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Endometrial hyperplasia: types, symptoms and treatment, prevention

One of the main forms of proliferative diseases caused by abnormal cell proliferation is endometrial hyperplasia (ET), the most common pathology of the inner lining of the uterus. In the system of the international classification of diseases - ICD 10, endometrial hyperplasia has the code No. 84.0, 85.0, 85.1, depending on the form of manifestation.

What it is? Endometrial hyperplasia of the uterus is a pathology characterized by excessive growth and change in the structure of the endometrial tissue. The basis of the disease are hormonal disorders that stimulate the proliferative cell activity of the endometrium, which increases its size and uterine growth.

The development of the disease is promoted by changes in the structure of the endometrium during the menstrual cycle. In the middle of the cycle, under the action of estrogen, its layer increases and is more supplied with blood, creating conditions for the adoption of a zygote (fertilized cell). If this does not happen, a part of the tissue cellular elements is destroyed and leaves the body with menstrual secretions.

Disruption of hormonal regulation, with a quantitative preponderance of estrogens over progestins, leads to the growth of the endometrium, but its full destruction does not occur. The inner uterine membrane increases from 1 mm. up to 8 mm. and continues to grow, giving "food" for the development of hyperplastic processes.

Endometrial hyperplasia Changes in the inner mucous layer of the uterus can manifest themselves in various pathological forms.

Content

Varieties of the disease

Depending on the developmental process and the clinical course of the hyperplastic process, the pathology manifests itself in various forms of endometrial hyperplasia, and in various degrees of severity - mild, moderate, and severe. It cannot be argued that endometrial hyperplasia is cancer, but it can safely be said that many of its forms are capable of malignancy.

1) Glandular hyperplasia of the endometrium - a benign neoplasm, characterized by ease of clinical course. Malignancy in malignancy does not exceed 4% of cases.

It is characterized by a thickening of the inner uterine sheath with a winding and expanded structure of tubular glands, with a group or irregular arrangement. The output of mucus from the glands is free.

2) The development of the glandular-cystic form is due to the strong proliferation of cells in the mouth of the glands, which, by blocking the mucous outflow, contribute to the formation of vesicular cystic benign lesions filled with mucus.

They are sensitive to estrogens, as they develop during the period of hormonal changes - during puberty, the beginning of menstrual cycles and during menopause .

3) In the cystic form, the development process is similar to the previous type of pathology, with the only difference that the cysts are not filled with mucus, but with healthy epithelium cells, which eliminates the process of malignancy.

4) Characteristics of focal pathology (adenomatous polyp) notes focal accumulation of rapidly expanding cells, under the influence of hormonal disorders. On the mucous membrane appear education with altered cystic glands inside.

Perhaps the development of malignant tumors on the site of focal elevations.

5) Atopic HE (adenomatosis) is the most dangerous pathology. It is characterized by rapid cell division and maximum proliferation of tissues with a constantly changing structure. High risk of cancer.

Almost a third of women have a process of malignant fibroids, with atypical endometrial hyperplasia. Treated pathology solely by the method of complete removal of the uterus.

6) Endometrial polyps containing rejected functional or regenerating basal layer of endometrial tissues

Danger of endometrial hyperplasia

Danger of endometrial hyperplasia

The greatest risk of hyperplastic changes in the inner layer of the uterus is a high risk of cancer and the deprivation of reproductive functions of women (infertility). In addition, various gynecological diseases can develop on the background of EH:

  • polypous formations in the uterus and cervical canal;
  • development of myomatous nodes;
  • genital adenomyosis;
  • cysts of the genital glands;
  • long menstrual cycles.

The main reason for the development of hyperplastic changes in the mucous layer of the uterine membrane is due to many factors and special predisposing conditions conducive to the development of pathology. These include:

  1. Changes in hormonal background, disrupting the imbalance of sex hormones. It is provoked by mastopathy and myomatous nodes, disorders of the endocrine and reproductive functions of the sex glands, improper use of oral contraceptives.
  2. Malfunctions in metabolic processes caused by impaired carbohydrate and fat metabolism due to obesity, chronic liver disease, diabetes mellitus or hypertension.
  3. Diseases of the adrenal glands, thyroid and pancreas, contributing to enhanced cell growth.
  4. The age factor affecting the hormonal imbalance - the period of menopause and puberty.
  5. Inflammatory and infectious gynecological diseases and intrauterine contraceptives.
  6. Diagnostic cleansing and abortions that violate the receptor sensitivity of the mucous layer to progestins, contributing to prolonged cell division.
  7. Failure of the protective functions of the immune system due to the erroneous attack of phagocytes on endometrial cells, taking them for foreign agents.
  8. Genetic factor.

Symptoms of endometrial hyperplasia

Symptoms of endometrial hyperplasia

The main signs of endometrial hyperplasia are associated with changes in the nature and duration of menstrual flow. Symptoms that accompany hyperplasia are:

  • Disturbances in the menstrual cycle, associated mainly with polyposis formations on the normal mucous membrane of the uterus. Against the background of a regular cycle, there may be discharge in the form of blood before the monthly cycle and after it, manifest abundant menstrual flow.
  • Bloody "daubs" between cycles.
  • Delayed discharge and sudden heavy and prolonged bleeding.
  • The duration of menstrual discharge (menorrhagia) with polyps of fibrous and glandular-fibrous genesis.
  • Dysfunctional uterine bleeding (metrorrhagia) in the intermenstrual period, manifested as a result of polypous formations on the mucous membrane of the uterus. Such symptoms of endometrial hyperplasia are characteristic of women in the premenopause phase.
  • The endocrine factor of infertility due to impaired follicle formation or the impossibility of implanting zygotes.

Treatment of endometrial hyperplasia

The therapeutic process of hyperplastic changes in the uterine endometrial endometrial tissue is not easy and long, requires a comprehensive approach, consisting of four stages.

Остановки кровотечения при помощи: 1. Stopping bleeding with:

  • Estogen-progestin drugs (hormonal hemostasis);
  • Scraping;
  • The use of uretonic drugs (prevention of bleeding);
  • Antianemic treatment - blood transfusion (plasma transfusion, filtered or gamma-irradiated red blood cell mass), iron supplementation;
  • Parenteral fluid therapy;
  • Vitamin therapy and coagulant intake.

Супрессивной гормонотерапии (коррекция уровня гормонов): 2. Suppressive hormone therapy (correction of hormone levels):

  • Prescription of progestin drugs (from three months to six months in a continuous mode);
  • Normalization of the central nervous system and autonomic disorders - gestagens + GnRH agonists, in the same mode;
  • Progestin monotherapy, with the detection of endometriotic atrophy (after abortion, or age).

Восстановления гормонального статуса (восстановление менструального цикла): 3. Restoration of the hormonal status (restoration of the menstrual cycle):

  • Women of reproductive age are prescribed medications for the hyperstimulation of ovulation processes and the gonads, for older women, exclusively applied to drugs containing male hormones;
  • The drug "duphaston" with endometrial hyperplasia is used as hormone replacement therapy, eliminating the deficiency of endogenous progesterone.

Clinical examination

After effective treatment of endometrial hyperplasia with hormone therapy drugs, women should be in the dispensary for five years, after surgery - up to six months.

With the ineffectiveness of conservative therapies, methods of surgical intervention are used:

  • freezing lesions by the method of cryodestruction;
  • laser cautery (ablation);
  • resection of the uterus (hysterectomy) - complete removal of the body with a high risk of malignancy.

The effect of endometrial hyperplasia on pregnancy

In pathological processes of endometriotic tissues pregnancy is impossible, ovulation does not occur. But, if this fact has already happened - the egg can not develop in the damaged areas of the mucous membrane.

The only form of hyperplasia in which pregnancy can occur is focal. Such cases are very rare and need careful and gentle treatment, with special supervision by a physician.

Typically, pregnancy is recommended to interrupt and conduct a comprehensive treatment - with this disease, there is a high risk of developing various pathologies in the fetus, a spontaneous miscarriage or development of oncology is not excluded.

Timely diagnosis and treatment fully restore reproductive function.

Preventive measures

It should be realized that endometrial hyperplasia is a background pathology for the development of oncological processes. And the main measure of prevention is compliance with the rules of routine examinations, which will help to identify the disease in time and start treatment.

Independently prevent the development of the disease by observing completely uncomplicated rules:

  • use contraceptive methods to rule out medical abortions;
  • give preference to hormonal contraception and refuse intrauterine;
  • normalize body weight.
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