What is uterine adenomatosis? Polyps in the uterus are small growths that do not produce severe pain but still cause health problems. They are formed on the endometrial mucosa. Adenomatous polyp is not very different from other types of uterine polyps - it is only distinguished clinical symptoms. However, uterine adenomatosis should be treated in short time, since the disease can quickly degenerate, thereby acquiring malignant properties. So, how to identify the development of adenomatosis and how is the disease treated?
About the disease
Often, during a preventive ultrasound, women find out that they have endometrial adenomatosis. However, they begin to claim that they did not feel any symptoms of the onset of the disease.
Adenomatosis of the uterine mucosa is benign neoplasm, manifested as a violation of the base of the cells that make up the uterine cavity.
If focal adenomatosis develops quickly, benign polyps can quickly degenerate into malignant ones, which causes significant harm to health.
As a rule, this disease is characterized by an overgrown neoplasm or the appearance of growths on the walls of the uterus. This is what is considered initial stage the occurrence of the disease, since polyps gradually begin to form from such growths. Important: the outcome of treatment and the patient’s condition do not depend on how long the polyp is in the uterine cavity, since they can cause the same harm to human health.
Today, focal adenomatosis is mainly encountered by women whose age varies between 30-50 years, but sometimes the pathology also occurs in young representatives of the fairer sex.
The shape of the resulting polyp is similar to an ordinary mushroom:- The neoplasm has a thin stalk attached to the lining of the uterus.
- The polyp has a body that resembles a mushroom cap.
The size of such a neoplasm is small and amounts to 5-10 mm. Basically, polyps are located on the uterine fundus, completely covering it.
Signs and causes of the disease
Treatment of the disease should be carried out after identifying the causes of adenomatosis, because the preparation of a treatment regimen depends on them.
The causes of the disease include:
- disturbances in the functioning of the immune system;
- performing an abortion or cleaning the uterine cavity;
- "horse racing" hormonal levels;
- frequent stress and depression;
- development of miscarriage in the first weeks of pregnancy;
- untreated inflammatory diseases occurring in the genitals;
- endocrine problems in women;
- untreated fibroids.
These are the main reasons for the development of pathology, but endometrial polyp also often occurs due to heredity. Doctors, first of all, pay attention to this reason, after which they prescribe additional tests.
Symptoms of this pathology include:- problems with conceiving a child;
- copious vaginal discharge of the blood type, which cannot be associated with menstruation;
- permanent bleeding after committing PA;
- pain in the lower abdomen, which often intensifies after sex or heavy exercise.
If the polyps are too large that they occupy the entire uterine cavity, this leads to the fact that the woman is unlikely to be able to fully bear the fetus.
How is pathology diagnosed and treated?
During the examination, the doctor prescribes several diagnostic methods to the patient:
- ultrasound examination of the uterine cavity;
- conducting a blood test;
- smear collection;
- study of hormonal levels;
- gynecological examination of the patient;
- biochemistry.
The doctor also takes into account all the patient’s complaints, after which he prescribes comprehensive treatment.
Atypical endometrial hyperplasia (adenomatosis) is a benign pathological growth and thickening of the uterine lining 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 atypical hyperplasia endometrium:
- 50% of patients have long delays menstruation, after which intense bleeding appears.
- In 10% of patients intense bleeding arise against the background complete absence 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.
Among others secondary symptoms can be distinguished chronic inflammation reproductive organs, mastopathy and fibroids, as well as the absence of pregnancy with regular sexual activity. During hygiene or sexual intercourse, contact bleeding may occur.
Adenomatosis cannot be determined only by clinical manifestations. Sometimes the disease is accompanied by symptoms similar to those of other diseases. It can be paroxysmal pain lower abdomen and lower back, decreased performance, fast fatiguability 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 gland;
- 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 atypical endometrial hyperplasia will help avoid cancer and other serious consequences.
To establish 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 development malignant processes.
Hysteroscopy
The examination is carried out by 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, 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 uniformly 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, when untimely treatment leads to oncology in 15–55% of cases. This form of damage is considered the most dangerous; it is accompanied by uncontrolled proliferation of glands, pathological changes their sizes and shapes. Distinctive feature diseases - the glands in the uterus take on tortuous shapes and grow to different sizes, become 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.
Note! Foci of the disease can also appear as a result of inflammation, trauma, abortion, disorders endocrine system and due to problems with excess weight.
Consequences of hyperplasia
If you don't timely treatment atypical endometrial hyperplasia, 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.
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 a surgical procedure in uterine cavity scars form that impede further diagnosis and treatment.
Cure prognosis
Prognosis for this pathology depends on general condition body, age and genetic predisposition. Based on reviews, competent treatment atypical endometrial hyperplasia provides full recovery and maintaining fertility.
The most severe form is considered to be adenomatosis in combination with any endocrine disruptions in women over 45 years of age. In this situation, extirpation is almost always required. Timely surgery will prevent the formation malignant tumors and will lead to complete recovery.
Preventive actions
To reduce the likelihood of developing adenomatosis, you must follow the basic recommendations:
- consult a doctor if cyclical symptoms occur uterine bleeding(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 a refusal to bad habits. It is recommended to keep healthy image life, perform regular basic physical 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 bloody discharge. For any cycle disturbances, changes in character menstrual bleeding, occurrence cramping pain in the abdomen, you should immediately consult a doctor. Timely diagnosis and proper therapy in most cases give favorable prognoses.
During the development of adenomatosis, the tissues of the uterine mucosa (endometrium) enter the uterine muscle layer and begin to grow. This process is accompanied by disruption of hormone synthesis and decreased immunity. Symptoms of adenomatosis include painful sensations during sexual intercourse, pain in the pelvic area before, during and after menstruation, disorders menstrual cycle, plentiful.
To date, the exact growths of uterine tissue have not been identified. However, it is believed that there is genetic predisposition To this disease. Women who engage in heavy physical labor are at risk. The development of adenomatosis is influenced by constant stressful situations, abuse of solariums and sunbathing.
Ultraviolet irradiation can cause a number of reactions in the body that are not dangerous for young people. After 30 years, the body is more susceptible to the effects of sunlight, so older women are advised to refrain from visiting resorts during the hot season; it is better to postpone their vacation to the “velvet season.” Mud baths can also negatively affect the condition of the endometrium. Uterine surgical interventions, curettage after abortion, and miscarriage increase the risk of developing adenomatosis.
Treatment of adenomatosis
Uterine adenomatosis requires compulsory treatment, otherwise it may provoke more serious illness- cancer. With adenomatosis, a woman will not be able to get pregnant; if conception does occur, there is a high risk of miscarriage. The disease is treated using 2 methods: drug therapy and surgical intervention. On early stage Hormonal medications are prescribed, which must be taken for at least 2-3 months. This type of therapy allows you to avoid surgery. At correct use hormonal agents are safe for the body and do not cause side effects.
Surgery consists of curettage of the uterine cavity with removal of the altered endometrium. The effectiveness of the operation will depend on the degree of development of adenomatosis: the more affected areas, the more difficult surgical intervention and a woman is less likely to become pregnant. Then the patient is prescribed hormone therapy to prevent endometrial proliferation. If the disease is severe, the uterus is removed. This treatment method is applicable if a woman does not plan to have children or her life is in danger.
Content
Adenomatosis is an atypical form of dyshormonal hyperplasia. Researchers believe this form of the disease precancerous condition. Considering that precancerous hyperplasia degenerates into cancerous tumor in approximately 10-20 percent of patients and in the same number of patients it undergoes reverse development, 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 characterized by the formation of a large number of glands, cysts, polyps, which contain cells with an intact structure. This is a relatively harmless form of the disease that still requires treatment.
Brain dysfunctions(hypothalamus) and weakened state immune defense organism (metabolic syndrome) can cause cancer when glandular hyperplasia any age.
Complex hyperplasia consists in the formation in the endometrial tissues of special structures - “glands in the gland”, which are not typical for normal structure uterus (polyps, glandular-cystic or glandular-fibrous formations with a special structure). This is focal adenomatosis.
Adenomatosis of the uterus is not cancer and this is not an indication for removal of the uterus.
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 identifying atypical cells According to the results of histology, it indicates a precancerous condition.
Regardless of research results hyperplastic processes in the uterus must be treated.
Treatment methods
To prevent further spread of the disease and its degeneration into a cancerous tumor, it is necessary to carry out treatment.
Adenomatosis most often causes infertility, but even if conception has occurred, there is a high risk of developing a threat of miscarriage or miscarriage.
At an early stage of the disease, treatment without surgery is possible. Allows you to avoid surgery long-term use hormonal drugs(combined oral contraceptives, estrogen - progestin drugs, gestagens, gonadotropin releasing hormone antagonists, androgens).
In more advanced cases, adenomatosis is treated 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 carried out under general anesthesia and allows not only to completely remove all affected tissue, but also to obtain a large number of material for 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 as minimal expansion is required cervical canal. 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, when other treatment methods are ineffective and high risks cancer development.
After the operation and receipt of 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 lining.
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, “daub”.
- Pain. Pain in the lower abdomen before critical days and during bleeding, lower back pain.
- Metabolic syndrome. Obesity, increased blood insulin levels, hair growth male type, voice changes and the appearance of other masculine traits.
- 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.
Ultrasound examination transvaginal method can with a high degree of probability 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 you suspect accompanying illnesses ovaries or the development of metabolic syndrome, a detailed blood test for sex hormones is prescribed.
Ultrasound for diagnosis should be carried out 5-7 days from the start of bleeding.
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.
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