Topical questions about endometrial hyperplasia:symptoms, treatment, prognosis, possibility of pregnancy

Update: October 2018

Content:

  • How often does endometrial hyperplasia occur?
  • How is hyperplasia related to the menstrual cycle?
  • Why does it occur?
  • What types of hyperplasia exist?
  • Can hyperplasia turn into cancer?
  • What are the symptoms of endometrial hyperplasia?
  • What research is needed to determine it?
  • Treatment and prevention of uterine hyperplasia
  • Frequently asked questions to the gynecologist

Endometrial hyperplasia – excessive growth of the lining layer
uterus from the inside.  This layer undergoes permanent cyclic
changes associated with the woman’s menstrual cycle.

Эндометрий  состоит из сосудов, соединительной ткани и 2
layers of epithelium (lower basal and upper functional).
It is the functional layer that is actively involved in menstruation.

How often does endometrial hyperplasia occur?

Гиперплазия эндометрия  – довольно распространенная
pathology occurring in 5 percent of gynecological patients.
This diagnosis in recent years sounds more and more often for various reasons.
The life expectancy of women has increased, the number of patients
metabolic syndrome and other pathologies increased,
ecological situation has worsened.  All this affects
reproductive health of the population. Most often, hyperplasia occurs
in adolescent girls or in premenopausal women, that is,
when hormonal changes occur in the body.

How is hyperplasia related to the menstrual cycle?

The normal menstrual cycle consists of 3 phases:

  • the increase in the thickness of the functional layer of the endometrium –
    proliferation
  • endometrial maturation – secretion
  • rejection of the functional layer leading to bleeding –
    desquamation

The first phase begins on the first day of menstruation. About
посередине цикла наступает  овуляция  — процесс выхода
eggs from the ovary during this period a woman can draw
внимание на появление тянущихся слизистых прозрачных secretions.
If fertilization does not occur at that moment, then under the influence of
hormones functional layer, together with the egg is rejected –
наступает менструация, возникают кровянистые highlight. Everything
processes during the menstrual cycle are controlled by sexual
hormones:

  • estrogens cause proliferation
  • прогестерон  — секрецию

Besides того, во время пролиферации происходит запланированная
гибель клеток  — апоптоз, который не дает эндометрию вырасти
больше, чем need to. This happens only if
women ovulation occurred, that is when the ratio of hormones
allows her to step on. If there was no ovulation (anovulatory
cycle), there is a prolonged effect of estrogen on the endometrium and
it thickens – resulting in hyperplasia
endometrium.

Why does it occur?

The trigger factor for the development of endometrial hyperplasia is
absolute or relative increase in estrogen content
Blood – hyperestrogenia, which occurs for various reasons:

  • age-related changes in the central regulation of sex hormones –
    change in the amount of estrogen before menopause
  • hormonal disorders – an excess of estrogen in deficiency
    progesterone
  • hormone-producing ovarian tumors, polycystic syndrome
    ovary
  • adrenal gland dysfunction
  • misuse of hormonal drugs
  • frequent abortions (complications), diagnostic curettage
  • genetic predisposition
  • воспалительные процессы женских половых bodies
  • associated diseases – hypertension, diseases of the dairy
    glands, obesity, diabetes, thyroid disease
    glands.

What types of hyperplasia exist?

According to the type of structure, the scale of distribution and the presence of anomalous
cells all endometrial hyperplastic processes are divided into groups:

  • Glandular cystic hyperplasia of the endometrium
  • Endometrial polyps (focal form of hyperplasia)
    • Ferrous
    • Glandular cystic
    • Glandular fibrous
    • Adenomatous
  • Atypical hyperplasia of the endometrium (adenomatosis)

Ferrous формы hyperplasia характеризуются большим количеством
glands, sometimes forming cysts. Cell structure in such 
the outbreak is not broken. Symptoms of glandular endometrial hyperplasia and
cystic forms are exactly the same. When atypical form
changes in hyperplasia (adenomatosis and adenomatous polyp)
in the structure of cells that are beginning to divide with great speed, in
therefore the amount of glands grows very quickly.

Can hyperplasia turn into cancer?

Hyperplastic processes should always cause oncological
wariness but only in a few cases they are
malignant. There are certain conditions under which
hyperplasia is considered a precancerous condition:

  • atypical hyperplasia at any age. According to statistics in 40
    the percentage of cases without treatment such hyperplasia is malignant,
    возникает рак endometrium.
  • frequent postmenopausal glandular hyperplasia
  • glandular hyperplasia in hypothalamic dysfunction
    any age, as well as metabolic syndrome.

Metabolic syndrome —  особое состояние организма, при
which the ability of immunity to attack cancer cells dramatically
reduced, and the tendency to hyperplasia is great. It is typical for him
ановуляторное infertility, диабет, obesity.

What are the symptoms of endometrial hyperplasia?

Uterine bleeding

The most noticeable and frequent symptom of endometrial hyperplasia
is uterine bleeding.

  • More than half of patients report delayed menstruation at 1-3.
    of the month, которые сменяются на длительные кровянистые выделения
    different intensity.
  • In rare cases, bleeding can be cyclical, i.e.
    manifest in the form of heavy and prolonged menstruation, painful
    monthly (reasons)
  • Most often, patients report an unstable menstrual cycle in
    over time, against which arise
    bleeding.
  • In 5 percent of cases, bleeding occurs on the background
    absolute absence of menstruation.
Metabolic syndrome

An important companion of endometrial hyperplasia is metabolic
syndrome. In such cases, the symptoms of bleeding
join:

  • obesity
  • hyperinsulinemia
  • symptom complex of male traits – the appearance of increased
    hair growth, change in voice and other signs of action
    male hormones
Other common symptoms

Often women with hyperplasia are called and other satellites
diseases:

  • вторичное infertility — отсутствие беременности после года
    regular sex life without protection
  • miscarriage – early miscarriages
  • хронические воспалительные заболевания половых bodies
  • mastopathy and fibroids
Other, more rare symptoms
  • contact bleeding during intercourse or
    hygiene procedures
  • cramping pain in the lower abdomen (more often – with polyps)

What research is needed to determine it?

  • Anamnesis. It is necessary to tell the doctor in detail about the features.
    menstrual cycle: at what age did menstruation begin, as
    How long and how much are going on, whether there were violations and delays.
    Анамнез  позволит специалисту определить все симптомы
    endometrial hyperplasia of the uterus.
  • Transvaginal ultrasound in the first phase of the cycle (for 5-7 days). With
    examination determines the thickness of the endometrium, its uniformity and
    structure. Hyperplasia can be suspected at a thickness of more than 7 mm.
    If the endometrium is thicker than 20 mm, the doctor may suggest
    malignant process. If the bleeding is prolonged, then ultrasound
    held independently of the day of the menstrual cycle.
  • Hysteroscopy and separate diagnostic curettage
    (cleaning) – at the same time play the role of research and treatment. To read
    about the state after hysteroscopy.
  • Investigation of the level of hormones in the blood in cases of suspected
    метаболический синдром и синдром поликистозных ovary. Usually
    определяют уровень ФСГ, ЛГ, эстрадиола, тестостерона, progesterone.
    It is also possible the level of adrenal hormones and thyroid
    glands.
  • Mammography – often the doctor prescribes an x-ray
    mammary glands to exclude proliferative processes.

Hyperplasia эндометрия информативность УЗИ с влагалищным
sensor is estimated at 68%, and hysteroscopy at 94%.

Treatment of endometrial hyperplasia

Therapy of hyperplastic processes depends on the age of the woman,
endometrial characteristics, comorbidities. With
endometrial hyperplasia treatment can be carried out by several
in ways.

  • Hormonal drugs

These include estrogen-progestin preparations, pure
progestins, agonists and antagonists of gonadotropin releasing hormone,
androgen derivatives. These drugs are prescribed only by a doctor.
individually and strictly according to indications. Doctor учитывает все возможные
contraindications for hormonal drugs: rheumatism,
thrombophlebitis, hypertension, diabetes, diseases
biliary tract and liver, smoking and alcohol increase the risk
development of side effects. Before and during treatment
should be carried out research and control of the immune
systems, vascular, endocrine glands, liver, are analyzed
blood.

  • �”Small” or conservative surgery

Removal of the endometrium (functional and basal layers) using
resectoscope. The controversial method, as it gives frequent recurrences of the disease and
contraindicated in suspected atypia.

  • Surgery

This is the removal of the uterus with or without the ovaries. Indications for
surgery:

  • ineffectiveness of conservative treatment for precancerous forms
    hyperplasia
  • повторные случаи предраковой hyperplasia
  • contraindications for hormone therapy
  • atypical hyperplasia in peri and postmenopausal
I stage of treatment – curettage

The first stage is therapeutic and diagnostic curettage.
uterine lining under the control of a hysteroscope (cleaning) and research
obtained material in cytological laboratories.

Scraping – removing the functional layer of the endometrium together
with its pathological formations. Study
performed under general anesthesia, visualization of the contents of the uterine cavity
by using a special apparatus – a hysteroscope. it
optical system equipped with a light source having a channel for
introduction to the uterus of surgical instruments. Thanks to the hysteroscope
the curettage procedure is safe and effective.

The cleaning itself is carried out using a curette, sometimes used
mechanism to stop bleeding.  Functional layer
эндометрия удаляют полностью,  содержимое полости матки
sent for histological examination, it will determine
nature of the process and tactics for further treatment of hyperplasia
эндометрия  после выскабливания.

II stage of treatment

Depending on the results of histological examination
Drug therapy is prescribed to prevent recurrence.
С  этой целью используют гормональные лекарственные средства,
taken in a specific dosage and on the appropriate schemes.

Treatment of glandular cystic hyperplasia

  • At girls in puberty and women under 35 years
    drugs containing estrogens and gestagens, for example,
    combined oral contraceptives (for and against their use).
    Preference is given to single-phase drugs with progesterone,
    which have a continuous effect on the endometrium,
    obstructing its growth. Treatment lasts from three months to six months.
    Endometrial glandular hyperplasia usually does not recur
    with proper therapy.
  • In women from 35 years old to perimenopause (the process of termination
    menstruation). In therapy, gestagens are used, without
    estrogen-containing components. Assign hormones in the second phase
    menstrual cycle, from 14 to 26 days after scraping or from
    beginning of menstruation. Endometrial hyperplasia is usually treated
    dufastone and urozhestan. Therapy also lasts 3-6 months.
  • У женщин в постменопаузе (после прекращения menstruation).
    Hyperplasia at this age is a rare occurrence, usually associated with
    hormone-producing formations of the ovaries. Hyperplasia
    endometrial menopause treatment should be prescribed only after
    careful examination of the ovaries (ultrasound and, if necessary,
    laparoscopic examination). If there are no tumors, then they prescribe
    17-hydroxyprogesterone caproate in a dosage of 125 mg 2 times a week, on
    for six months – eight months. After the end of therapy
    endometrial biopsy must be performed and the resulting
    sample in the laboratory.

Treatment of atypical hyperplasia

Women of reproductive age and perimenopause.
Therapies of choice are gonadotropin releasing hormone agonists in
for half a year. Some drugs must be taken every day.
(buserelin acetate), some have a prolonged effect and
require reception 1 time in 28 days.

After 6 months from the start of treatment is usually required to repeat
endometrial curettage with histological examination. Besides
In addition, each month of treatment ends with an ultrasound
a study that controls the thickness of the endometrium (less than
5 mm).

When combined with atypical hyperplasia with myoma or
metabolic syndrome requires surgical treatment with
careful inspection of the ovaries. Continuous monitoring requires
condition of mammary glands.

Plan of follow-up atypical hyperplasia:

  • УЗИ эндометрия 1 раз в  месяц
  • выскабливание с гистологическим исследованием раз  в 3
    of the month
  • УЗИ ovary раз в 3 of the month (с допплерометрией)
  • Breast ultrasound and mammography every 6 months
  • control signs of metabolic syndrome (cholesterol and
    blood glucose)

Postmenopausal women are indicated for surgical treatment with
a thorough revision of the ovaries.

Complications and Prevention
Prevention of hyperplasia Complications
  • avoid abortions
  • 2 times a year examined by a gynecologist
  • timely diagnosis and treatment of diseases of the female genital
    bodies
  • reducing risk factors – blood pressure control with
    hypertension, blood glucose levels in diabetes, reducing
    obesity weights
  • to lead a healthy lifestyle – yoga, fitness,
    Bodyflex, good nutrition and relaxation
  • chronic anemia on the background of bleeding
  • infertility
  • transition to cancer atypical forms of hyperplasia
  • most often – recurrence of the disease

Frequently asked questions to the gynecologist

Is it possible to cure endometrial hyperplasia with folk
in ways?

Treatment of folk remedies endometrial hyperplasia does not have
no scientific justification. Usually the use of such
The methods are simply useless, and sometimes it can be harmful.
For example, if a patient has an allergy to some
herbs used in the folk treatment of endometrial hyperplasia.
Besides того, некоторые растения содержат так называемые
phytoestrogens, which can aggravate the growth process of the internal
layer of the uterus.

Can I get pregnant with the diagnosis of “hyperplasia”?

Pregnancy with severe diffuse endometrial hyperplasia
usually does not occur or end in early miscarriage. It’s all about
that the fertilized egg for the development of the embryo must
firmly adhere to the inner wall of the uterus, forming in the future
placenta. Hyperplastic endometrium does not create
necessary conditions for such an implementation. Hormonal treatment and
scraping allow you to “refresh” the inner layer of the uterus by making
pregnancy is possible.  In some cases
(polycystic ovary syndrome) for pregnancy need to
undergo additional treatment.

Is it possible to postpone the treatment of endometrial hyperplasia?

Hyperplastic process is not always accompanied by
dangerous bleeding, but often carries a hidden threat. Risk
malignancy, infertility, chronic anemia requires
immediate visit to the doctor at the first symptoms. Is unacceptable
with endometrial hyperplasia, herbal therapy, many physiotherapy and
self-medication without the appointment of a specialist.
Competent and timely treatment will allow to restore
reproductive health and wellness.

Is it possible with hyperplasia to do scraping
woman, will there be problems with pregnancy?

When hyperplasia is found, scraping should be done,
chances of getting pregnant after such treatment will be much more.

Does polyp always clean?

If the polyp is single, it is often limited to removing it.
education, without scraping.

I was prescribed buserelin to treat endometrial hyperplasia,
introduced into “artificial menopause.” Is there a risk not to get out of this
menopause in the future?

No, the effect of buserelin is reversible. Increase menopause can
only ovarian removal and chemotherapy.

I am 35 years old, I planned to conduct IVF, but during the examination
found a polyp of the endometrium, is assigned to remove the formation. When
Can I join an IVF program?

After removing a polyp, you can immediately enter into the stimulation protocol.
ovulation.

Has been treated endometrial polyp on the background of hyperplasia. Doctor
said that it is necessary to pass tests for infections transmitted by
sexually. Is it necessary?

There is evidence that mycoplasma and chlamydial infections
contribute to the recurrence of endometrial polyps. Инфекции need to
to treat

I am 50 years old. Scraping revealed atypical hyperplasia
endometrium. Be sure to remove the uterus or you can hold
ablation?

Endometrial ablation – removal of the entire inner layer from
preservation of the uterus. The method is non-traumatic, but after it is very difficult
to assess the condition of the uterus, you can skip the tumor. In such
age and with such a diagnosis is recommended removal of the uterus.

On day 2 after the “cleansing” scant bloody
highlight. Is this normal?

This is absolutely normal, you are recommended physical and sexual.
peace

My diagnosis is endometrial hyperplasia, after 2 weeks
Scraping is planned. Is it possible to conduct sexual
a life?

Yes, you can, if there is no pain and contact bloody
secretions.

According to the ultrasound results, the doctor suspected endometrial hyperplasia and
proposed to hold a pipe biopsy. What is this procedure?

Paypel test is performed on an outpatient basis for research
структуры endometrium. With the help of a special tool taken
a column of tissue that is examined for hyperplasia. If the test
revealed changes, then you will be recommended hysteroscopy with
scraping. Если результаты биопсии отрицательные, то need to
repeat ultrasound on day 5-7 of the next cycle.

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