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Endometrial adenomatosis treatment. What is adenomatous endometrial polyp and how to treat it?

It is very important for women faced with this diagnosis to understand the essence and sequence of this procedure, as well as to be aware of the possible consequences. For endometrial hyperplasia, curettage, according to reviews, is used very often.

What kind of pathology is this?

Endometrial hyperplasia is a benign neoplasm in the endometrium (inner layer of the uterus), leading to its thickening and increase in size. The reason for this process is an increase in the number of stromal and glandular elements located in the endometrium.

There are different types of endometrium:

Glandular (increase in glandular tissue).
Glandular-cystic.
Adenomatosis. This is a precancerous pathology. In about 10 percent of cases it develops into a malignant tumor.
Fibrous and glandular-fibrous endometrial polyps. This is the most common type of hyperplasia. They rarely become malignant, but can cause endometrial cancer.

Below we will look at what reviews are written about the scraping procedure.

Endometrial hyperplasia is a pathology common in all age groups in women. Most often, however, this pathology occurs during puberty or menopause, when dramatic hormonal changes occur in the body.

Prerequisites

The prerequisites for endometrial hyperplasia are:

Failure in hormonal balance (progesterone deficiency against the background of an excess of estrogen).
Diabetes mellitus, hypertension, obesity, diseases of the thyroid gland, adrenal glands, etc.
Uterine fibroids and adenomyosis.
Genetic predisposition.
Abortion.

For endometrial hyperplasia in menopause, curettage, according to reviews, is the only method of therapy.

Signs

The main symptom of all types of this pathology is irregular and non-cyclic bloody discharge. They usually appear between menstruation or after a delay. The discharge is not abundant, spotting. An excess of estrogen in a woman’s body can lead to infertility, while endometrial hyperplasia will not manifest itself in any way. Therefore, the absence of pregnancy with regular sexual activity for a year is a serious reason to consult a specialist. Hyperplasia is often confused with fibroids (if this diagnosis is present) or with early miscarriage.

Endometrial hyperplasia is diagnosed (curettage and reviews will be discussed below) after a gynecological examination, ultrasound of the pelvic organs and hysteroscopy (examination of the uterus using a special device). The scraping obtained during hysteroscopy is examined to determine the type of hyperplasia. An aspiration biopsy can also be performed, when a histological examination is performed on a piece of the endometrium. Checking estrogen and progesterone levels is also one of the ways to diagnose endometrial hyperplasia.

Therapy for endometrial hyperplasia is necessary for everyone, regardless of age and degree of damage. Hysteroscopy and curettage are the most effective methods of treatment and diagnosis. Below we will talk in detail specifically about curettage. According to reviews, endometrial hyperplasia may occur in postmenopausal women.

Indications and contraindications

Curettage (endometrial scraping) is a common procedure in gynecology. It is an invasive intervention into the structure of a woman’s genital organs. During this manipulation, the doctor removes the functional layer of the mucous membrane with a special instrument without affecting other tissues. By the next menstruation, the endometrium recovers on its own.

But in rare cases, it happens that endometrial hyperplasia is cured without curettage (there are reviews on this matter).

Cleaning the uterine cavity is performed for the purpose of diagnosing or treating various gynecological diseases. Therefore, procedures are divided into therapeutic and diagnostic. The last option is used if the following symptoms are present:

Irregular monthly cycle.
Heavy and prolonged menstrual bleeding.
Menorrhagia (bleeding between periods).
Algomenorrhea (painful sensations during menstruation).
Infertility.
Suspicion of the presence of a malignant formation.

Quite often there are benign growths of the mucous membrane (focal or diffuse). Therefore, curettage for endometrial hyperplasia, according to reviews, is very common. It is important for women who are waiting for confirmation of their diagnosis.

For medicinal purposes, curettage is used not only for hyperplasia, but also for other pathologies, namely:

Submucosal (submucosal) fibroids.

Polyps of the body and cervix.

Frozen or ectopic pregnancy.

Childbirth with pathology.

The conditions listed above can be cured with curettage. Among other things, this procedure is performed as one of the methods of terminating an unwanted pregnancy. And although other methods are now more used, such as vacuum aspiration or medical abortion, this procedure is still relevant.

It is important to remember that the endometrial curettage procedure for hyperplasia in menopause, according to reviews, also has contraindications. For example, in case of acute infectious and inflammatory diseases of the vagina and cervix, the procedure should be abandoned, as it can cause damage to the uterus. The exception is the case of retained placenta during childbirth.

Preparation and carrying out the procedure

As with any invasive intervention, endometrial hyperplasia requires careful preparation. The first thing to remember is that the procedure is performed on certain days of the menstrual cycle, which reduces bleeding. The second is that a multifaceted examination of the woman is necessary, including:

General blood and urine analysis.
Microscopy of the vagina (smear).
Bacterial culture of secretions.
Blood test for biochemistry and hormones.

Such an examination is necessary to identify pathologies accompanying hyperplasia, as they can interfere with curettage or lead to postoperative complications. Before the procedure, a woman must comply with the following conditions:

Stop taking any medications.
Refrain from sexual activity.
Stop using intimate hygiene products, including vaginal suppositories and tablets. The consequences of curettage of endometrial hyperplasia and reviews are of interest to many.

You should stop taking medications two weeks before the procedure, other conditions are met a few days before the procedure. 12 hours before surgery you should stop eating and drinking, that is, you should come to the procedure on an empty stomach.

The most important thing that worries the patient before the procedure is, in fact, how it is carried out. Curettage is performed under stationary conditions in a gynecological operating room. Since this manipulation is very painful, the patient must be put under anesthesia using intravenous anesthesia. If the procedure is performed after childbirth or miscarriage, then anesthesia will not be required, since the cervix will be sufficiently dilated.

At the initial stage, the cervical canal is opened with the help of a special metal dilator. Next, the mucous membrane is directly scraped with a curette (surgical spoon). Sometimes a vacuum aspirator is used for this purpose. But before inserting it, it is necessary to check the location and length of the uterine cavity, as bending is possible.

Ideally, the operation is performed under the control of a hysteroscope, however, a “blind” option is also possible. The hysteroscope displays an image on the monitor that clearly shows which areas require curettage. A biopsy may also be taken at the same time for further examination. Endometrial hyperplasia may require a two-stage procedure - first the uterine cavity is scraped, and then the cervical canal. Curettage for endometrial hyperplasia in postmenopause and reviews will be discussed below.

Consequences of scraping

When curettage, the surface layer of the endometrium is removed, and that is why its regeneration requires a certain amount of time. As a rule, this is a quick process, comparable in duration to regular menstruation. However, this procedure still damages the mucous membrane, so paroxysmal pain in the lower abdomen and spotting are possible. Initially, the discharge is clot-like, then bloody, bloody, and after a week and a half it stops, and everything returns to normal. If the pain is intense and bothers the woman during the postoperative period, it is possible to take anti-inflammatory drugs such as Ibuprofen. Other treatment options after curettage for endometrial hyperplasia during menopause, according to reviews, are not required.

Possible complications

After surgery, there may be a delay of up to 4 weeks or more. If there is a delay of more than three months, it makes sense to contact a gynecologist. This should also be done if the discharge does not stop and the pain intensifies, or if the temperature rises. Such symptoms indicate the presence of complications, for example:

Endometritis (inflammatory process).
Uterine bleeding.
Hematometra (collection of blood in the uterus).

Endometrial hyperplasia, curettage: reviews from doctors

During the operation, damage to the uterus, rupture by a cuvette, dilator or probe, is possible. This can happen due to incompetent manipulation or due to the lack of a hysteroscope. Over time, these lesions will heal, and adhesions may appear in their place, which may well cause the embryo to fail to attach to the wall of the uterus and, accordingly, infertility.

Treatment of endometrial hyperplasia after curettage, according to reviews, should be comprehensive.

After a successful procedure, a woman is advised to be attentive to her health and allow her body to recover fully.

Rules after surgery

Gynecologists advise adhering to the following rules during the next two weeks after surgery:

Sexual abstinence.
Do not take a bath or go to the sauna, eliminate any thermal stress on the body.
Do not use syringes or tampons.
Avoid active physical activity.
Do not take blood thinning medications such as Heparin or Aspirin.
Control three months after the procedure with blood donation for hormones.

Important question

No less exciting for a woman who has undergone curettage is the question of the future possibility of conceiving a child. Unfortunately, no one can give a specific answer to this. No specialist can guarantee a future pregnancy. This depends on the individual characteristics of the body, on the success of the procedure, and on the reason for which the manipulation was carried out. If endometrial hyperplasia does not affect the ovaries, then there should be no obstacles to childbearing after the procedure; pregnancy can occur during ovulation following the operation.

Is curettage necessary for endometrial hyperplasia? Reviews confirm that there is an alternative. More on this later.

With numerous relapses of hyperplasia, drastic measures can be taken. If the patient does not intend to give birth again, we may talk about complete removal of the endometrial mucosa. In particularly difficult cases, the uterus, ovaries and appendages can be completely removed. Therapy in this case will be long and complex, because such measures greatly affect the hormonal balance in a woman’s body.

To avoid future health problems, only experienced doctors should be trusted to perform curettage; in this case, the woman is required to strictly follow all recommendations in the pre- and postoperative period.

Curettage for endometrial hyperplasia during menopause

Reviews confirm that when the hormone estrogen accumulates excessively in a woman’s body while progesterone decreases, this can lead to such a dangerous disease as endometrial hyperplasia during menopause. The risk group includes representatives of the fair sex who had long, heavy periods before menopause, with fibroids, inflammation of the endometrium or formations in the breast. Treatment consists of the following stages:

diagnostic curettage;
analysis of material from the uterus;
then the gynecologist selects the hormones necessary to stop hyperplasia;
curettage of found abnormalities in the uterus, using a laser in some places of cell proliferation;
hormonal and surgical forms of exposure are combined;
if there is a relapse of the disease, the organ is removed, after which a course of hormones is administered again.

Alternative

In addition to curettage of the uterine cavity, other types of therapy are used. The most important of them is conservative correction using medications. These are, first of all, hormonal drugs, the effect of which is aimed at restoring the estrogen-progesterone balance in the body. The main drugs used in this case are:

The listed drugs can be prescribed as an independent type of treatment or as maintenance and restorative therapy after curettage. In the latter option, it is possible to achieve the greatest effect from treatment. In addition to these drugs, immunomodulators, antioxidants and other drugs aimed at maintaining normal body health can be prescribed. But still, treatment of endometrial hyperplasia with curettage, according to reviews, is more effective.

It represents a necessary measure in the diagnosis and treatment of many gynecological diseases, including pathological conditions of the endometrium. The procedure is relatively simple, but requires high-quality execution, highly qualified specialists performing it, careful preparation and attentive attitude to your body during the rehabilitation period. All this will help to avoid problems in the future and will contribute to positive dynamics in treatment.

Reviews

The opinions of patients regarding this procedure are quite ambiguous. Many note that with endometrial hyperplasia, a relapse occurs some time after curettage. In such a situation, it is necessary to understand the importance of subsequent therapy after the operation, because in itself, curettage of the uterus for endometrial hyperplasia, according to reviews, does not cure, but only removes the symptoms.

What is endometrial adenomatosis

Adenomatosis is an atypical form of dyshormonal hyperplasia. Researchers consider this form of the disease to be a precancerous condition. Considering that precancerous hyperplasia degenerates into a cancerous tumor in approximately one percent of patients and undergoes reverse development in the same number of patients, it is necessary to very carefully and carefully monitor the patient’s condition and test results.

What is endometrial hyperplasia

Endometrial hyperplasia is an excessive and uncontrolled proliferation of cells and tissue structures of the outer mucous layer of the uterus. Divided:

simple (glandular and glandular-cystic);
focal/complex (endometrial adenomatosis).

Glandular hyperplasia is characterized by the formation of a large number of glands, cysts, and polyps that contain cells with an intact structure. This is a relatively harmless form of the disease that still requires treatment.

Complex hyperplasia consists in the formation of special structures in the endometrial tissue - “glands in the gland”, which are not characteristic of the normal structure of the uterus (polyps, glandular-cystic or glandular-fibrous formations with a special structure). This is focal adenomatosis.

Uterine adenomatosis and cancer

Any changes in the uterus (proliferation of cells and tissues, changes in cell structures, the appearance of neoplasms, etc.) should cause a certain concern, because there is a risk of developing cancer. However, they are not really malignant very often.

Focal adenomatosis is considered a precancerous condition, but the main evidence of its danger is a histological examination of scraping tissue from the uterine cavity. The term “without atypia” as a result of the study indicates the benign nature of the process and the minimal risk of developing uterine cancer in the near future. And the detection of atypical cells based on histology results indicates a precancerous condition.

Treatment methods

To prevent further spread of the disease and its degeneration into a cancerous tumor, it is necessary to carry out treatment.

At an early stage of the disease, treatment without surgery is possible. Long-term use of hormonal drugs (combined oral contraceptives, estrogen-progestin drugs, gestagens, gonadotropin-releasing hormone antagonists, androgens) allows you to avoid surgery.

In more advanced cases, adenomatosis is treated with surgical methods, the essence of which is the mechanical removal of diseased tissue areas. Types of surgery for adenomatosis.

Scraping. Surgical cleaning of the uterine cavity using a curette is perhaps one of the most common methods of treating this pathology. This operation is performed under general anesthesia and allows not only to completely remove all affected tissue, but also to obtain a large amount of material for a detailed histological examination.
Hysteroscopy. A minimally invasive surgical intervention in which tissue removal occurs under the control of a video camera, which allows for the safest and most accurate removal of adenomatous nodes. This method is considered less traumatic since minimal expansion of the cervical canal is required. However, the risks of developing relapses of the disease, according to statistics, are somewhat greater than with classical curettage.
Amputation of the uterus (hysterectomy) - complete or partial removal of an organ. This operation is performed strictly according to indications, mainly in postmenopausal women with frequently recurrent disease, with ineffectiveness of other treatment methods and a high risk of developing cancer.

After surgery and obtaining histology results, therapy is carried out aimed at normalizing hormonal levels and improving local immunity to stimulate the growth of healthy tissue of the uterine mucosa.

Reasons for development

Several reasons have been identified that can cause hyperplastic changes in the endometrium of the adenomatous type. But none of them can be considered a 100% guarantee of the development of the disease in the future.

Hormonal disorders. An imbalance in the production of estrogens and gestagens leads to uncontrolled growth of endometrial tissue.
Ovarian diseases. Lack of ovulation almost always leads to endometrial growth.
Incorrect or uncontrolled use of hormonal drugs.
Disturbances in the functioning of the endocrine system.
Diseases of the liver and biliary tract.
Hereditary factor.

Symptoms and diagnosis

The main symptoms of the development of hyperplastic processes in the uterus.

Bleeding. Heavy menstruation, acyclic bleeding, spotting.
Pain. Pain in the lower abdomen before menstruation and during bleeding, pain in the lower back.
Metabolic syndrome. Obesity, increased insulin levels in the blood, male-pattern hair growth, voice changes and the appearance of other masculine characteristics.
Fertility problems. Infertility and miscarriage are one of the main symptoms of hyperplasia.
Mastopathy.
Inflammatory diseases of the pelvic organs.
Painful intercourse, blood in the discharge after intercourse.

An ultrasound examination using the transvaginal method can highly likely confirm or refute the diagnosis. However, of key importance in the diagnosis of adenomatosis is the determination of the presence of atypical cells in tissues, which can only be confirmed as a result of a detailed analysis - a histological examination of scrapings from the uterine cavity. Additionally, if concomitant ovarian diseases or the development of metabolic syndrome are suspected, a detailed blood test for sex hormones is prescribed.

In any case, treatment of hyperplastic changes in the uterus of any nature must begin as early as possible. If the gynecologist has already diagnosed adenomatosis, it is better to immediately ask for a referral to an oncologist. Many women are afraid to contact such doctors, but as practice shows, precancerous forms of the disease are best treated by specialized specialists.

When does endometrial hyperplasia occur, its signs, treatment and the likelihood of malignancy

For practical gynecology, the processes of endometrial hyperplasia, which range from 15 to 40% and occupy second place after infectious pathology in the structure of all gynecological diseases, are a multifaceted and complex problem.

This is explained by their tendency to have a recurrent long-term course, the absence of specific symptoms, the difficulty of carrying out timely differential diagnosis and difficulties in choosing adequate treatment. Why is hyperplasia dangerous and what are its causes?

Endometrial hyperplasia - what is it?

Endometrial hyperplasia is a morphofunctional pathological condition of the uterine mucosa, consisting of diffuse or focal growth (proliferation) of glandular and stromal structures with a predominant lesion of the glandular component in the functional (superficial) layer, much less often in the basal layer of the endometrium. The thickness of the endometrium with hyperplasia exceeds the norm depending on the phase of the menstrual cycle - up to 2-4 mm in the early proliferation phase and domm during the secretory phase.

In recent decades, there has been a steady increase in the number of pathological hyperplastic processes in the uterine mucosa, due to an increase in the average age of life of the female part of the population, an unfavorable environment, an increase in the number of somatic chronic diseases, many of which are to one degree or another associated with the hormonal system or have influence on her.

The frequency of pathology is 10-30% and depends on its form and age of women. It occurs in girls and women of childbearing age, but most often between 35 and 55 years of age, and according to some authors, in half of women who are in the late reproductive or menopausal period.

In recent years, there has been an increase in the number of cases of the disease. Moreover, this growth occurs in parallel with the increase in the number of diseases of uterine cancer, which ranks 4th among all malignant tumors in women, and 1st among malignant neoplasms of the genital organs.

Various forms of hyperplasia of the uterine mucosa - is it cancer or not?

Pathological changes in the endometrium are benign, but at the same time it is noted that against their background, malignant tumors develop much more often. Thus, simple endometrial hyperplasia without atypia in the absence of treatment accompanies uterine cancer in 1% of cases, with atypia - in 8-20%, complex atypical form - in 29-57%. The atypical form is considered a precancerous condition.

How is endometrial hyperplasia different from endometriosis?

If the first is localized only within the uterine mucosa, then endometriosis is a chronic progressive recurrent benign disease, which in its growth and spread resembles a malignant tumor.

Endometriotic tissue cells are morphologically and functionally similar to endometrial cells, however, they grow into the wall of the uterus, spread and grow beyond it - in the fallopian tubes and ovaries. They can also affect neighboring organs (peritoneum, bladder, intestines) and be transported by blood flow (metastasize) to distant organs and tissues.

Causes of endometrial hyperplasia and its pathogenesis

Due to the presence of a specific receptor apparatus in the uterine mucosa, it is a tissue that is highly sensitive to changes in the endocrine status in the female body. The uterus is the “target organ” for the effects of sex hormones.

Periodic cyclic changes in the endometrium are caused by a balanced hormonal effect on the receptors of the nuclei and cytoplasm of cells. Menstruation occurs as a result of rejection of only the functional layer of the endometrium, and restoration of glandular structures occurs due to the proliferation of glands of the basal layer, which is not rejected.

Therefore, the occurrence of hormonal imbalance in a woman’s body can cause disruption of the differentiation and growth of endometrial cells, which leads to the development of their limited or widespread excessive growth, that is, local or diffuse endometrial hyperplasia develops.

Risk factors for the occurrence of pathological processes of cell proliferation in the endometrium are:

hypothalamic-pituitary syndrome or Itsenko-Cushing disease;
chronic anovulation;
the presence of hormonally active ovarian tumors;
polycystic ovary syndrome;
Tamoxifen therapy (an antitumor and antiestrogenic drug) and estrogen replacement therapy;
chronic inflammatory processes of the internal genital organs, frequent abortions and diagnostic curettages (occur in 45-60% of women with hyperplasia);
fasting and psycho-emotional stress conditions;
diseases of the thyroid gland, the hormones of which modulate the influence of female sex hormones (estrogens) at the cellular level;
violation of the metabolism of fats and carbohydrates, in particular diabetes and obesity;
pathology of the liver and biliary system, the result of which is a slowdown in the processes of estrogen utilization in the liver, which leads to hyperplastic processes in the uterine mucosa;
hypertension;
postmenopausal period - due to increased hormonal activity of the adrenal cortex;
immune changes, which are especially pronounced in women with metabolic disorders.

Hormones play a major role in the development of endometrial tissue proliferation. Among them, the primary role belongs to estrogens, which, through their participation in the metabolic processes of cells, stimulate the division and growth of cells. At different periods of life, absolute or relative hyperestrogenism can be provoked by one or another of the above factors.

During puberty

Hyperplastic processes in this period are caused mainly by anovulation cycles, and they, in turn, are associated with a disorder in the activity of the hypothalamic-pituitary system. The latter is accompanied by unstable frequency and amplitude of GnRH (gonadotropin-releasing hormone) emissions that persist for a long time, which is the cause of inadequate secretion of follicle-stimulating hormone (FSH) by the pituitary gland.

The result of all this is premature (before reaching the stage that corresponds to ovulation) follicular atresia in many menstrual cycles. In this case, a relative excess of estrogen occurs (as a result of the monotony of its production) with the secretion of progesterone (deficiency), which does not correspond to the stages of the menstrual cycle, which causes defective growth of the endometrium. Predominantly glandular epithelium grows while the growth of the stromal component lags. Thus, adenomatous or cystic endometrial hyperplasia is formed.

During the reproductive period

Excessive levels of estrogen during the reproductive period can occur as a result of:

hypothalamic disorders, hyperprolactinemia, frequent stressful conditions, fasting, chronic somatic diseases, etc., leading to dysfunction of the hypothalamus-pituitary gland system;
disturbances in the hormonal feedback mechanism, as a result of which in the middle of the menstrual cycle the secretion of luteinizing hormone is not activated, which means there is no ovulation;
changes directly in the ovaries themselves with the growth of their stroma, follicular cysts, ovarian polycystic disease, etc.

During the periods of premenopause and perimenopause

Cycles of non-ovulation are caused by age-related changes in the activity of the hypothalamic-pituitary system, resulting in changes in the intensity and frequency of GnRH release. According to these cycles, both the secretion of FSH by the pituitary gland and the effect of the latter on ovarian function change.

Insufficient estrogen levels in the middle of the menstrual cycle, which causes a decrease in stimulation of luteinizing hormone secretion, as well as depletion (by this age) of the ovarian follicular apparatus lead to anovulation. In postmenopausal women, the activity of the adrenal cortex increases, which also plays a role in the development of endometrial hyperplasia.

In addition, recent studies indicate the primacy of tissue resistance to insulin, which is caused by hereditary or immune factors, for example, insufficiency of insulin receptors in tissues, the presence of specific antibodies against insulin receptors or blockade of the latter by growth factors similar to insulin and inherited, etc.

These genetic and immune disorders can cause metabolic disorders (carbohydrate metabolism disorders and diabetes mellitus, male obesity, atherosclerosis, etc.), as well as functional and structural changes (hypertension, coronary heart disease, etc.). They are considered secondary to the tissues' inability to respond to the action of insulin, which automatically leads to increasing secretion of insulin in the body.

An increased concentration of insulin, acting on the corresponding ovarian receptors and growth factors, stimulates multiple follicles, causing the development of polycystic disease, excessive production of androgens in the cysts, which are transformed into estrogens. The latter cause a lack of ovulation and hyperplastic processes in the endometrium.

Along with this, the state of uterine hormonal receptors is also of no small importance, which is not least influenced by mechanical damage (abortion, curettage) and inflammatory processes. Due to a deficiency of receptors, very often hormonal treatment of endometrial hyperplasia (in 30%) is ineffective, since its sensitivity to hormonal drugs is insufficient.

An important role in the development of pathological proliferation is played not only by the intensification of the processes of proliferation of the endometrial cells themselves, but also by gene dysregulation of their apoptosis (programmed timely cell death).

Thus, the mechanism of proliferative processes in the uterine mucosa is determined by the complex interaction of many factors, both systemic (neurondocrine, metabolic, immune) and local (cellular receptor and genetic apparatus of the uterine mucosa) nature.

This mechanism is implemented mainly as a result of:

excessive influence of estrogens with insufficient counteraction of progesterone;
abnormal reaction of the glandular structures of the uterine mucosa in response to normal estrogen levels;
due to the high activity of insulin growth factors in insulin resistance, accompanied by high insulin concentrations (metabolic syndrome, type II diabetes mellitus, polycystic ovary syndrome).

Classification of endometrial hyperplasia

Pathomorphologically and cytologically, the following forms of hyperplasia are distinguished:

simple glandular - cystic expansion of the glands is mostly absent; if proliferative processes are pronounced, then cystic expansion is possible in some areas of the mucous membrane; this form, in this case, is called glandular-cystic and is a stage of a single process;
glandular-stromal, characterized by proliferation of both glandular and stromal structures; depending on the severity of this process, the glandular-stromal form is divided into active and resting; thickening of the endometrium occurs due to the superficial layer;
atypical, which is also called atypical glandular and adenomatous; This form is characterized by the severity of proliferative changes and a wide variety of morphological patterns.

Depending on the severity of changes of a proliferative and atypical nature, mild, moderate and severe degrees of the pathological condition are distinguished, and depending on its prevalence, diffuse and focal forms are distinguished.

In 1994, the World Health Organization (WHO) proposed a classification that is generally followed today. However, in practical gynecology and oncology, the terminology of other authors is often used in parallel.

According to the WHO classification, endometrial proliferation can be:

Without cytologically detectable atypical cells (non-atypical).
With atypical cells (atypical).

The first, in turn, differs as:

Simple endometrial hyperplasia, which corresponds to the previously accepted term “glandular cystic hyperplasia”. In this form, the volume of the mucous membrane is increased, there is no atypia of cell nuclei, the structure of the endometrium differs from its normal state in the activity and uniform growth of the glandular and stromal components, the uniform distribution of vessels in the stroma, the uneven location of the glands and the moderate cystic expansion of some of them.
Complex or complex hyperplasia, or grade I. Corresponds to adenomatosis (in other classifications). In this form, proliferation of the glandular epithelium is combined with a change in the structure of the glands, in contrast to the previous form. The balance between the proliferation of glands and stroma is disturbed in favor of the former. The glands have a structurally irregular shape, and there is no cellular-nuclear atypia.

Atypical proliferation is divided into:

Simple, which corresponds (according to other classifications) to atypical hyperplasia of the second degree. It differs from the simple non-atypical form by the significant proliferation of glandular epithelium and the presence of atypical cells. Cellular and nuclear polymorphism is absent.
Atypical complex (complex), in which changes in the endometrium are of the same nature as in non-atypical, but, unlike the latter, atypical cells are present. Signs of their atypia are a violation of cell polarity, irregular stratification of the epithelium and its change in size, nuclear cell polymorphism, enlarged cell nuclei and their excessive staining, expanded cytoplasmic vacuoles.

In the WHO classification, local hyperplasia (single or multiple polyps) is not distinguished as an independent variant. This is explained by the fact that polyps (polypous hyperplasia is a term sometimes used by practitioners) are considered not as a variant of endometrial hyperplasia as a result of hormonal disorders, but as a variant of the productive process in chronic endometritis, which requires appropriate bacteriological examination and anti-inflammatory and antibacterial treatment.

Clinical picture

In the vast majority of cases, the main symptom in women of different ages is dysfunctional uterine bleeding and/or spotting from the genital tract. The nature of menstrual disorders does not depend on the severity of proliferative processes in the endometrium.

Menstrual irregularities are possible in the form of delayed menstruation for up to 1–3 months, which is subsequently replaced by bleeding or spotting (in% of women with endometrial hyperplasia). Somewhat less often, cyclic bleeding lasting more than 1 week, corresponding to menstrual days, is possible. They are more common among women who do not have metabolic disorders.

Menstruation with endometrial hyperplasia is usually long. Their intensity can vary - from moderate bleeding to heavy bleeding, with large blood loss (profuse). On average, in 25% of cases, bleeding occurs due to anovulatory menstrual cycles or absence of menstruation (in 5-10% of women with hyperplasia).

In menopausal women, menstruation is irregular, followed by ongoing bleeding or spotting. During menopause, short-term or long-term scanty discharge of blood is possible.

Other, less significant and uncharacteristic signs of uterine endometrial hyperplasia are pain in the lower abdomen and bleeding after sexual intercourse, heavy lifting, and long walking (contact bleeding).

In addition, there may be general complaints that are caused by both blood loss over a long period of time and metabolic and/or neuroendocrine disorders. These may be headaches, thirst, palpitations, high blood pressure, sleep disorders, decreased performance and fatigue, psycho-emotional instability, excessive weight gain, the appearance of pink stretch marks and pathological hair growth, the development of pelvic pain syndrome, psycho-emotional disorders, and decreased quality of life.

A small percentage of patients have no symptoms. Pathological changes in their mucous membrane are detected during random examinations, sometimes not even related to gynecological diseases.

Hyperplasia and pregnancy

Is it possible to get pregnant if this pathology develops?

Considering the etiology and pathogenesis of the development of the pathological condition in question, it becomes clear that endometrial hyperplasia and pregnancy are practically incompatible. Infertility is associated not only with the fact that the altered mucous membrane does not allow the fertilized egg to implant. The reasons, predominantly hormonal in nature, that caused these pathological changes are also the causes of infertility.

Therefore, endometrial hyperplasia and IVF are also incompatible. However, a preliminary course of necessary treatment at the stage of preparation for pregnancy most often contributes to conception and successful resolution of pregnancy.

In some cases, when there is moderate hyperplasia, implantation of a fertilized egg is possible in a relatively healthy area of the uterine mucosa. But this usually leads to spontaneous abortion or fetal development disorders.

Endometrial hyperplasia after childbirth develops relatively rarely. However, its relapse is quite possible, even in the form of an atypical form. Recurrent endometrial hyperplasia, especially its atypical forms, is dangerous due to its tendency to transform into a malignant hyperplastic process. Therefore, in the postpartum period, it is necessary to be under the supervision of a gynecologist, conduct additional examinations and, if necessary, undergo a course of prescribed therapy.

Diagnostics

The diagnosis is made based on various methods, the results of which are specific to the corresponding age period.

Among the diagnostic methods, the main ones are:

Ultrasound examination using a transvaginal probe

According to various sources, its information content ranges from 78 to 99%. The thickness of the endometrium during hyperplasia in the secretory phase exceeds 15 ± 0.4 mm (up to 20.1 ± 0.4 mm); in the postmenopausal period, a thickness of more than 5 mm indicates a hyperplastic process. Exceeding the value of 20.1 ± 0.4 mm already raises suspicion of the possibility of adenocarcinoma. Other M-echo signs of hyperplasia are the heterogeneous structure of the uterine mucosa, inclusions similar to small cysts, or other ECHO-positive formations of varying sizes.

Separate diagnostic curettage of the mucous membrane of the cervix and uterine cavity

The study is most informative on the eve of menstruation. Further histological examination of the obtained material allows us to more accurately determine the nature of the morphological changes occurring. Cytological examination reveals the presence of cellular atypia. Indications for repeated curettage are recurrent bleeding in the postmenopausal period and monitoring the effectiveness of the course of hormonal treatment.

Read more about the procedure in our previous article.

Being a fairly informative technique (informativeness ranges from 63 to 97.3%), the study significantly increases the diagnostic value of separate curettage. It is advisable to carry it out on days 5-7 of the menstrual cycle. Hysteroscopy for endometrial hyperplasia makes it possible to differentiate the morphological forms of transformation of the uterine mucosa. Hysteroscopic signs are:

with simple hyperplasia - the thickness of the endometrium is more than 15 mm, its uneven surface with the presence of multiple folds of pale pink or, less often, bright red color, pronounced vascular pattern, uniform arrangement of the excretory ducts of the glands;
with cystic - folded bright red surface, increased thickness, unevenness of the vascular network, in the projection of superficial vessels - a large number of cysts.

Treatment

Can endometrial hyperplasia go away on its own?

Considering that it is not a disease, but a pathological condition of the endometrium, caused by the above factors and development mechanisms, self-healing does not occur. Moreover, this pathology is often recurrent.

When choosing treatment tactics, the presence of somatic pathology and diseases of the internal genital organs, the age period and the morphological state of the uterine mucosa are taken into account.

Conservative therapy

The principle of treatment consists of three main stages:

Stopping bleeding, the methods of which largely depend on the age period. They can be non-hormonal, hormonal and surgical.
Restoration or suppression of the menstrual cycle.
Carrying out the prevention of relapse of the pathological process.

Puberty

In adolescence, endometrial hyperplasia is treated without curettage. To stop bleeding, first of all, symptomatic therapy is used, for which drugs that increase the tone of the muscular wall of the uterus (uterotonic drugs) are prescribed for no more than 5 days. These include Oxytocin, Dinoprost, Methylergometrine.

In addition, pharmaceutical hemostatic drugs (Vikasol, aminocaproic acid), vitamin therapy (folic acid, vitamin “B1”, pyridoxine, vitamin “E”, ascorbic acid) and additionally - traditional medicine that help stop bleeding (nettle, stinging nettle) are used. bag, etc.).

If there is no effect, progesterone drugs are prescribed, and if necessary, a combination of them with estrogens (Regulon, Femoden, Marvelon, Rigevidon, etc.). In some cases, progesterone drugs are prescribed in shock dosages, which leads to separation of the uterine mucosa, similar to curettage or menstruation (hormonal curettage). Further treatment in order to prevent relapses is carried out using progestin or complex (estrogen-gestagen) hormonal drugs.

Reproductive and menopausal period

In women of the reproductive and menopausal periods, treatment of endometrial hyperplasia begins with separate therapeutic and diagnostic curettage. After a histological examination of the mucosal preparation, certain hormonal agents are selected in individually selected dosages in order to prevent relapses of the pathology or surgical treatment.

In reproductive age, therapy is aimed at both eliminating hyperplasia of the uterine mucosa and restoring ovulation cycles; in perimenopausal age, it is aimed at restoring the regularity of menstrual-like reactions or at suppressing them.

For these purposes, such agents as Utrozhestan (micronized natural progesterone), the complex estrogen-progestogen drug Janine, as well as Norkolut (norethisterone), Duphaston (dydrogesterone), Depo-Provera, antigonadotropic hormones, GnRH agonists (stimulants) (Goserelin, Buserelin) are used , Luprid depot, Zoladex, Diferelin), etc.

How to take Duphaston for endometrial hyperplasia?

Duphaston, like Norkolut, should be taken from the 16th to the 25th day of the menstrual cycle in a daily dose of 5-10 mg. The drug is prescribed for six months (at least 3 months) with subsequent control ultrasound examinations after six months and 1 year.

The greatest difficulty is the treatment of hyperplasia in women with metabolic disorders (excess body weight) and increased serum insulin levels. For such patients, annual monitoring of blood lipoproteins and glucose levels, a glucose tolerance test and testing of blood insulin levels are necessary.

Of great importance is the normalization of body weight through increased physical activity, especially in the fresh air, which helps reduce the concentration of lipids in the blood, and proper nutrition. The diet for endometrial hyperplasia should be balanced, but in such a way that its daily calorie content is limited to a maximum. This must be ensured by limiting the content of carbohydrates and fats in food and increasing the amount of proteins.

Surgical treatment

Indications for surgical treatment are:

In reproductive age - lack of effectiveness of conservative treatment of simple atypical and complex non-atypical forms for six months, as well as 3 months for atypical complex forms of pathology.
In the menopausal period, there is no effect from six-month conservative therapy for complex non-atypical and simple atypical hyperplasia, as well as 3-month therapy for an atypical complex form of pathology.

Among surgical methods, in cases with atypical forms of hyperplasia, removal of the uterus is indicated. In women with non-atypical forms of pathology, especially those of reproductive age, in recent years, mainly gentle surgical methods such as endometrial ablation and hysteroresectoscopy have been used.

Unconventional treatment

Many women, not wanting to take hormonal drugs, carry out repeated curettage or accept the offer of surgical treatment (if necessary), use treatment with folk remedies (infusions and decoctions of medicinal plants and their preparations) or homeopathic drugs - Genikohel, Kalium carbonicum, Mastomethrin, Acidum nitricum, etc. .

Folk remedies include, for example, an infusion of nettle leaves, a decoction of burdock roots or a tincture of its leaves, a decoction of a collection consisting of calamus, stinging nettle leaves, common knotweed, white cinquefoil root, shepherd's purse (herb) and knotweed, and others medicinal plants.

However, it is necessary to understand that folk remedies, as well as homeopathic treatment, are possible only for symptomatic purposes - stopping bleeding, replenishing vitamins and microelements, increasing myometrial tone.

Their use for the treatment of endometrial hyperplasia is not only ineffective, but also contributes to prolonging the process, leading to the risk of significant blood loss and associated complications, as well as the transformation of a benign pathological condition of the endometrium into a malignant formation.

Atypical endometrial hyperplasia (adenomatosis) is a benign pathological growth and thickening of the uterine mucosa with changes at the cellular level. This pathology should be distinguished from ordinary hyperplasia and endometrial polyps.

Symptoms of the disease

Uterine bleeding (metrorrhagia) is the most common symptom of atypical endometrial hyperplasia:

50% of patients experience long delays in menstruation, after which intense bleeding appears.
In 10% of patients, intense bleeding occurs against the background of a complete absence of menstruation.
In some cases, bleeding is periodic and takes the form of painful periods.
Most patients complain of an unstable cycle, against which metrorrhagia appears.

A frequent manifestation of hyperplasia is metabolic dysfunction, accompanied by obesity and an increase in insulin levels in the blood. Sometimes there are signs of increased male hormones, for example, a changed timbre of the voice or pronounced body hair.

Other secondary symptoms include chronic inflammation of the reproductive organs, mastopathy and fibroids, as well as lack of pregnancy with regular sexual activity. During hygiene or sexual intercourse, contact bleeding may occur.

Adenomatosis cannot be determined by clinical manifestations alone. Sometimes the disease is accompanied by symptoms similar to those of other diseases. This may include paroxysmal pain in the lower abdomen and lower back, decreased performance, fatigue and irritability.

Important! Women over 45 years of age often mistake hyperplasia for fibroids due to similar symptoms and do not seek help from a specialist. But we must not forget that fibroids, like atypical endometrial hyperplasia, can develop into cancer. To avoid such consequences, you need to visit a gynecologist every 6-8 months.

Causes of the appearance and development of the disease

The main cause of adenomatosis is an imbalance of female sex hormones: an increased proportion of estrogens and a decrease in gestagens. This process can be triggered by factors such as:

advanced chronic inflammation of the reproductive system;
damage to the uterus during childbirth, abortion, gynecological operations and diagnostic curettage;
impaired metabolism, obesity and diabetes;
long-term use of hormonal drugs;
pathology of the adrenal glands, pancreas and thyroid glands;
menopause.

The cause of atypical endometrial hyperplasia is directly related to changes in the functionality of the ovaries, which leads to an imbalance between male and female hormones. As a result, mucosal cells begin to grow involuntarily. During menstruation, they are not rejected; first, an adenomatous layer is formed, and later hyperplasia.

Diagnosis of pathology

Timely diagnosis of atypical endometrial hyperplasia will help avoid cancer and other serious consequences.

To establish an accurate diagnosis, the following procedures will be needed.

Ultrasound

Allows you to determine the type of pathology, the thickness and structure of the affected mucosa, as well as identify the presence of polyps. The disease can be suspected if the thickness of the endometrium is 7 mm or more. If the mucous membrane is thicker than 20 mm, this indicates the development of malignant processes.

Hysteroscopy

The examination is performed with a special optical device and allows you to determine the type of hyperplasia. This method provides the most objective and accurate data on the condition of the uterus. During the examination, the doctor identifies the source of the disease and, if necessary, performs a biopsy of the affected area. The procedure is performed under local anesthesia, and in rare cases, under general anesthesia.

Histological examination

At this stage, an analysis of the endometrial tissue is performed under a microscope, the characteristics of the affected layer, the structure of cells and nuclei are given, and atypical changes in their properties are identified. The study is carried out separately using pipel biopsy or during hysteroscopy. The sensitivity of the procedure for cancer and hyperplasia is almost 100%.

Analysis of hormone levels in the blood

Prescribed for identifying symptoms of metabolic dysfunction and polycystic ovary syndrome. This analysis shows the level of follicle-stimulating and luteinizing hormones, estradiol, adrenal and thyroid hormones, testosterone and progesterone levels.

Types of hyperplasia

Cellular changes in adenomatosis of the inner lining of the uterus always occur in different ways. Hyperplastic processes can be accompanied by damage to various elements of the endometrium, according to which several types of atypical hyperplasia are distinguished:

glandular;
complex;
focal.

Glandular hyperplasia is characterized by a high intensity of cell proliferation and significant changes at the cellular level. The growth of the endometrial layer occurs mainly due to an increase in the glandular substance; the glands acquire a tuberous shape and evenly increase in size.

In addition to the activation of cell growth, the disease is accompanied by changes in the structure of the nuclei - this indicates the onset of malignant processes. This form of the disease can also occur as a result of thinning or atrophy of the endometriotic layer.

Complex atypical endometrial hyperplasia is a precancer of the uterus, which, if not treated in a timely manner, leads to cancer in 15–55% of cases. This form of damage is considered the most dangerous; it is accompanied by uncontrolled growth of glands, pathological changes in their size and shape. A distinctive feature of the disease is that the glands in the uterus take on tortuous shapes and grow to different sizes, becoming elongated and rounded.

Focal hyperplasia occurs as a result of insufficient production of estrogen in the body. Eggs do not mature and estrogen is not produced regularly. As a result, the egg cannot leave the ovary, and menstruation continues for a long period. Rejection of endometrial tissue occurs at a slow pace, part of the mucous remains inside and provokes the appearance of neoplasms.

Pay attention! Foci of the disease can also appear as a result of inflammation, trauma, abortion, endocrine system disorders and due to problems with excess weight.

Consequences of hyperplasia

If atypical endometrial hyperplasia is not treated in a timely manner, the pathology can lead to infertility; in some cases, degeneration of endometrial cells occurs and a malignant tumor of the uterus occurs.

Treatment

Treatment of hyperplasia can be conservative or surgical, carried out on an outpatient basis or in a hospital setting. Its main purpose is to stop bleeding and prevent the development of tumors.

To urgently stop metrorrhagia, curettage and procedures to replace blood loss are prescribed, in some cases a transfusion is required.

Drug therapy

If curettage has been performed, iron supplements and other medications are prescribed to improve blood counts. Women under 35 years of age are prescribed combination medications, for example, oral contraceptives with estrogens and gestagens. Preference is given to products with progesterone, which prevents endometrial growth.

Patients from 35 years of age to perimenopause are prescribed gestagens without estrogen-containing drugs (for example, duphaston or utrozhestan).

Adenomatosis in postmenopause is a fairly rare occurrence. Therapy is determined after a detailed examination. If no tumors are detected, oxyprogesterone is prescribed to treat hyperplasia.

In total, drug treatment can last from six months to 8 months. Every 3 months a control pipell biopsy is performed followed by histological analysis.

Surgical intervention

In case of relapse of the disease, extirpation (removal) of the uterus is performed.

Sometimes electrosurgical resection is used - the overgrown layer is removed through the cervical canal.

In extreme cases, ablation of the affected layer is carried out (removal of the uterine mucosa). The procedure is performed only in cases where traditional surgery poses a threat to life. Because after such surgical manipulation, scars form in the uterine cavity, which impede further diagnosis and treatment.

Cure prognosis

Prognosis for this pathology depends on the general condition of the body, age and genetic predisposition. Based on reviews, proper treatment of atypical endometrial hyperplasia ensures complete recovery and preservation of the ability to bear children.

The most severe form is considered to be adenomatosis in combination with any endocrine disruption in women over 45 years of age. In this situation, extirpation is almost always required. Timely surgery will prevent the formation of malignant tumors and lead to a complete recovery.

Preventive measures

To reduce the likelihood of developing adenomatosis, you must follow the basic recommendations:

consult a doctor if cyclic uterine bleeding occurs (this is especially important after 35 years);
in case of unstable menstruation, take oral contraceptives prescribed by your doctor;
regulate nutrition and reduce body weight (if you are overweight);
after menopause, do not use only estrogens for hormonal therapy, but combine them with gestagens.

Prevention of atypical endometrial hyperplasia should be accompanied by giving up bad habits. It is recommended to lead a healthy lifestyle and perform regular basic exercise to keep the body in good shape. It is important to monitor your immunity, avoid hypothermia and inflammation of the reproductive system.

Results

Endometrial hyperplasia with atypia is a hypertrophied growth of tissue of the uterine mucosa. The disease occurs with heavy irregular bleeding or spotting. If there are any cycle irregularities, changes in the nature of menstrual bleeding, or cramping pain in the abdomen, you should immediately consult a doctor. Timely diagnosis and proper therapy in most cases give favorable prognoses.

Atypical changes in endometrial tissue that occur against the background of a hyperplastic process lead to uterine cancer in 40% of cases. Endometrial adenomatosis is an obligate precancer that requires urgent treatment: timely surgery will help prevent a fatal disease.

At the first stage of pathology, hyperplasia occurs - thickening of the uterine mucosa

Hyperplastic processes of the endometrium

A malignant tumor of the uterine body never occurs unexpectedly - in most cases, in the first stages of the disease, hyperplastic changes and endometrial adenomatosis occur, which include:

Typical endometrial hyperplasia (simple and complex);
Atypical hyperplastic process (simple and complex adenomatosis, adenomatous polyp).

The main differences between typical and atypical hyperplasia are the following changes in the tissue:

structural (disturbances in the structure and relationship of glandular cells);
cellular (internal pathological changes in the membrane and contents of endometrial cells);
nuclear (increase in the number of cell nuclei, change in shape and size).

The more diverse and complex the disorders, the higher the risk of developing a malignant tumor. Any typical hyperplasia is a background change that can become the basis for precancer. Endometrial adenomatosis is an extremely high risk of oncopathology (in some cases it is impossible to reliably exclude cancer against the background of pronounced atypical changes).

Endometrial adenomatosis - pathogenetic variants

Depending on the cause, there are 2 types of precancerous lesions in endometrial tissue:

Exchange-endocrine pathogenetic variant (60-70% of all cases);
Atrophic type of precancerous changes (30-40%).

In the first case, the basis of pretumor pathology are the following factors:

an increase in the concentration of estrogen in a woman’s blood (hyperestrogenism), caused by severe hormonal imbalances;
disorders of fat metabolism (excess weight, metabolic syndrome);
problems with carbohydrate metabolism (impaired glucose tolerance, diabetes mellitus).

In the second case, the provoking factors for the development of the disease are:

inflammatory processes in the reproductive organs (endometritis, cervicitis, adnexitis);
consequences of mechanical trauma (abortion, diagnostic curettage, long-term wearing of an intrauterine device).

Endometrial adenomatosis is one of the steps leading to uterine cancer. The processes of tumor growth are slow, but inexorable: having discovered a precancerous process, it is necessary to carry out all the necessary examinations as soon as possible and begin full-fledged treatment of the pathology.

The basis of the tumor in the uterus is adenomatosis in the endometrium

Symptoms of pathology

One of the first signs of a hyperplastic process may be. A woman should always monitor the rhythm and abundance of her periods, noting the beginning and end of her period every month. You should consult a doctor if the following symptoms appear:

rhythmic but heavy menstruation;
acyclic uterine bleeding;
prolonged scanty bleeding on the days of expected menstruation;
change in rhythm (frequent periods, delays in the arrival of menstrual periods);
lack of desired pregnancy.

It is advisable not to delay your visit to the doctor, especially if your cycle is shortened (menstruation twice a month) or your period comes with heavy blood loss.

Basic diagnostic methods

After a standard gynecological examination, the following doctor’s prescriptions must be completed:

Transvaginal;
Aspiration biopsy with cytological examination;
with taking a biopsy.

With a transvaginal ultrasound, the doctor will see hyperplasia or polyp

If an endometrial polyp is identified, removal of the intrauterine formation will be required using hysteroresectoscopy. Treatment tactics completely depend on the histological conclusion, on the basis of which the doctor will choose an effective method of therapy.

Treatment tactics

Identified endometrial adenomatosis requires active treatment measures - it is unacceptable to delay therapy or use ineffective and pointless folk remedies. The age of the patient is of great importance - in young women, preference is given to organ-preserving techniques; in older women, the uterus must be removed. The main surgical treatment methods include:

total curettage of the uterine cavity;
endometrial ablation (radio wave, laser);
simple hysterectomy.

Hormone therapy is effective only in the metabolic-endocrine variant of the hyperplastic process, when the hormonal sensitivity of endometrial tissue is confirmed. If an atrophic type of precancer is detected, surgery should be performed without trying to use drug treatment.

The diagnosis of uterine adenomatosis is quite common today. In fact, it is a precancerous stage, which without proper treatment can develop into a serious disease that requires long and expensive treatment.

Causes and symptoms of the disease

The causes of adenomatosis do not always lie in the notorious genetic predisposition, which plays an important role in this matter. In addition to it, the cause of the development of adenomatosis can be:

Stressful situations. Not only negative emotions can play the role of a catalyst, but also joy that has shaken the body too much;
Sunbathing. It has been scientifically proven that ultraviolet rays, so beloved by modern man, do not always have a positive effect on the body. The optimal time to tan is before 11 a.m. and after 3 p.m. The rest of the time, ultraviolet waves can contribute to the development of cancer or their precursors, including adenomatosis;
Frequent surgical interventions. The harmful effects of anesthesia often affect the condition of all internal organs, including causing adenomatosis of the uterus;
Weakening of the immune system. The immune system, especially during the period of spring vitamin deficiency, needs constant replenishment. It is he who is responsible for the protective functions of the body, repelling many serious diseases.

It is almost impossible to detect uterine adenomatosis at home and without special equipment. However, there are certain symptoms that should definitely force the patient to see a doctor:

Bleeding;
Frequently recurring pain in the lower abdomen;
Acute headache;
Fatigue and reluctance to do anything;
Menstrual irregularities;
Pain during intercourse.

Having identified one of the symptoms, a woman should under no circumstances resort to self-medication. This way you can waste time and start a disease that will develop from a micro stage into one that requires the intervention of a surgeon.

Treatment Options

Regardless of the reasons for the development of the disease, it will be treated with hormonal drugs and, less often, with surgical intervention. A radical way to get rid of the disease once and for all is to remove the uterus, but it is resorted to extremely rarely in order to preserve a woman’s reproductive function.

The diagnosis of microadenomatosis is considered the initial stage, which can be cured with the help of constant use of hormonal drugs according to a regimen drawn up by a doctor. Treatment can take from several months to several years, but in most cases it can completely eliminate both symptoms and causes. In this case, the patient should not interrupt the course on her own without informing the doctor, even if the symptoms have completely gone away. These actions can cause a relapse, which is extremely difficult to treat.

In some cases, in addition to drug treatment, the doctor may prescribe a number of procedures that directly affect the walls of the uterus. One of them is electrocoagulation or influencing the seal using an electric current. During the procedure, the woman is under anesthesia, which minimizes pain. This treatment is carried out once, supplemented only by medications and ultrasound monitoring.

Another fairly common procedure is embolization. A thin tube is inserted into the walls of the uterus, which contains substances that block the flow of blood to the tumor. Over time, without constant replenishment, it begins to decrease and practically disappear. It is often not necessary to remove the formation from the uterus after drying out.

You can learn more about this procedure by watching this video:

If the first two procedures did not bring the desired effect, ablation is introduced into the treatment - scraping out the overgrown endometrium from the vaginal walls. It will be effective only when the tumor has not yet penetrated too deeply into the walls of the uterus. If this happens, the patient will undergo surgery performed under general anesthesia.

Traditional treatment of adenomatosis

Like any serious disease, adenomatosis requires specialist intervention and cannot be treated at home. Its folk treatment with medicinal herbs can be an addition to the prescribed regimen, nourishing the body's internal resources.

The most effective remedy, approved even by medicine, is douching an infusion of celandine, nettle, oak bark and cudweed into the uterus. All components are taken in equal proportions, poured with boiling water and infused for several hours. Then the broth is carefully filtered and slightly heated before use. A number of gynecological diseases can be treated in this way, the list of which includes adenomatosis.

The photo shows a gynecological douche

Among the folk methods that have the approval of official medicine, there is also treatment taken orally, in the form of a decoction of celandine, juniper fruits, poplar and birch buds, as well as tansy blossom. The tincture should be taken 3 times a day after meals, 200 ml. Such treatment in combination with medications helps strengthen the immune system, reduce the harmful effects of medications on it, and also improves the reproductive function of the uterus, weakened during the illness.

No matter how correct the self-selected treatment may seem, it should in no case be made the main one. All deviations from the prescribed regimen must be discussed with your doctor! And only in this case will it be able to give the proper result, and a serious illness of the uterus can be forgotten.

Hyperplastic processes in the uterus are common gynecological lesions. What is atypical endometrial hyperplasia? This is a pathological growth of the inner uterine lining with a change in the properties of its cells.

This type of change is distinguished along with simple hyperplasia and endometrial polyps. In Russia, the term “adenomatosis” is often used to refer to this condition.

Reasons

Pathology is often associated with several risk factors that need to be promptly and targetedly identified every time a woman visits a gynecologist.

Atypical uterine endometrial hyperplasia occurs when the balance of female sex hormones is disturbed: an increase in estrogen content and a decrease in the level of gestagens.

Causes of pathology:

persistence or atresia of follicles leading to;
ovarian tumors that synthesize hormones (granulosa cell tumor, tecomatosis and others);
strengthening the function of the pituitary gland to produce gonadotropic hormone;
excessive function of the adrenal cortex, for example, in Itsenko-Cushing's disease;
violations during treatment with hormonal drugs, in particular tamoxifen.

Adenomatous endometrial hyperplasia often occurs against the background of other hormonal disorders:

obesity;
liver diseases (hepatitis, cirrhosis), in which the utilization of estrogen is slowed down;
diabetes mellitus;
hypertension;
thyroid diseases.

Other risk factors:

age after 35 years;
absence of pregnancies;
early onset and late cessation of menstruation;
smoking;
cases, uterus or intestines in the family.

In addition to neurohumoral changes, damage to the endometrium due to abortion, curettage, and endometritis is also involved in the development of hyperplasia.

Can atypical endometrial hyperplasia turn into cancer?

This condition is considered precancerous at any age; the probability of its malignant transformation depends on the degree of atypia and ranges from 3 to 30%.

Development mechanism

The endometrium changes during the menstrual cycle under the influence of hormones. In the first phase, estrogens produced in the ovaries cause the lining cells in the uterus to grow and prepare for pregnancy. In the middle of the cycle, an egg is released from the ovary - ovulation occurs, after which the level of another hormone - progesterone - increases. It prepares the endometrium to receive and develop a fertilized egg.

If pregnancy does not develop, the level of all hormones decreases, and menstruation occurs - the rejection of the upper layer of the endometrium.

Hyperplasia of the inner lining of the uterus is caused by excess estrogen against the background of decreased progesterone levels. This condition occurs in the absence of ovulation. The endometrium does not shrink, but continues to thicken under the constant influence of estrogens. Its cells change shape and can become pathological, which will later lead to cancer.

Hyperplasia usually occurs after menopause, when egg production stops and progesterone levels drop. It can also appear during irregular ovulation, as well as under the influence of other reasons.

Classification of atypical hyperplasia

Any hyperplastic processes in the endometrium, according to the 2004 WHO classification, are divided into hyperplasia without atypia and atypical.

Atypical hyperplasia can be mild, moderate or severe. It refers to precancerous conditions. According to the modern classification, it is characterized by the proliferation of endometrial glands with changes in the structure of cells.

There are two forms of pathology: simple and complex.

Simple atypical endometrial hyperplasia is characterized by excessive proliferation of endometrial glands with a normal structure of cells and their nuclei. This form turns into cancer in 8% of cases.
Complex atypical endometrial hyperplasia, or adenomatosis with atypia, is accompanied by disorganization, disruption of the normal structure of glandular cells, changes in their shape and nuclei. This form often turns into cancer - in 29% of patients.

Severe atypical endometrial hyperplasia differs from early stage cancer in that it does not penetrate the lamina that separates the surface layer (epithelium) from the underlying tissue (stroma). Therefore, atypical cells grow and multiply in the upper layer of the endometrium, without entering the blood vessels and lymph nodes.

There are focal and diffuse forms of damage:

Focal atypical endometrial hyperplasia develops in a limited area, often in the area of the corners or fundus of the uterus. It manifests itself later and is less easily diagnosed.
Diffuse covers the entire inner surface of the uterus and causes early symptoms of the disease.

A form such as atypical glandular endometrial hyperplasia is not distinguished in the modern classification. refers to forms without atypia; in many cases it is not a precancer.

Clinical manifestations

The main signs of atypical endometrial hyperplasia do not differ from other forms of hyperplastic processes:

irregular uterine bleeding;
disruptions in menstrual rhythm;
heavy menstruation;
bleeding during sexual intercourse;
spotting in postmenopausal women.

Abdominal pain is not typical for this pathology. In young women, endometrial hyperplasia is often accompanied by infertility.

Diagnostics

It is impossible to make a diagnosis based on the patient’s complaints alone. Therefore, in case of menstrual irregularities, it is necessary to undergo additional examination methods.

Transvaginal ultrasound of the uterus

The method provides a lot of information about the condition of the endometrium and can be used for rapid diagnosis in all groups of women.

If hyperplasia is suspected, the thickness of the endometrium is assessed (M-echo). In young women in the 2nd half of the cycle, it should not exceed 15 mm. In postmenopausal women taking, the endometrium should be no thicker than 8 mm. If hormone replacement therapy is not carried out, the thickness of the M-echo after the cessation of menstruation should not exceed 5 mm. If this value is greater, the risk of atypia and endometrial cancer is 7%.

Transvaginal ultrasound of the uterus

Histological examination

Analysis of endometrial tissue under a microscope helps to make a definitive diagnosis. It characterizes the structure of the epithelial layer, the structure of cells and nuclei, and reveals their atypia. This examination is performed with or during hysteroscopy. However, the sensitivity of biopsy for detecting atypia and cancer does not reach 100%.

Cytological examination

When obtaining an aspirate from the uterus, it is also examined under a microscope, but the information content of such an analysis is lower than histology. The method is used as screening during clinical observation, as well as to evaluate the effectiveness of treatment.

If there is insufficient information and the presence of other diseases of the uterus, computer or diffusion-weighted is indicated.

In case of endometrial hyperplasia, it is necessary to exclude cancer of the uterus and ovaries.

Treatment

The goal of therapy is to stop uterine bleeding and prevent the development of endometrial cancer.

In pre- and postmenopausal women, hysterectomy (removal) is indicated. The issue of removing the ovaries is decided individually, although it is advisable to perform an oophorectomy, especially in elderly patients. This significantly reduces the risk of ovarian cancer later in life.

Surgery is necessary due to the high risk of developing uterine cancer. The laparoscopic method is preferable, in which there is no large incision, the surrounding tissues are little injured, and the recovery period is much shorter than with conventional surgery. Lymph nodes are not removed.

Hormone therapy

In young patients, bleeding is stopped using curettage, and then hormonal therapy is prescribed. At the same time, a woman should be aware of the high risk of uterine cancer, even if all recommendations for drug treatment are followed. If having a baby is no longer planned, the best option is to have a hysterectomy.

Hormonal treatment of atypical endometrial hyperplasia is carried out using three groups of drugs:

gestagens (medroxyprogesterone);
antigonadotropins (gestrinone);
gonadotropin-releasing factor agonists (goserelin, buserelin).

For the introduction of progesterone into the body, the most effective intrauterine device is "". You can also take these drugs in tablet form.

If atypical hyperplasia is combined with ovarian pathology, hormone therapy is practically ineffective.

2 months after starting to take hormones, curettage under hysteroscopy control is prescribed. The same procedure is carried out after completion of treatment. The duration of the course is 6 months, and when using depot forms of Buserelin, Goserelin or Triptorelin, only 3 injections are required with an interval of 28 days. The purpose of taking and criterion for the effectiveness of hormonal drugs is atrophy (thinning) of the endometrium and its glandular layer.

Relapses of hyperplasia after hormonal therapy occur quite often: in 14% of patients with the Mirena system installed and in 30% when taking gestagens in tablets. Therefore, such patients require long-term observation.

Intrauterine device "Mirena"

After achieving the effect, the second stage of treatment begins - rehabilitation to restore the menstrual cycle and reproductive function. To do this, the woman is prescribed combined contraceptives for six months. After this, separate curettage with hysteroscopy is again necessary.

After completing hormonal therapy, it is necessary to constantly monitor ovulation. With anovulatory cycles, the risk of relapse of the disease is very high. Ovulation can be determined using special tests, as well as a simple method of measuring rectal temperature. For anovulation in young women, its stimulation with Clomiphene is recommended, and if this drug is ineffective against the background of the syndrome, surgical intervention is necessary.

After complete completion of all treatment stages, control is carried out after 3 and 6 months. A cytological examination of the aspirate from the uterus and an ultrasound scan are performed, and after 6 months, curettage is also performed under the control of hysteroscopy.

The complete cessation of menstruation after hormonal treatment in premenopausal women is a good sign. Clinical observation is carried out for another 1-2 years, regularly doing ultrasound and examining aspirate from the uterine cavity. If irregular bleeding returns, a woman should immediately consult a doctor, as this is a sign of a relapse of the disease.

Surgical treatment

Recurrence of atypical hyperplasia in young women requires removal (extirpation) of the uterus. If the disease returns in a pre- or postmenopausal patient, the scope of the operation is expanded to panhysterectomy (removal of the uterus and appendages).

One of the modern treatment methods that can be used is transcervical endometrial resection, that is, removal of the inner layer of the uterus through the cervical canal.

In extremely rare cases, instead of removing the uterus, endometrial ablation is performed. This is only possible if there is a risk of major surgery to life. Even an experienced endoscopist cannot guarantee complete removal of atypical tissue from the uterine cavity, which can cause endometrial cancer.

In addition, after such an operation, adhesions form in the uterine cavity, which interfere with further observation of the patient. Conceiving and carrying a pregnancy after endometrial ablation is extremely problematic. Therefore, leading gynecologists in Russia and foreign countries do not recommend such intervention.

If a woman decides to become pregnant after treatment for hyperplasia, it is necessary to obtain at least one biopsy sample confirming regression of the disease. She should then see a fertility specialist for a pregnancy plan and follow-up plan. Optimal for such patients is.

Traditional methods

Atypical hyperplasia is a precancerous condition that is best treated with surgery. Taking only herbal medicines in this case is completely ineffective and can lead to rapid progression of the disease.

Medicinal plants can only be used as an addition to hormonal therapy:

Borovaya uterus - take 1 tbsp. a spoonful of leaves in 500 ml of water, heat in a water bath for 15 minutes, cool, strain and drink in several doses on an empty stomach;
raw beets - take 50-100 ml of juice per day;
viburnum bark - 1 tbsp. spoon in a glass of water, brew and drink throughout the day;
nettle leaves - brew in a water bath (2 tablespoons per glass of water), take throughout the day.

Prevention

To reduce the risk of endometrial hyperplasia, you must follow these rules:

use for hormone replacement therapy after menopause not estrogens in their pure form, but their combination with gestagens;
for irregular menstruation, take combined oral contraceptives as prescribed by your doctor;
reduce weight;
If irregular bleeding occurs over the age of 35, immediately consult a gynecologist.

With the right choice of treatment, the prognosis for atypical hyperplasia is favorable: in most patients, the development of uterine cancer can be prevented. The best long-term results are recorded after removal of the uterus.