Hyperplasia (abnormal growth) endometrium - a benign process and an excessive increase in the thickness of the uterine lining.
Endometrial hyperplasia arises as a result of proliferation of glandular cells and other tissues. It leads to disruption of the functional activity of the endometrium (the violation of menstruation, problems with conception).
Under normal conditions, the endometrium grows in the first phase of the cycle under the influence of estrogens, and is constrained to the second phase of the cycle under the influence of progesterone. The pathology of the endometrium grows uncontrollably, can capture individual sections (lobular hyperplasia) or the entire inner shell.
Causes
The main cause of endometrial hyperplasia today considered to exceed the physiological level estrogen with a relative deficiency progesterone. Such a condition may result in:
- receiving estrogen-containing preparations without receiving progesterone
- period menopause,
- syndrome polycystic ovary,
- female obesity,
- awkward age to hormonal surges and impaired hormonal metabolism.
Most often, endometrial hyperplasia occurs in young nulliparous women or in women during premenopause.
Concomitant diseases that can amplify manifestation hyperplasia, are hypertension, diabetes diabetes Both types of thyroid disease, problems with chest and adrenal glands. Predispose to the development of hyperplasia:
- inflammation of the genitals,
- production abortions and curettage,
- uterine fibroids,
- adenomyosis,
- unfavorable heredity of genital diseases.
Kinds
According to the predominance of certain elements in the growing endometrium released:
- glandular hyperplasia type (excessively proliferating endometrial glands)
- cystic glandular hyperplasia type (breast cysts and grow about the same)
- adenomatous hyperplasia with presence of atypical cells, premalignant. Degeneration such hyperplasia reaches 10%.
- polypous form hyperplasia. It is a focal proliferation of the endometrium, which has the character of the fibrous, fibro-glandular and glandular. May be on the leg, they are rarely malignant, but may be disadvantageous for any background gynecological diseases.
Manifestations of endometrial hyperplasia
Endometrial hyperplasia is mainly manifested recurrent bleeding non-cyclic nature.
Spin blood may be between periods or after menstrual periods, long spotting. They are modest, smearing the blood clotted.
In adolescence, can be heavy bleeding with clots, leading to anemizatsii. Anovulatory menstrual cycle, due to the suppression of oocyte maturation excess estrogen. In rare cases, hyperplasia asymptomatic, giving itself felt infertility.
Endometrial hyperplasia menopause appears reappears after a period of absence of menstruation bloody discharge acyclic nature.
Hyperplasia is considered as a precancerous condition, and therefore it requires special supervision, according to the doctors up to 1% of cases of hyperplasia goes into cervical cancer.
Diagnostics
The basis of diagnosis of endometrial hyperplasia of examination female gynecologist, laboratory and instrumental investigations.
The main ones include:
- Ultrasound examination of the uterus and appendages vaginal probe
- hysteroscopy with a fence material gistoloicheskoe research and possible diagnostic curettage of the uterus,
- if necessary to clarify the type of hyperplasia spend aspiration biopsy.
One of the most important laboratory research is to determine the level of sex hormones in the blood serum, as well as the level of adrenal hormones, thyroid gland.
Treatment of endometrial hyperplasia
Treatment is carried out immediately after diagnosis method is selected based on the age and symptoms of the disease.
The most effective method - hysteroscopic removal of polyps or separate diagnostic curettage endometrial diffuse process.
However, the treatment process is a multi-stage endometrial hyperplasia.
First of all, it carries out scheduled or emergency curettage. Resorted to emergency for bleeding and anemizatsii patients.
After receiving the results of histology appoint:
- combined oral contraception - Janine, Yasmin, regulon, for half the traditional scheme of reception,
- bleeding in girls at a young age, oral contraceptives can be used in several large doses to non-operating stop bleeding,
- progestin drugs (utrozhestan, djufaston) a second phase of the cycle,
- vnutrimtochnuyu spiral Mirena with progestins,
- drugs antagonists of gonadotropin (buserelin) after the age of 35 years.
These drugs create an effect similar to a climax, but it is reversible.
After the scraping operation control is performed for six months, if recurs form adenomatous hyperplasia of the endometrium - hysterectomy shown. When other forms of recurrent process and ineffectiveness of other treatments for endometrial ablation is performed, its man-made destruction.
Complications and prognosis
The most dangerous complication of endometrial hyperplasia is the transformation of the uterine cancer.
Not less dangerous relapses and persistent bleeding with the development of anemia, infertility.
Forecast favorable in most cases, the disease fails to heal within 6-12 months of taking the drugs and surgery.
