Endometrial hyperplasia menopause. That is, the symptoms of uterine treatment, scraping, glandular, focal, atypical, simple, complex

At the age of about 45-50 years in the female body are natural changes in the hormonal background, affecting the overall health. Endometrial hyperplasia during menopause - is a pathology, frequent, which carries the threat of increased risk of developing malignancies.

What is endometrial hyperplasia

Reproductive organ is the uterus muscle, the inner layer of which is called the endometrium. Under the influence of female hormones the first half of the menstrual cycle (estrogen) of the inner layer of the uterus cells proliferate, preparing thus the way for the pregnancy. When fertilization does not occur, the body is freed from unnecessary tissue with the help of menstruation.

Such phenomena are natural, cyclical processes of nature.

However, according to statistics, 15-40% of women of different age groups, there is a pathological excessive implementation Endometrial uterine cells to other layers with increasing thickness, not extending to the end of the cycle (hyperplasia endometrium).

Of the total number of patients in 75% of cases, the manifestation of hyperplasia accounted for before the menopausal period. Explained such statistics that menopausal cycles become anovulatory (without egg maturation), neuroendocrine system continuously indicates the lack of estrogen.

As a result, the hormone begins to be produced continuously in high concentrations. Pathology is dangerous because it can regenerate tissue endometrial cancer cells.

Causes

Menopause is characterized by the fact that in endometrial hyperplasia result in a variety of factors, but the main cause of abnormal growths of tissue in the uterus is hormonal imbalances - increased concentration of estrogen to stimulate the endometrium against the background of progesterone deficiency (hormone second half month cycle).

Causes hormonal imbalances are the following factors.

• Overweight. Fat cells have the ability to produce estrogen, ie to increase their levels in the blood. Thus progesterone concentration decreases.
• The transition from the reproductive function to menopause. In this period there is a natural hormonal changes.
• Wrong hormonal agents. The pathology may result from the use of drugs for therapy of mammary gland cancer or other diseases.
• The presence of polycystic ovary - hyperplastic transformation of bodies and their replacement by connective tissue cells, synthesizing estrogen atypical. The growth of ovarian tissue is a shortage or a surplus of hormones.
• Thyroid disease. It does not directly affect the increase in estrogen endocrine diseases such as diabetes, hyperthyroidism, thyroiditis.
• genetic predisposition. Scientists have proven that there is a link between genetics and flow characteristics of menopause.
• Mechanical trauma to the uterus. Frequent abortion, surgical intervention, cleaning help reduce the perception of progesterone by the body, acceleration of growth of endometrial tissue.
• adrenal pathology. Problems with the authorities lead to metabolic disturbances.
• The presence of tumor formation in the uterus. Fibriomy fibroids and disrupt the normal body nutrition.
  
• Abnormalities in liver function. Decrease of binding globulin sex hormones, leads to the appearance of free estrogen cells.

Normal endometrial thickness with menopause

Due to hormonal changes occurring with age in women layer endometrial thickness gradually decreases. This is a natural process in the menopausal period. Normal uterine mucosa thickness thus considered to 5 mm ± 2 mm. There are cases where the thickness of the indicator is different from the norm because of the peculiarities in the hormonal background of different women.

In order to detect abnormalities, it is necessary to observe in the dynamics of development. To this end assigned ultrasound with period 1 once every 3 months. Thus, the fixed thickness of the mucous layer of the uterus during menopause, revealed deviations from normal values.

When there is a consistent increase in endometrial abnormalities is 3 mm or more, diagnosed "Endometrial hyperplasia".

Symptoms of menopause

Endometrial hyperplasia menopause between 10 - 30% of cases are asymptomatic. Identification of pre cancerous conditions in such a case is difficult. Therefore, gynecologists recommend that women within the area of ​​cancer risk held ultrasound genitals 2 times a year.

However, there are a number of symptoms that should cause a woman to see a doctor gynecologist immediately:

• in the period before the climate, if there is menstruation, it is required to monitor its regularity;
• the presence of spotting mid-cycle;
• strong month with heavy and prolonged discharge;
• sudden resumption of menstruation after a break of 12 months;
• exacerbation of chronic disease on the background of reduced immunity;
• violation of weight for no apparent reason;
• the emergence of a heightened sense of thirst;
• constant fatigue;
• strange selection uneven color of the genital organs;
• monthly cycle is less than 21 days;
• possible headaches;
  
• any bleeding from the vagina after the menopause (including scant or smearing).

Classification

The endometrium consists of two main layers: the basal and functional. Basal mucosal cells have high rates of regeneration processes. The functional layer is built up during the menstrual cycle and is rejected at monthly.

Changes in the tissues of the uterine endometrium are different in nature and subject to them divided form hyperplasia:

1. glandular. Endometrial glands are modified in shape (in the form of meanders, loops) with an increase in volume. When this gland gather in groups, growing. As a result, it lost the boundary between the basal and functional layers. Women suffering from this disorder, there are plentiful monthly with a large blood loss and severe pain. Forms glandular hyperplasia: active - cells divide rapidly under the influence of high estrogen concentrations; chronic - with a small level of estrogen cell division occurs rarely.
2. Glandulocystica or cystic. Type differs from other types of presence of cysts (tumor formations, filled with liquid) in the endometrium. Cysts developing due to active dividing endometrial tissue bridging gland mucus barrier yield.
3. basal. Characterized shape increasing basal cells located foci or diffuse (groups). Focal character leads to the appearance of polyps in the mucous membranes of the uterus - outgrowths in size from a few millimeters to a few centimeters. In these processes, functional tissue gradually becomes thinner.
4. Adenomatous or atypical. In addition to the glands in the proliferation of the uterine mucosa anomalies in their structure. It considered normal when the gland are separated from one another via the epithelium. Here there is a pathological process of grouping glands with tumors. Identified cases of the appearance of the epithelium in the middle of the prostate. Diseases can be observed how in one layer of the uterus, and the two simultaneously, increasing the risk of development of cancer.

Endometrial hyperplasia in postmenopausal diffuse type covers all the surface of the mucous layers. Lobular hyperplasia appears in limited areas of the body.

modern classification

Modern classification of endometrial hyperplasia differs depending on histological and cytological features of the mucous membranes. Pathology in the structure of the glands (histology) divide the disease into simple and complex (complex) type.

Abnormalities in the structure of the tissue characteristics imply the presence or absence of atypical processes (defects in the functional and biochemical properties of cells).

These assumptions form the setting of one of the four diagnoses:

• Simple disease without atypia.
• Complex (complex) type without atypia or adenomatous.
• Simple atypical appearance.
• Complex (complex) atypical type.

Simple hyperplasia without atypia developed benign in women during pre-menopause. Type characterized by the presence of anovulatory cycles. In 60% of cases pathology goes without treatment. If you apply therapy with progestins, some 84% of patients cured. Only 3% of patients observed in the transformation of cancer.

Difficult or complex disease without atypia independently passes in 56% of cases.

When a simple or complex form of the disease with atypia degeneration in oncology hyperplasia was observed in 36% of cases, 27% - pathology develops, even when using progestins (55% of the therapy has a positive Effect).

Complex (complex) pathology of endometrial hyperplasia without atypia with abnormalities in the basal cell differentiation and functional layers of the uterus It relates to diseases classified difficult due to intermittent volatile cell growth (diagnoses may be assigned to the subjective point of view).

Any assessment of pathology, above all, should be based on the degree of atypia, as it has the greatest value when selecting a treatment method (cyclic progestins, prolonged or gestagens hysterectomy).

development mechanism

The endometrium in the uterus is composed of specific receptors, actively respond to sex hormones. Natural physiological processes in the body that occur in cycles, dependent on a balanced set of effects of hormones. Any violation of estrogen and progesterone change the division rate of endometrial cells, their structure and function.

As a result of developing hyperplastic processes - the replacement of the functional and the basal layer of the uterus connective tissue.

A great role in the development of defects in the formation of the uterine mucous membranes takes the concept relative and absolute concentration of estrogen, deficiency or lack of level progesterone.

Hyperestrogenia appears before the climatic period of the following reasons:

• formation of anovulatory cycles as a result of the termination of production of the follicles;
• hyperplastic processes in the ovaries or the presence of these tumor-producing hormones;
• pathology pituitary gonadotropin in the formulation;
• pathological changes in the adrenal cortex because illiterate conducted hormonal therapies.

There are cases when violations of hyperplastic endometrium are no abnormalities in the hormonal balance. hyperplasias cause in these cases is the infectious-inflammatory processes in the tissues. The proportion of these patients is 30% of the total number of patients.

Endometrial hyperplasia menopause may occur due to the pathologies associated with the exchange endocrine system:

• disorder of fat metabolism;
• improper digestion with sex hormones by the liver or gastrointestinal apparatus;
• due to the decline of the body's defenses;
• by thyroid problems.

Diagnostics

At the age of 40 to 60 years, women are encouraged to come to the reception to the gynecologist every 6 months. If there are complaints, especially on uterine bleeding, it is necessary to conduct the differential diagnosis.

The main stages of the survey are:

• primary data collection, patient complaints;
• definition of a hormonal background;
• elucidation of the presence of endometrial hyperplasia due to hormones;
• detection of clinical signs of a lack of progesterone (weight gain, fatigue, depression, headaches, depression of immunity) against high estrogen (edema, diseases of the mammary glands, fluid retention, high blood velocity folding, failure thyroid function gland);
• gynecological examination.

Further laboratory studies are conducted indices of blood (biochemistry, general, hormones) and additional specific clarifying picture of the disease.

Following ways:

• Ultrasound examination of the reproductive system. US shows thickness endometrial polyps, tumors.
  
• The endoscopic method using optical instruments. Study relates to a surgical procedure using local anesthesia, is performed without hospitalization, it takes a little time. As modern optical devices used hysteroscope introduced through the cervix or laparoscope entering the body cavity through the incision (a few millimeters) in the umbilicus.
• Radioisotope study. The method makes it possible to identify not only hyperplasia, but the extent of its activity. The method is based on comparison of test doses of radioactive phosphorus.
• Histological method. Research carried out by scraping the uterine cavity, followed by studying tissue samples. The method is often used with the hysteroscope.
• Aspiration. The procedure is performed for the control of disease treatment, also at the dispensary examination. The method is based on the suction of the uterus with its contents, followed by the study.
• Gistoimmunohimicheskoe biopsy and examination. Appointed by the methods under suspicion for cancer or for monitoring the effectiveness of the measures.

Preparations for the treatment of

Treatment of endometrial hyperplasia includes two directions: conservative and operative. The conservative method is aimed at restoring hormonal levels.

Surgery removes the immediate cause of the disease.

Hormonal treatment is given for a period of 3 months or more. After the courses of preparations to conduct a full histological scraping. If it detects the absence of clinical effect of therapy, surgery is appointed.

The women in the menopause are shown to use progestins and progestins preparations containing progesterone and antagonists of gonadotropin-releasing factor. Comparison of the effects of drugs can be summarized in the table.

names means	Effect	Instructions for use
Artificial substitutes for progesterone: Norkolut, Djufaston	Increase the level of progesterone in the blood, allowed for the treatment of endometrial hyperplasia in any age category	2 times a day 1 tablet
Antagonists of gonadotropin: Orgalutran, Tsetrotid	Reduce estrogen production, cell division activity endometrial atrophy causing	The intramuscular injection 1 time per day

People's treatment

Endometrial hyperplasia in menopause can be treated with folk remedies as additional procedures to primary therapy. In this widely used upland grass of the uterus (ortiliya sided), nettle, burdock, plantain, cinquefoil. The duration of action is 3 months or more.

Alcoholate ortiliya sided:

• plant is dried;
• 1 tbsp. l. pour a glass of alcohol or vodka;
• insist on for 2 weeks;
• use of 1 hour. l. 3 times a day, with some liquid.

Broth from ortiliya sided:

• 1 tbsp. l. herbs poured 0.5 liters. of boiling water;
• put on a steam bath for fifteen minutes;
• use in 3 divided doses 1 hour before the meal.

cinquefoil herb is used in the form of decoction:

• 1 tbsp. l. Plants poured 0.5 l of boiling water;
• put on a steam bath for fifteen minutes;
• defend 2 hours;
• It takes 20 min. after meal.

Tincture of nettle:

• 200 g of plant poured 0.5 liters vodka or alcohol;
• stand infusion 14 days;
• use of 1 hour. l. 2 times a day.

Decoction of nettle:

• pour 2 tablespoons. l. plants on 1 tbsp. boiling water;
• boil water bath for fifteen minutes;
• consume up to 5 times a day for 1/4 Art.

Decoction of cucumber ovaries:

• 50 g of dried cucumber ovaries;
• poured 0.5 liters. water and boiled for 5 min .;
• uphold;
• take 100 mg 3 times a day.

Decoction of plantain:

• 1 tbsp. l. herbs pour 1 tbsp. water;
• boil for a quarter of an hour;
• defend 2 hours;
• use 4 times a day for 1 st. l.

Surgery

Surgery may be a cardinal (complete removal of the uterus) and health-saving (cleaning, hysteroscopy, laparoscopy, laser effects, cryosurgery). Surgical intervention reduces the likelihood of recurrent pathologies, eliminating the cause of the disease.

Appointments for operations are:

• focal dysplasia and atypical;
• relapses after treatment;
• the presence of large blood loss;
• No effect of drug therapy.

Types of surgical procedures are described below:

• Cleaning endometrial cancer (Scraping) is carried out under general anesthesia for 20-30 min. The physician removes the entire mother functional layer. The method does not guarantee recurrent relapses.

  

• cryolysis is frozen out of the endometrium due to the low temperatures. Chilblained mucosa die and extend in the form of clotted blood.
• ablation or laser cauterization is performed under general anesthesia by heating mucous membranes. Prizhzhennye pieces of endometrial otmiraya, leave the blood.
• Hysterectomy or complete recovery of the body - the most common way to treat women in menopause. The method has two options: the removal of one only of the uterus or body appendages (ovaries, pipes).
• hysteroscopy surgery can remove endometrial polyps and fibroids.
• Laparoscopy It allows access to the organs of the reproductive system without open surgery. The procedure is performed under local anesthesia. After 2-3 hours, can be discharged from the clinic. The operation allows you to remove fibroids and polyps.

Treatment of endometrial hyperplasia in Menopause can be a lengthy procedure. Due to the presence of new effective drugs and technologies, you can choose the best way of treatment. Timely diagnosis makes it possible to avoid complications in the form of pathology of cancer.

Registration of the article: Lozinski Oleg

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