September 20, 2008, 23:59
Good day! I am a gynecologist. Scant bleeding is acceptable for 1 day. Further, they should be characterized as seric. Are you prescribed antibiotics?
 - September 21, 2008, 14:09
DoctorIrina Yes, I was prescribed tsiprolet for 5 days, but today there is less discharge. But it still goes. And my stomach pulls a little. On the day of the cleaning were quite abundant, on the next day less, and today I can call scanty. And what about that belly smacks what say. Is it normal?
 - September 21, 2008, 14:10
I take antibiotic as prescribed in the morning and evening. Maybe he does not help?
 - September 22, 2008, 04:19
. I was late with the answer ((_______ but I think the story will be interesting to someone .______________ 2.5 years ago there was a delay of 12 days (((______ I got tired. I passed the analysis on the human chorionic embryo - negative result, I got nervous more. ( ((I ran into the nearby clinics; I did an ultrasound; the endometrium was greatly enlarged. I was intimidated “properly”, which is very serious. I need to IMMEDIATELY Separate curettage. _________ I refused. After that, I was already threatened with uterine cancer . (((___________ I refused to do this (that is, I said that I would think. 12 days, I thought that I had time to think) ______________- Result: ON THE NEXT DAY AFTER INSURANCE IN THE CLINIC, I started my period. _______ (I am not an idiot. I she passed all blood tests (including tumor markers, among others), and made ultrasound after the end of her period. RESULT: EVERYTHING. IN - NORMAL. and endometrium, including)) ._____________________ I am VERY MUCHYWE. advised cleaning of all forces ..) _______ and I hope that my brains will serve my health more than once. ))