An ultrasound can diagnose endometrial hyperplasia. On what day of the cycle is it better to do an endometrial ultrasound, and when to do Doppler ultrasound for endometriosis and hyperplasia? The impact of endometrial hyperplasia on current and future pregnancies

2013-11-18 14:28:54

Vika asks:

Hello! help interpret the ultrasound results: the body of the uterus is 50-41-43 cm. Myometrium is homogeneous, m echo 7mm. not expanded, heterogeneous structure with hypo and hyperechoic inclusions. (WHAT DO THEY MEAN?) OD 39-32mm, not enlarged of the usual structure, with an anechoic inclusion of 24mm, with an internal mesh structure - corpus luteum, OS - 39-19 not enlarged, of the usual structure with an anechoic inclusion of 20mm (what is this?) Free liquid in the posterior fornix in small quantities. Regional lymph nodes are not enlarged. Conclusion: echo signs of endometrial hyperplasia. I had an ultrasound before my period, 26 DC. Cycle 26-30 days. For hysteroscopy after 2 unsuccessful IVF. We were referred to an IVF clinic with a suspected polyp. And here they wrote hyperplasia, although the endometrium is only 7mm, maybe this is the case? Thank you.

Answers Gritsko Marta Igorevna:

It’s too early to talk about hyperplasia, because the endometrium is only 7 mm, and before menstruation it will naturally be heterogeneous. Ovulation has passed, but the follicle in the other ovary has not ovulated (anechoic inclusion).
I advise you to undergo an ultrasound scan of the pelvic organs immediately after menstruation, on the 7-9th day of m.c. Then it will become clear whether there is hyperplasia or not.

2015-07-10 14:23:38

Olesya asks:

The answer to your question

June 30, 2015
Olesya asks:
asked a question - Hello!
I am 33 years old. I want to get pregnant. but my diagnosis is glandular endometrial hyperplasia.
I am currently collecting documents for IVF, but I was told that with such a diagnosis they do not accept IVF. According to tests, ovulation is monthly (confirmed by tests, folicometry and the presence of VT in all observation cycles), AMH and FSH are normal, in the middle. There are no signs of hyperplasia on ultrasound. It was discovered in 2012 during hysteroscopy and lapare. The diagnosis was made - ZHE, Endometriosis, endometrial polyp. underwent treatment with Differentelin No. 3. IR for 6 months. After this time, my husband lost viable sperm - 3% of the total was normal, planning was postponed, and GGE returned for the third cycle - the thickness of E at 21 dc was already 18 mm. Accordingly, B did not work out.
everything was deleted. in June 2015, I also had a hysteroscopy on the 11th day of MC - the endometrium was 6-8 mm when the norm was up to 4 mm.
accordingly, again endometrial hyperplasia, although this time without polyps.
menstruation is regular, day by day. There is no bleeding, all hormones are normal - I even checked my insulin. with and without load.
I'm just desperate! I can’t find the cause of this hyperplasia. Now I have a new husband, his SG is excellent, without deviations.
I understand that these are the consequences of an abortion 10 years ago.
but there must be a reason!
Now, I'm waiting for the results of immunohistochemistry. really, this won't do anything for me?
treatment was prescribed - Yarina 3-27 DC. 3 months. The gynecologist-endocrinologist is against it - he says that treatment with duphaston 16-25 dC is enough. By the way, I was never treated with gestagens - I was immediately taken to the ICU.
I read that you need to drink DUF with 3 DC...
In general, what else to examine? what treatment tactics should I choose?

June 29, 2015

Reproductologist, Ph.D.
information about the consultant
Hello, Olesya! The first question is what is your weight and height? Are you overweight? The cause of endometrial hyperplasia lies in the endocrine factor - the level of estrogen. Fat is a depot of estrogen, so if you are overweight, a similar pathology can be observed. The treatment tactics are usually as follows - cleansing with further prescription of hormone therapy, COCs, for example, to adjust hormonal levels. You can prescribe gestagens (the same as Duphaston), but such issues cannot be resolved virtually. Definitely, until the problem with the endometrium is resolved, you will not be accepted into the IVF program.

I answer - my height is 175 cm, weight 60 kg. As you can see, we are not talking about obesity at all.
hormone tests:
my hormone levels are 5 DC
LH - 9.97 with norm 1.1 - 11.6
FSH 9.77 at a norm of 3-14.4
Estradiol 57.8 - normal 0-84
Prolactin (it happens to me, it fluctuates, which, however, does not affect ovulation in any way) - 471 when the norm is 95-700.
testosterone - 0.61 with a norm of 0-4.3
progesterone 0.62 with a norm of 1.05 - 3.83
TSH - 1.37 when the norm is 0.4 - 4.0
free thyroxine 14.5 when the norm is 10-24.5.
DHEA - 2.13 at a norm of 0.95 - 11.6
CA -15-3 - 14.4 with a norm of 9.2-38
SA-125 - 18.4 at a norm of 1.9-16.3
insulin - 4.56, normal 0-29.1
ATA - 19.4

on the 21st day of the cycle (cycle 26-27 days) - 67.8 with a norm of 10-89

at 2 DC (they said it was to be taken on this very day) - AMH - 5.51 with a female norm of 1.5 (0.08-10.6). prognosis - risk of developing ovarian hyperstimulation if more than 3.0

It seems to me that in the first phase progesterone is low. maybe this is the issue??? Maybe I should actually take progesterone continuously? I am very afraid that GE will return. The last hystera was performed on June 16, 2015.

July 09, 2015
Palyga Igor Evgenievich answers:
Reproductologist, Ph.D.
information about the consultant
Hello, Olesya! According to ultrasound, the diagnosis of “endometrial hyperplasia” can be suspected after undergoing examination in the first phase of m.c. (immediately after the end of menstruation) On the 11th day of m.c. endometrial thickness of 6-8 mm is considered normal. After the last hysteroscopy, did the histologist diagnose ZHE or are you just waiting for the conclusion? If there is no specific histology conclusion yet, then we are talking about nothing. I don’t see any indications for the use of IVF today. If your husband’s spermogram is excellent, you are ovulating, the fallopian tubes are passable (by the way, have you checked them?) and hyperplasia is not histologically confirmed, then you need to try to get pregnant on your own. How long have you been openly sexually active with your new husband? If ZGE is confirmed again, then I would advise taking COCs (the same Yarina) for a period of 3 months and planning pregnancy while canceling.

Doctor, I have been living with my new husband without protection since December 2013. Histology confirmed simple glandular endometrial hyperplasia. It was not visible on ultrasound. It was a focal form. Forming polyps are questionable. Micropolyp of the cervix. The pipes are passable. And endometrium - they cause inflammation of the stroma. The receptors respond to both hormones - estradiol and progesterone. I drink janine. And I was readmitted - I asked for an aggravation. Currently being treated with antibiotics. And they prescribed physio. I know Janine sometimes drinks without a break for 3 months. Should you still take a break? Should I go to Eco afterwards - despite the fact that everything seems to be ok, there has been no pregnancy since 2010. I'll be 34 this year (((

Answers Palyga Igor Evgenievich:

Hello, Olesya! If endometritis (inflammatory process of the endometrium) is present, it must be treated with antibiotic therapy. Physiotherapy won't hurt either. Take COCs for 3 months according to the schedule (there is no need to take them continuously). If you and your husband have been openly sexually active for more than a year and do not become pregnant, then it is still rational to plan IVF, although you can try to get pregnant on your own after a course of treatment for endometritis while you have stopped using COCs. If it doesn’t work out, then the option of IVF remains.

2015-01-14 19:01:55

Nadezhda asks:

Hello, I'm very worried. Today I had an ultrasound, see the doctor only in 5 days. Please tell me, is this very scary, can we suspect the worst? The left ovary and uterus are all fine. The right one is not visualized. In the projection of the ovary, intimately to the right rib of the uterus, an ovoid-shaped formation measuring 75 by 53 mm is visualized, heterogeneous in structure with hyperechoic inclusions and an area of ​​reduced echogenicity in the center, without peripheral vascularization. The conclusion is a tumor-like formation of the right ovary. Ultrasound signs of endometrial hyperplasia. Adhesive process in the pelvis. Thank you in advance! The doctor said the mass is larger than the uterus, I’m terrified

Answers Radko Vitaly Yurievich:

Nadezhda While you are waiting for an appointment with a doctor, take a blood test for ovarian tumor markers (CA-125 + HE-4). Lack of peripheral blood flow is a good sign. Don’t get too upset yet, it’s too early to draw conclusions, further examination is necessary.

2014-05-14 16:26:02

Maria asks:

Hello! I'm 55. I've been menopausal for 5 years now. I have been experiencing health problems for the last year. Anemia of the body, bleeding. I recently had an ultrasound and was diagnosed with signs of endometrial hyperplasia, diffuse changes in the myometrium. The endometrium is 5 mm thick and has a normal structure. The structure of the myometrium is diffusely heterogeneous. The uterus is not enlarged. I took tests for cancer cells. They will be available only in a month. Tell me how dangerous this is for health? Can this be treated? (medically or surgically) And what are the further consequences? Thank you.

Answers Gritsko Marta Igorevna:

In case of endometrial hyperplasia and bleeding, you need to carry out cleaning with further prescription of hormone therapy. Don’t worry, at your age this is quite common and can be successfully treated.

2014-03-05 18:47:51

Galina asks:

Hello. My husband and I want a child. Ultrasound analysis showed: the body of the uterus is determined, position in anteflexio, dimensions 46*38*50 mm. The myometrium is homogeneous, the endometrium thickness of the functional layer is 20 mm, taking into account the day of the cycle, it is thickened. The structure of the structure is isoechoic, moderately heterogeneous, closer to the secretory type. The cervix is ​​determined by its size, the structure is not changed, the cervical canal is not dilated. The left ovary measures 31*15*15, volume 3.6 cm in kV. The structure is with a corpus luteum of 18*16 mm; with color circulation, active blood flow is not recorded. The right ovary is determined to be 26*15*14 mm, volume 2.7 cm cubed. The structure is not changed - follicles are 4.6 mm in diameter, in a section up to 8 mm. Conclusion Ultrasound signs of endometrial hyperplasia. I donated blood for hCG, the result is 0-5, there is no ectopic pregnancy, but my period is 10 days late. Can the above diagnosis affect pregnancy? I was prescribed Duphaston tablets, I will take them from March 6th.

Answers Gritsko Marta Igorevna:

You are not pregnant, you have a hormonal imbalance, that’s why you were prescribed duphaston in order to induce menstruation. Are your periods heavy? If yes, then endometrial hyperplasia can indeed be suspected.

2014-01-31 09:15:41

Victoria asks:

Hello! Please help me figure it out! I am 33 years old, my periods come on time “+” “-” 2-3 days, all my life I have had them for 6-7 days, 2-3 days - heavy. There has never been any bleeding during the intermenstrual period. I had 1 birth (the child is already 14 years old), 2 abortions, 1 miscarriage, 1 abortion and 1 miscarriage. My husband and I always protected ourselves with a condom, calculating dangerous days, i.e. Open sexual intercourse always took place the last week before menstruation. Now we are in our second month of living openly sexually for the purpose of pregnancy. Nothing worries me. I measured BT for half a year and kept a chart. Passed tests for hormones. At 4 d.c. - LH - 11.21 mIU/ml, FSH - 6.70 mIU/ml, Prolactin - 9.7 ng/ml, Estradiol - 50.0 ng/ml; At 21 d.c. - Testosterone-0.379 ng/ml, Progesterone-8.62 ng/ml. Next, I took PCR diagnostic tests for infections. Results: Neisseria gonorrhoeae - NOT detected, Trichomonas vaginalis - NOT detected, Chlamydia trachomatis - NOT detected, Mycoplasma genitalium - NOT detected, HPV 16,18,31,33,35,39,45,51,52,56,58,59 - NOT detected, Ureaplasma urealiticum col. - 0, Mycoplasma hominis count. - 0, Gardnerella vaginalis count. - 0, Biovars T 960 - 0, Biovars PARVO - 0
BUT!!! The ultrasound data alarms me - everyone is different! I'll write a conclusion.
1) 2011, 24 d.c. - Ultrasound signs of endometrial hyperplasia(?), endometrial polyps cannot be excluded
2) 2011, 13 d.c. - Echo signs of structural changes corresponding to previous metroendometritis. Multifollicular ovaries.
3) 2013, 9 d.c. - Echo signs of possible polyposis
4) 2013, 9 d.c. - Ultrasound data for chronic metroendometritis, bilateral salpingoophoritis. Endometrial pathology cannot be ruled out (polypoid hyperplasia?) P.S. Moreover, I came to this doctor with a question to see if I specifically had polyps or not, she answered that she couldn’t see!!!
And so I decided to undergo an MRI of the pelvis, which completely killed me!!!
2014, 7 d.ts. (they also smeared menstruation, but very, very little, literally 1 drop). Here's what it says:
The uterus is in the anteversio anteflexio position, with dimensions: body of the uterus - 5.7 * 4.6 * 5.9 cm, cervix - 3.1 * 2.3 cm. The organ cavity is slightly expanded, there is a thickening of the endometrium up to 1.0 cm ( does not correspond to the MC phase), the MR signal from it is quite homogeneous, without signs of intracavity formations.
The transition zone is clearly differentiated, in the area of ​​the anterior wall of the uterine body, a locally expressed zone of thickening of the transition zone up to 1.0 cm is determined (focal adenomyosis?), throughout the rest of the thickness the maximum is 0.6 cm, with isolated small cystic inclusions, probably post-inflammatory character. Myometrium without focal formations.
The ecclesiastical canal is not dilated, the endocervix is ​​quite homogeneous. In the cervical area, multiple Nabothian cysts measuring 0.3-0.5 cm are identified.
The right ovary measures 4.0*2.1 cm, with clear, even contours, contains a moderate number of follicles, up to 1.1 cm in size, against the background of which a rounded formation is determined in the structure of the ovary, a hyperintense MR signal on T1VI, T2WI, FS, measuring 1.2*1.0 cm, with clear contours, probably an endometrioid cyst. The adjacent sections of the tube are somewhat thickened. There is also a slight accumulation of fluid along the periphery of the ovary, probably due to a chronic inflammatory process.
The left ovary measures 3.6*2.0 cm, the structure contains a moderate number of follicles, up to 1.0 cm in size. The structure of the ovary reveals a rounded formation, a hyperintense MR signal on T1VI, FS, with a hypointense T2VI rim on the periphery, measuring 0.9*0.6 cm, it is also likely an endometrioid cyst. The adjacent sections of the tube are somewhat thickened. There is also a slight accumulation of fluid along the periphery of the ovary, probably due to a chronic inflammatory process.
The bladder contains a small amount of urine, its walls are not changed. Filling defects are NOT detected in its lumen.
There was NO convincing evidence for enlargement of regional lymph nodes at the time of the study.
A small amount of free fluid is detected in the pouch of Douglas.
Conclusion: MR signs of thickening of the endometrium of the uterine body, probably due to its hyperplasia. Local area of ​​thickening of the transition zone of the anterior wall of the uterine body, with heterogeneity of its structure (focal adenomyosis?). Formations of both ovaries, most likely endometrioid cysts. MR signs of chronic bilateral salpingoophoritis.
I've heard a lot about commercial diagnoses. I live in a resort town where everything is built on money. Tell me, can I get pregnant? Is there any danger in anything? I'm going abroad and want to undergo an ultrasound there. I am alarmed that according to the tests everything is fine, but only the ultrasound gives me different types of sores. I had all the ultrasounds for testing purposes. Moreover, one doctor referred me for surgery, another said that I would undergo treatment and everything would pass. In 2013, I took Wobenzym, Polygynax Suppositories, Unidox Solutab, Mikosicht, Bifiform = 10 days. And then it turned out that everything was sad for me! Apparently these fears prevent me from calmly enjoying my sex life. and conceive a child. I will note that my husband and I have just begun to live an open sex life. Thank you!

Answers But Galina Nikolaevna:

Endometrial hyperplasia and ovarian endometriosis may be accompanied by unchanged tests, which are presented above.
Taking into account the MRI results, it is recommended: ultrasound in the second phase of the cycle (on the eve of menstruation), endometrial aspiration bipsy (performed on an outpatient basis).

2013-11-24 13:22:00

Elena asks:

Hello! I am 49 years old. Ultrasound shows signs of endometrial hyperplasia and adenomyosis. The doctor prescribed RDV and hysteroscopy, tests for hormones and tumor markers. The cycle became irregular, sometimes there was nothing for 2 months, sometimes several times a month. When is it better to take tests for hormones and tumor markers with such an irregular cycle?

2013-10-06 10:05:49

Irina asks:

Good afternoon. I am 40 years old, 2 pregnancies (2 cesareans), no abortions. Menstruation begins and ends with spotting, including 3-5-rarely 7 days, of which 1 day is very heavy (generally heavy periods from the age of 12). No pain. The abundance during the day is the only thing that worries me, but an ultrasound showed that there are hyperechoic inclusions of 1-2 mm in the myometrium, and most importantly, that the thickness of the endometrium is 22 mm and, as a result, the conclusion is stage 2 endometriosis of the uterine body, signs of endometrial hyperplasia. Please explain whether it is possible to start treatment with hormones. therapy without scraping (I’m very afraid of this) - after all, the endometrium is renewed every month - so you can try it from the beginning of a new cycle? - or I misunderstand something. And is this done somewhere with a laser, so it’s not mechanical?

2013-08-28 12:20:58

Ekaterina asks:

I am 20 years old.
At the age of 14 I had anorexia - I didn’t have my period for six months (they started six months before), I lost weight from 57 to 41-42 kg in about 3 months.
When I came to my senses, I began to recover, after the first menstruation they did an ultrasound - the dystrophy began to improve, there was a suspicion of a follicular cyst, but the specialist said that it would most likely go away on its own after a couple of cycles. I started to get better and ended up with 63.
I have not been and am not sexually active. During examinations at school until the 10th grade, gynecologists did not find anything, and after that I did not go to the doctors - nothing bothered me. I had heavy but not particularly painful periods. Since my mother had the same ones, I did not go to the doctors. Since the 10th grade I had iron deficiency anemia, they treated it symptomatically - they took pills, as soon as the iron level increased, they stopped. The fact that the anemia was returning worried us, we made a visit to specialists and found a cyst at the gynecologist, 18 cm (I still didn’t fully understand what kind, it seemed to be follicular). There were signs of endometrial hyperplasia (19 mm in the second phase).
After laparoscopy, regividone was prescribed. After 3 cycles, everything on the ultrasound was fine, even the ovary was restored in size. But I started gaining weight. Recommended by Jess.
Jess drank 6-7 packs, no complaints. Now I did an ultrasound on the 7th day of the cycle. The ovaries are fine, but the endometrium in the uterus is 11 mm. They diagnosed a “sign of hyperplasia.” It should be noted that during the previous cycle I had a slight intestinal disorder, I took a couple of tablets of chloramphenicol, and all this against the backdrop of a 2-week vacation at sea with a tan. And during the cycle before that, I generally had a fever and took 2 courses of antibiotics.
Sorry for such a long and detailed story, but I have a question. I really liked Jess - I don’t feel any side effects at all, I can easily tolerate it. His periods are of average abundance, there is one strong day, the rest are of average, medium-sparse abundance. Now the doctor advised me to switch to Janine as it has an anti-endometriosis effect. Could it be that this hyperplasia was provoked by the events of this summer and does not mean that Jess is not suitable for me? If so, could this also appear on a COC aimed specifically at treating this disease? How concerned should we be about this ultrasound result?

Uterine endometrial hyperplasia is a disease of the inner lining of the uterus, in which changes occur in the stroma and glands of the endometrium. In this case, the cells of the mucous membrane grow, and the endometrium thickens significantly compared to the normal state. How to treat this disease and is it dangerous? Let's figure it out.

Uterine endometrial hyperplasia - what is it?

The disease is based on increased reproduction and, in some cases, a change in the structure of cells, as a result of which the volume of the uterus itself increases.

Most often, the disease is caused by hormonal imbalances and develops against the background of pathologies of lipid and carbohydrate metabolism, various gynecological diseases, as well as some extragenital disorders.

Uterus in normal condition and with hyperplasia

Women whose bodies intensively produce estrogens and have a deficiency of progesterone are more susceptible to endometrial hyperplasia than others.

Thus, the main risk group includes women suffering from mastopathy, uterine fibroids, polycystic ovary syndrome, endometriosis, as well as lipid metabolism disorders, hypertension, liver diseases in which the breakdown of hormones is disrupted, as well as high blood sugar levels.

Women during menopause and late menopause, suffering from obesity, diabetes mellitus and arterial hypertension are significantly susceptible to the development of endometrial hyperplasia.

The main and most dangerous complication of hyperplasia is the malignancy of the structure, that is, its degeneration into a cancerous tumor. Malignancy of hyperplasia occurs in 1–55% of cases, depending on the type and rate of development of the disease, as well as the woman’s age and previous diseases.

Reasons for appearance

Most often, the development of the disease occurs against the background of hormonal disorders. The body of a woman of reproductive age is subject to cyclical changes, the most pronounced ones being the ovaries and the endometrium of the uterus. From the first day after menstruation, the endometrium enters the proliferation stage, due to which it prepares for a possible pregnancy.

Throughout the entire cycle, thickening occurs, and in case of unsuccessful pregnancy, rejection of the mucous layer of the uterus, the volume of which increases approximately 10 times during one menstrual cycle.

Thickening or hypertrophy of the endometrium occurs due to an increase in the intercellular substance, as well as an increase in the size of epithelial cells, connective and glandular tissue.

Most often, the development of the disease occurs against the background of hormonal disorders.

If hormonal levels are disrupted, in particular, an increase in the amount of estrogen production, a decrease in the amount of progesterone and a change in their ratios in the blood, a disruption may occur in the cyclic process occurring in the endometrium: its volume may begin to increase not due to the intercellular fluid, but due to increased reproduction and formation new cells.

Such hormonal disorders are characteristic of ovarian dysfunction caused by approaching menopause, polycystic disease and hormonally active ovarian tumors, mastopathy, as well as obesity (excess adipose tissue is also capable of producing estrogens).

An increase in the level of estrogen in the blood can be caused not only by internal processes, but also by external factors, for example, taking hormonal drugs, such as contraceptives, without progesterone.

The risk of endometrial hyperplasia also increases in women who have suffered from certain somatic diseases and conditions: obesity, chronic stress, hypertension, liver disease with its functional failure.

Endometrial hyperplasia is often preceded by diseases and surgical treatment of the uterus: uterine leiomyoma, inflammatory diseases of the endometrium, intrauterine disorders of organ development, abortion, curettage for endometrial hyperplasia.

Disease during menopause

During the age-related decline of ovarian function in the female body, strong hormonal changes occur, similar to what occurs during puberty. The gradual depletion of the ovaries and a decrease in the number of ovulatory cycles in a weakened body often leads to an imbalance of hormones.

In addition, during perimenopause, the endometrium becomes more sensitive to the cyclic effects of hormones and gradually begins to undergo involutive changes and atrophy. Due to this, endometrial hyperplasia in women of premenopausal and menopausal age occurs many times and even tens of times more often than in women of reproductive age.

The percentage of endometrial hyperplasia in menopausal women sometimes reaches 73%, and in more than 60% of cases the disease is accompanied by severe uterine bleeding, and in 30–50% of cases it can develop into cancer.

That is why endometrial hyperplasia in the menopause is given special attention, especially when choosing a treatment method.

Classification

Depending on the mechanism of development of the process, as well as the type of its course, glandular and glandular-cystic, atypical hyperplasia or adenomatosis (focal and diffuse), as well as glandular and fibrous endometrial polyps are distinguished. Depending on the degree of development, simple, moderate and complex forms of hyperplasia are distinguished.

Glandular

Refers to benign or background processes occurring in the endometrium of the uterus. Manifested by proliferation of endometrial stroma and glands. At the same time, the mucous membrane thickens, and an irregular arrangement of glands in the stroma is observed. The glands acquire a tortuous shape.

Depending on the severity of proliferation processes, active and resting forms of glandular endometrial hyperplasia are distinguished, which corresponds to acute and chronic forms of the disease.

In the active stage, a large number of mitoses are observed in the cells of the stroma and epithelium of the glands, which indicates intense stimulation of the process by estrogens. The chronic form is characterized by rare mitoses formed during prolonged exposure to low levels of estrogen.

Malignancy of glandular hyperplasia occurs in 2–18% of cases and most often occurs in premenopause. Therefore, the presence of this disease in premenopausal women is considered a precancerous condition.

Glandular-cystic

It is the same glandular hyperplasia, but more pronounced. In the glandular-cystic form, cystic-enlarged glands are observed, which are absent in the glandular form of hyperplasia.

Cystic

Similar to the concept of glandular cystic hyperplasia. It is characterized by dilated glands that are lined with normal epithelium.

Basal

It is quite rare. It is characterized by thickening of the basal layer of the endometrium due to the proliferation of the glands of its compact layer, as well as stromal hyperplasia with the appearance of polymorphic nuclei of large stromal cells.

Atypical

Adenomatosis or atypical endometrial hyperplasia is characterized by more intense proliferation of glands and their structural restructuring.

At the same time, endometrial cells not only multiply intensively, but the structure of their nucleus changes, which in some cases is a sign of the development of oncology.

Adenomatosis can develop in the functional, basal or simultaneously in both layers of the endometrium, and the latter option is the most dangerous due to the high probability of the formation degenerating into oncology.

Depending on the location of atypical hyperplasia, diffuse and focal forms of the disease are distinguished

Adenomatosis can develop not only in hyperplastic endometrium, but also in thinned and atrophic ones.

There are cellular hyperplasia of the endometrium, in which changes occur at the level of stromal and epithelial cells, and structural, characterized by changes in the shape and location of the glands. According to the degree of development of the disease, its forms are distinguished: weak, moderate and severe.

With a weak degree of adenomatosis, glands of various sizes are separated by multinucleated and columnar epithelium of the glands, as well as thin layers of stroma. A moderate degree of development is characterized by a change in the shape of the glands. With a pronounced form, there is an abundant proliferation of glands and their close contact with each other, as well as an almost complete absence of stroma between them. In this case, polymorphism is noted in the multinuclear epithelium of the glands.

Depending on the location of atypical hyperplasia, diffuse and focal forms of the disease are distinguished.

Diffuse

It is formed evenly over the entire surface of the endometrium. In this case, proliferation of uterine epithelial cells occurs along with a uniform thickening of the entire endometrial layer.

Focal

It is expressed in the proliferation of cells in a limited area of ​​the uterine cavity. It often develops against the background of glandular or glandular-cystic hyperplasia, in polyps, as well as unchanged endometrium.

Endometrial polyps

In approximately 0.5–5.5% of cases of detected hyperplasia of the mucous membrane of the uterine body, the changes are in the nature of polyps - the growth of individual areas of the endometrium with the underlying stroma. There are fibrous, glandular and glandular-fibrous polyps, adenomatous and with focal adenomatosis.

Fibrous polyps are characterized by a predominance of connective tissue, glandular polyps - by a glandular component. Glandular-fibrous ones are characterized by the presence of glands of various shapes and lengths, thickening of the walls of blood vessels. Adenomatous polyps are characterized by intensive growth of the epithelium and an abundance of glandular tissue; in some areas of polyps with focal adenomatosis, active proliferation of epithelial glands and its structural restructuring are observed.

Modern classification

At the moment, a more modern classification is more often used, according to which hyperplasia is divided into simple and complex atypical or without atypia.

Simple endometrial hyperplasia

• Simple typical hyperplasia is characterized by an increase in the number of glandular and stromal structures compared to normal ones, with the former slightly predominant. In this case, the following picture develops:
• the endometrium increases in volume;
• the structure of the endometrium changes (the stroma and glands are active, the glands are unevenly located, cystic expansion of some of them is observed);
• vessels in the stroma are evenly distributed;
• nuclear atypia is absent;
• progresses to cancer in 1–3% of cases.

Simple atypical endometrial hyperplasia manifests itself in a change in the normal location of the nuclei of glandular cells, as well as their unusual, often round shape.

Simple typical hyperplasia is characterized by an increase in the number of glandular and stromal structures compared to normal

Polymorphism of cell nuclei is often observed; large nucleoli are often found in them. Characteristic signs of this form of the disease include:

• cellular dyspolarity;
• anisocytosis;
• increased size and hyperchromatism of nuclei;
• expansion of vacuoles;
• cytoplasmic eosinophilia;
• In approximately 8–20 cases out of 100, malignancy occurs.

Complex

Complex typical hyperplasia is expressed in the close arrangement of the glands of the entire endometrium or in separate foci. It is characterized by the following manifestations:

• more pronounced proliferation of glands compared to simple typical hyperplasia;
• the glands acquire an irregular structure and shape;
• the balance between the proliferation of stroma and glands is disrupted;
• multinucleation of the epithelium is more pronounced in comparison with the same simple typical hyperplasia;
• nuclear atypia is absent;
• progresses to uterine cancer in approximately 3–10% of cases.

Complex atypical endometrial hyperplasia is the most dangerous handicap for a woman, developing into uterine cancer in approximately 22–57% of cases. It is characterized by pronounced proliferation of the epithelial component with atypia at the cellular and tissue level. At the same time, the glands become varied in shape and size and are located irregularly. The epithelium lining the glands consists of large cells with round or elongated polymorphic nuclei.

Moderate

It is a transitional phase from simple to complex hyperplasia of the corresponding form, therefore it does not have clear signs and is not distinguished as a separate stage of the disease.

Symptoms and signs

Quite often, endometrial hyperplasia is asymptomatic and is detected only during a routine ultrasound. Of the symptoms accompanying the pathology, the following are most often noted:

1. Menstrual irregularities. It is the most common and almost constant symptom of the disease. Women of reproductive age with polyps that arise against the background of a normally functioning endometrium experience bloody discharge before and after regular menstrual bleeding, as well as heavier menstruation.
2. Bloody spotting between periods
3. Delayed menstruation followed by prolonged and heavy uterine bleeding.
4. Menorrhagia with fibrous and glandular-fibrous polyps, metrorrhagia with anovulatory cycles and the presence of endometrial glandular polyps. Such symptoms are more typical for women over 45 years of age who have entered the premenopausal phase.
5. Infertility, in the absence of which there is a violation of the process of egg formation or the impossibility of implantation into the endometrium.

Diagnostics

The most common diagnostic method is ultrasound using an intravaginal probe. The picture allows you to see the thickening of the endometrium, as well as determine the presence and location of polyps in the uterus. Ultrasound diagnostics is the simplest, cheapest, least traumatic method for studying endometrial hyperplasia, but its information content does not exceed 60%.

• Echosalpingography

It is aimed primarily at studying the patency of the fallopian tubes, but during the examination the cavities in the uterus, characteristic of polyps and hyperplasia, are quite clearly visible.

• Biopsy

In the second half of the menstrual cycle, if the presence of a disease is suspected, an aspiration or biopsy of the uterine mucosa is performed, followed by examination of the material under a microscope. This method gives high results, but is ineffective in cases of focal spread of changes, since there is no guarantee of taking material specifically from the focus of hyperplasia.

• Hysteroscopy

Hysteroscopy with targeted biopsy is one of the most informative methods for studying the disease. Allows you to take samples directly from the lesion, as well as visually assess the condition of the inner lining of the uterus.

This method gives the most vivid picture of the nature and degree of development of hyperplasia, and at the same time it is also a method of treating the disease.

During the procedure, the inner lining of the uterine body and, separately, the cervical canal are scraped with a mandatory histological examination of the material taken.

The affected endometrium can only be removed mechanically

Based on the results of histology, an accurate diagnosis is established and treatment is prescribed. Curettage of the uterine cavity is the first and almost inevitable stage of treatment for hyperplasia, since the affected endometrium can only be removed mechanically.

In addition, in some cases, a radioisotope study of the uterus is carried out using radioactive phosphorus, which makes it possible to determine not only the presence, nature and extent of the disease, but also its activity.

Drug treatment

Treatment can be either medication or surgery followed by drug therapy. In this case, the tactics and principles of treatment are selected taking into account many factors: the type of hyperplasia, the age of the patient and her state of health.

The basis of drug therapy in the treatment of endometrial hyperplasia is hormone therapy using combined oral contraceptives, gestagens or GnRH agonists. Conservative treatment is aimed at regulating hormonal levels by reducing estrogen levels, as well as stopping the proliferation of the uterine mucosa and reducing foci of hyperplasia.

Combined oral contraceptives

Treatment with COCs is often prescribed to adolescent girls or young nulliparous women with heavy, irregular menstruation due to glandular or glandular cystic hyperplasia. In some cases, in order to avoid curettage, COCs are also prescribed for hormonal hemostasis, so as not to resort to emergency curettage. The course of therapy is long, lasting at least 6 months. The drugs are taken according to a contraceptive regimen.

Synthetic analogues of progesterone

Treatment with gestagens is prescribed to women of any age with any form of this disease. Long-term treatment is often carried out over 3–6 months. While taking gestagens, intermenstrual bleeding may occur.

Duphaston

One of the most well-known effective gestagenic drugs used in conservative treatment. Prescribed for long-term use for at least 3 months, 2 tablets 3 times a day from 16 to 25 days of the menstrual cycle. In case of bleeding for 3-4 days, the dose is doubled, then the standard regimen is continued.

Norkolut during the period of illness

The drug is not an active gestagen, but has a pronounced antiestrogenic character. For glandular cystic hyperplasia, 1 tablet per day is prescribed from the 16th to the 25th day of the menstrual cycle for 3–6 months. To stop bleeding caused by hormone therapy, take 1-2 tablets per day for 6-12 days.

Mirena

The Mirena intrauterine device is used as an effective contraceptive, as well as a means of hormonal therapy as a local progestogen. The positive aspects of treatment with Mirena include a long-term (5 years) and effective method of protection against unwanted pregnancy and the local therapeutic effect of hormones on the endometrium of the uterus.

The negative aspects of using the product include the possibility of intermenstrual bleeding in the first few months after installation of the IUD, as well as painful menstruation.

Gonadotropin releasing hormone agonists

AGnRH is a modern and most effective class of drugs used in the treatment of endometrial hyperplasia. The advantage of treatment with drugs of this class is the high percentage of positive treatment results, the possibility of flexible dosing, as well as switching to a convenient regimen for taking the drug - only once a month.

The active ingredients of the drugs block the production of sex hormones, resulting in endometrial atrophy and inhibition of cell and tissue proliferation. With the help of GnRH agonists, in most cases, infertility and hysterectomy can be avoided.

How to treat with surgical methods

Surgical treatment can be carried out using various methods and in various volumes.

• Curettage of the uterine cavity

It is both a diagnostic and therapeutic measure carried out to remove the pathological layer or section of the endometrium and stop bleeding. Materials removed from the body of the uterus must be subject to histological examination.

• Cryodestruction

Used for the treatment and prevention of endometrial hyperplasia. The essence of the method is based on the effect of low temperatures on the affected area.

As a result, the hyperplastic layer of the endometrium is rejected

As a result, the hyperplastic layer of the endometrium is rejected, vessels larger than 2 mm in diameter do not undergo necrosis.

• Cauterization or laser ablation

The method involves exposing the affected area to laser or high temperatures using an electrosurgical instrument.

In this case, the pathological areas are destroyed, and the uterine epithelium is naturally restored.

• Removal of the uterus or hysterectomy

Indicated in the presence of complex atypical hyperplasia in premenopausal women. In this case, the ovaries are preserved, but their tissues are thoroughly examined for the presence of oncological processes. Complete removal of the uterus along with appendages is indicated for obvious oncological processes, as well as for adenomatosis in postmenopausal women.

• Combined treatment

In most cases, it involves surgical treatment followed by restorative hormone therapy, and in some cases, previous use of hormones can significantly reduce the volume of the operation or affect lesions that are beyond the reach of surgical removal.

Treatment of hyperplasia with traditional methods

When choosing folk remedies for the treatment of endometrial hyperplasia, it is important to take into account that the best effect is achieved by combining traditional methods of treatment with hormonal therapy and surgical treatment. Long-term use of herbal medicines without formal treatment can lead to aggravation of the situation.

• Comprehensive 4-week course of juices and celandine

For the first month, you should drink 50–100 ml of fresh carrot and beet juice every day. Morning and evening before meals, take 1 tbsp. l. flaxseed oil, washed down with 1 tbsp. water. Twice a month you should douche with an infusion of celandine (3 liters of boiling water and 30 g of fresh herbs).

In the second month, 100 ml of Cahors tincture and aloe juice are added to the daily treatment: 400 ml of juice, 400 ml of natural honey and 700 ml of Cahors leave for 2 weeks. Three times a day, an hour before meals, drink 1.5 tbsp. tincture of boron uterus (1 tbsp. dry herb per 0.5 liter of boiling water).

In the third month, douching is removed. At the beginning of the fourth month, they take a week's break, after which they continue treatment with tincture of boron uterus and linseed oil.

• Nettle treatment

Prepare an alcohol tincture: 200 g of fresh herbs per 500 ml of 70-proof alcohol, leave for 2 weeks. Take 1 tsp to restore immunity. twice a day.

You can prepare a decoction of 2 tbsp. l. leaves and a glass of boiling water. Take ¼ cup up to 5 times a day.

• Herbal collection

Prepare a mixture in the ratio 1:1:2:2:2:2 from shepherd's purse grass, serpentine, cinquefoil and calamus roots, nettle leaves and knotweed grass. 2 tbsp. l. the mixture is poured with 500 ml of water, boiled for 5 minutes and wrapped for 1.5 hours. Take 100 ml twice a day.

The impact of endometrial hyperplasia on current and future pregnancies

Any disease of the female reproductive system can lead to infertility, including endometrial hyperplasia.

In this case, the disease always develops against the background of a hormonal disorder, in which the production of an egg often does not occur.

If the follicle matures and the egg is fertilized, pregnancy will also not take place due to the impossibility of implantation of the egg into the body of the uterus.

Pregnancy with endometrial hyperplasia is a fairly rare occurrence.

Pregnancy with endometrial hyperplasia is a fairly rare occurrence that threatens, at a minimum, miscarriage, and at most, serious developmental defects.

In addition, with a long-term illness, the formation of tumors that were not diagnosed before pregnancy is possible, which grow rapidly along with the fetus, and in the case of an oncological nature, threaten the life of both the child and the mother.

In most cases, pregnancy simply does not occur. However, restoration of reproductive function after hyperplasia is possible in almost all cases. Therefore, if she wants to give birth to a child after hyperplasia, a woman must undergo a comprehensive examination and a mandatory course of treatment, after which after 1–3 years she will be able to plan a pregnancy.

Unfortunately, not every woman regularly comes for a routine gynecological examination. As a result, many problems, diseases and pathologies are identified only when a woman decides to give birth to a child, but conception does not occur. It is at this point that she consults a doctor to identify the cause, and research may reveal endometrial hyperplasia on ultrasound.

Endometrial hyperplasia

Endometrial hyperplasia is a deviation in the structure and functioning of the mucous membrane, which covers the uterine cavity from the inside, and is called the endometrium. As a result of this pathological process, mucosal tissue begins to grow uncontrollably.

Symptoms of pathology

You should consult a doctor if a woman has the following symptoms, since this is how endometrial hyperplasia can manifest itself:

• after menopause, scanty bloody discharge appeared;
• prolonged periods with heavy discharge;
• unstable menstrual cycle;
• the occurrence of bleeding at inappropriate times;
• infertility;
• Pain intensified during menstruation.

However, there are also cases when the pathology occurs without any symptoms. In this case, the woman may not even suspect that she has endometrial hyperplasia, but the doctor discovers this disease during an ultrasound or during a gynecological examination.

Causes of pathology

The most common reasons that provoke the development of endometrial hyperplasia include the following factors:

• hormonal imbalance;
• overweight;
• gynecological problems and diseases;
• abortions;
• surgical interventions in the uterine cavity;
• endocrine diseases;
• mastopathy;
• increased blood pressure;
• liver diseases;
• hereditary factor.

It is worth knowing that a single cause most likely will not provoke the appearance of endometrial hyperplasia, but a combination of several factors is quite capable of causing the development of this pathology.

Diagnosis of endometrial hyperplasia

If there is a suspicion that a woman has hyperplasia, the doctor will prescribe a series of examinations. For comprehensive diagnostics, the following methods are used:

• examination of the woman by a qualified gynecologist;
• conducting hormonal screening;
• ultrasound examination (ultrasound);
• histological examination;
• biopsy;
• dopplerography;
• X-ray;
• hysteroscopy.

Such a comprehensive examination allows you to diagnose the disease, assess the extent of pathological processes and identify possible threats, for example, detect changes in cells that threaten cancer.

Gynecological examination

During the examination, the gynecologist manually palpates the uterus and ovaries and takes a smear to perform a cytological examination and study the vaginal microflora. In addition, in order to clarify the diagnosis, it may be necessary to donate blood to analyze hormone levels.

Histological examination

With endometrial hyperplasia, the final conclusion is made only after a histological examination. With this method, endometrial tissue is examined by a specialist using a microscope. As a rule, you need to wait about two weeks for a histological report.

Hysteroscopy

This is one of the most modern types of research. During the procedure, the uterine cavity is examined using optical instruments, and tissue is taken for histological examination in a targeted manner. The doctor, seeing a visual image of the uterine cavity, identifies areas that are suspicious and performs curettage in the affected areas.

X-ray

If the diagnosis of endometrial hyperplasia is confirmed, then before starting treatment, the doctor will send the woman for an x-ray of the mammary glands (mammography). This is done to identify possible pathological processes.

Carrying out ultrasound for diagnosis

In case of endometrial hyperplasia, ultrasound is performed to study the changes that have occurred in the uterine cavity, clarify the thickness of the endometrium, identify foci of pathology and locate polyps. The study is performed with a special sensor, which is inserted into the woman’s vagina.

The main advantages of ultrasound include the non-invasiveness of the method, fairly low cost, painlessness and accuracy in diagnosing pathologies of the uterine endometrium.

This type of study makes it possible to determine indicators that must meet standards that differ depending on a certain phase of the menstrual cycle.

Unlike the muscular layer of the uterine cavity (myometrium), the endometrium has clear outlines and has significant acoustic density. The thickness of the mucosa varies according to the phase of the menstrual cycle. If an ultrasound reveals thickening of the endometrium, which is uniform in value and has pronounced contours, while having heterogeneous echogenicity, then such indications are a clear sign of hyperplasia. In addition, the ultrasound method can detect the presence of polyps. This formation is benign in nature and is formed from endometrial tissue.

When is it preferable to perform an ultrasound procedure?

When diagnosing endometrial hyperplasia, it is preferable to do an ultrasound immediately after the end of menstruation. It is on days 5-7 of the cycle that the thickness of the endometrium is thinnest. Therefore, if the result obtained is more than 7 mm, then the presence of hyperplasia can be assumed, and with values ​​of 20 mm and above, there is a high probability that pathological processes in the endometrium are malignant.

On different days of the menstrual cycle, the thickness of the endometrium fluctuates, and when performing an ultrasound, the normal values ​​are:

• 5-7 days - the thickness of the endometrial tissue is 5-6 mm;
• 12-14 days - endometrial tissue rapidly increases and amounts to 10-15mm;
• 23-25 ​​days - the thickness of the endometrial tissue is about 18 mm;
• 26-27 days - the endometrial thickness is at around 17 mm.

You can't do an ultrasound during your period. since the uterine cavity during this period is filled with blood, and its presence will not allow the doctor to properly examine the uterus. If, during an ultrasound, the values ​​obtained exceed normal values, then it can be assumed that the woman has endometrial hyperplasia.

Sonographic indicators indicating the presence of pathology

Sonographic signs that indicate the presence of endometrial hyperplasia include the following:

1. The indicators of the median uterine structure are 14.6-15.4 mm.
2. Polyps with a size of 16.1-17.5 mm were identified.
3. When the obtained value is 19.7-20.5 mm, the presence of a malignant tumor can be assumed.

If a woman has already reached menopause, then the main sign of endometrial hyperplasia is the M-echo indicator, which has reached a value of 5 millimeters or more.

The main echographic symptoms that may indicate the presence of hyperplasia:

• increased sound conductivity;
• the M-echo contour differs in smoothness or unevenness;
• the nature of the heterogeneous structure of endometrial tissue;
• changes in the relief of the mucous layer of the uterine cavity.

If during an ultrasound examination the signs listed above are revealed, then we can say that the woman has hyperplasia.

Preparing for a transvaginal ultrasound

Before performing an ultrasound procedure, it is necessary to follow certain rules, since this helps to increase the reliability of the examination indicators. To prepare for a transvaginal ultrasound, you must complete the following steps:

1. A few days before the examination, you need to exclude from your diet foods that increase gas formation (white cabbage, legumes, grapes, pears, etc.).
2. On the eve of the ultrasound, an enema is recommended.
3. Before the procedure, you need to empty your bladder.

If a woman is additionally prescribed an echohysterosalpingoscopy to determine the patency of the fallopian tubes, then preparation for it is carried out according to the same scheme as for a transvaginal ultrasound.

How is transvaginal ultrasound performed?

When it is necessary to diagnose endometrial hyperplasia, ultrasound is performed using the transvaginal method, since with this approach it is possible to examine the uterine cavity in more detail. The procedure itself consists of the following steps:

1. A woman empties her bladder before the examination. Then all clothing below the waist is removed.
2. The specialist who conducts the study places a condom on a special sensor and applies a gel-like preparation to enhance the passage of ultrasonic waves. The sensor itself is made in the form of an oblong cylinder, and its diameter is 2-2.5 cm.
3. After the sensor is inserted into the woman's vagina, the scanning procedure begins, taking on average 10 to 20 minutes.
4. During the procedure, the health care provider takes pictures so that other specialists can also study your medical history.

When the study is completed, the specialist receives information about the condition of the uterine cavity and other organs of the reproductive system, and the obstetrician-gynecologist deciphers the data.

Treatment of endometrial hyperplasia

Treatment of uterine endometrial hyperplasia can be carried out through conservative therapy or through surgical intervention. The conservative method of treatment involves the use of various drugs containing hormones:

1. Oral contraceptives. Often prescribed to adolescents and women of reproductive age. The treatment itself varies in duration and lasts at least six months.
2. Gestagens. Use for at least three months. For women, they can prescribe the Mirena spiral, which has a therapeutic effect and is also a contraceptive.
3. Analogs of releasing hormones. These products have the best results and are administered only once a month.

Surgical interventions for endometrial hyperplasia include curettage. During this procedure, only the affected endometrium is eliminated, so the tissue is subsequently restored and the woman retains her reproductive function. After curettage, the patient is prescribed hormonal therapy.

But in situations where cancer cells are identified, it is most likely necessary to carry out a procedure in which the endometrial tissue is completely destroyed. After such an intervention, the mucous membrane is not restored and the woman loses her ability to bear children. In the most severe cases, the woman has a hysterectomy (surgery to remove the uterus).

Prevention methods

Preventive measures include:

• regular visits to the gynecologist (twice a year);
• treatment of gynecological diseases;
• monitoring blood sugar levels;
• use of oral contraceptives;
• daily feasible physical activity;
• normalization of body weight.

It is very important for a woman to take care of the general health and normal functioning of the reproductive system, because without paying due attention to gynecological diseases, she risks getting very unpleasant consequences, expressed in the form of infertility and the appearance of malignant tumors. In order not to deal with the consequences later, you need to be examined by a gynecologist on time and be attentive to the signals that the body sends.

The cause of unusual uterine bleeding, infertility and other pathologies in women is often abnormal thickening and changes in the structure of the inner lining of the uterus (endometrium). Such changes (hyperplasia) are associated with hormonal disorders in the body, as well as with previous diseases of the uterus. A change in the state of endometrial cells leads to their degeneration into a malignant form. Regular gynecological examination, especially during menopause, will allow you to diagnose hyperplasia at an early stage and provide timely treatment.

Content:

Why does endometrial hyperplasia occur?

The inner lining of the uterus undergoes constant changes associated with the menstrual cycle. In the first half of the cycle, it swells, a vascular network develops, and conditions are created for the attachment and nutrition of the fertilized egg. If pregnancy does not occur, the epithelial layer of the membrane is torn off and excreted from the body in the form of menstrual bleeding.

With hyperplasia, the connective and glandular tissue of the endometrium grows excessively, the membrane thickens and the volume of the uterus increases. The danger is that abnormal changes can lead to cancer.

The causes of abnormal development of endometrial cells are hormonal disorders that occur during puberty or menopause. In addition, the causes are various diseases associated with metabolic disorders and the functioning of the endocrine system, diseases of the external and internal genital organs.

Symptoms of endometrial hyperplasia are most often observed when there is a violation of the levels of estrogen and progesterone in the body. Hormone imbalance occurs in the following cases:

• the presence of mastopathy, uterine fibroids, polycystic ovary syndrome;
• inflammatory diseases of the uterus and ovaries;
• operations on the uterus, curettage;
• diseases of the pancreas, digestive system associated with impaired fat metabolism, obesity;
• liver diseases, diabetes mellitus;
• taking hormonal drugs, contraceptives.

Video: The mechanism of endometrial hyperplasia

Types of endometrial hyperplasia

Depending on the nature of the changes in endometrial tissue, the following types of disease are distinguished:

1. Glandular hyperplasia. It is formed by the proliferation of cells of the connective and glandular tissue of the endometrium. This is a benign process. The endometrial mucosa thickens, and the tubular glands that penetrate it become bent. There is an acute form of the disease, which occurs as a result of a sharp increase in estrogen levels, as well as a chronic form - with a slight change in estrogen levels over a long period.
2. Glandular cystic dysplasia. The glands become clogged. They become filled with mucus and swell, causing cysts to form.
3. Atypical hyperplasia (adenomatosis). Not only does pathological proliferation of cells occur, but the structure of the nucleus changes, which is already characteristic of malignant diseases.

Forms of endometrial hyperplasia

Based on the degree of damage to the inner surface of the uterus, diffuse and focal forms of hyperplasia are distinguished. In the diffuse form, the entire surface of the endometrium is affected, its layer thickens evenly.

The focal form is characterized by damage to a separate area of ​​the surface. An example of a focal form of the disease are endometrial polyps. They look like overgrown formations with connective (fibrous) tissue at their base.

The more complex the changes occurring in the structure of endometrial tissue, the greater the likelihood of the disease becoming malignant. In case of slight changes in the shape of the glands, the probability of cancer is 1-3%. In complex cases of atypical changes, it increases to 22-57%.

Symptoms of hyperplasia

Symptoms of endometrial hyperplasia cannot always be distinguished from manifestations of other gynecological diseases. Often the disease is discovered during the next preventive examination or when a woman consults a doctor about the absence of pregnancy.

Signs of glandular hyperplasia

Hyperplasia with changes in the structure of the glands can easily turn into an atypical form, which has the greatest likelihood of dangerous degeneration. The most typical symptoms of glandular endometrial hyperplasia in women of reproductive age are:

1. Disorders of the menstrual cycle. Menstruation comes irregularly, the volume of discharge is uneven, and heavy bleeding is more common. Before and after menstruation, clear discharge mixed with blood occurs.
2. The appearance of bleeding between normal regular menstruation (metrorrhagia).
3. The appearance of prolonged and heavy bleeding after a delay in menstruation.
4. Long (lasting more than a week) and heavy (about 3 times heavier than normal) menstruation (menorrhagia). Such menstruation is accompanied by severe pain in the lower abdomen and lower back. The woman experiences weakness, fatigue, and fainting. Anemia may occur. Such symptoms are most characteristic of endometrial hyperplasia with the formation of polyps (glandular, fibrous).
5. Infertility. It can occur as a result of underdevelopment of the egg due to hormonal disorders. Such symptoms of endometrial hyperplasia also appear due to the inability of a fertilized cell to attach to the wall of the uterus due to a violation of its structure.

One of the signs of the disease in teenage girls is the appearance of blood clots in menstrual flow.

Signs of focal endometrial hyperplasia

The lesions can have a diameter of 2 mm or more (up to several centimeters). Two types of pathology may occur. Firstly, if the level of estrogen exceeds the norm, then the maturation of the egg slows down, the detachment of the mucous membrane is delayed, so it has time to grow. An important symptom of hyperplasia in this case is prolonged and heavy bleeding, coinciding with the timing of menstruation, as well as minor spotting between menstruation.

Secondly, if there is a lack of progesterone, the eggs do not mature and ovulation does not occur. In this case, only part of the mucous layer is rejected, and polyps are formed from the remaining cells. A symptom of focal endometrial hyperplasia is menstrual bleeding lasting 10-14 days.

Signs of hyperplasia during menopause

Symptoms of endometrial hyperplasia can appear as early as premenopause. Menopause is a period during which menstrual irregularities are not unusual. Menstruation becomes irregular and its intensity may fluctuate.

If at this time women experience bloody or bloody discharge, they often do not attach much importance to this, mistaking it for menopause.

Age-related hormonal changes, previous abortions, chronic diseases of the genital organs, weakened immunity accelerate the onset of the disease. The likelihood of degeneration into uterine cancer increases.

If persistent hypertension is observed, diabetes mellitus is present, and there is a violation of fat metabolism in women over 45-50 years of age, then you need to pay special attention to such signs as prolonged and heavy bleeding or, conversely, scanty spotting. It is necessary to consult a doctor promptly to increase the chance of cure.

Signs of hyperplasia during postmenopause

During this period, an alarming sign is the appearance of bloody discharge of any duration and intensity, as well as pain in the lower abdomen, which is cramping in nature. Acyclic bleeding not associated with menstruation occurs with both polyps and uterine fibroids. They are also characteristic of malignant diseases.

Note: Women who experience late menopause (after 55 years) should be especially attentive to the appearance of such signs. Symptoms of endometrial hyperplasia are easily confused with menstruation that occurs during a prolonged menopause.

Video: Types of hyperplasia. Diagnosis using ultrasound

Sonographic signs of hyperplasia

One of the most important methods for detecting endometrial hyperplasia is uterine ultrasound. The method allows you to measure the thickness of the mucosa, detect polyps, and also estimate the size of the affected areas. In this case, the indicators are compared with the norms characteristic of individual phases of the menstrual cycle.

In a healthy uterus, the thickness of the mucosa in the first phase of the cycle is 3-4 mm, and in the second 12-15 mm. The echogenicity (sound conductivity) of the mucous membrane is greater than that of the muscle layer. With hyperplasia, the thickness of the mucosa does not change, the echogenicity is uniform, and the outlines of the thickening are even. If malignant changes have occurred, the contours of the thickening become uneven, and the echogenicity of different areas is heterogeneous.

The echographic symptoms of endometrial hyperplasia are considered to be the presence of polyps measuring 16.1-17.5 mm with a thickness of the muscle layer of 14.6-15.4 mm. Thickening of the wall up to 19-20 mm may indicate the presence of a cancerous tumor.

Uterine endometrial hyperplasia is a pathological growth of tissue of the uterine mucosa. This process is called proliferation, which occurs in the cells of glandular or stromal structures.

In this case, it is the glandular component of the superficial or basal (rare phenomenon) layer of the uterine endometrium that is most affected. The thickness of the endometrium in this case significantly exceeds normal parameters, which depend on the phase of the menstrual cycle.

At the initial stage of proliferation, the endometrium thickens to 2-4 mm, and during the secretory phase - from 10 to 15 mm. In recent years, cases of uterine endometrial hyperplasia have become increasingly observed, which is associated with many different factors. But this process is particularly influenced by the increase in the average age of women’s lives, as well as living conditions. It has been proven that patients who are often or constantly in an unfavorable environment suffer from endometrial hyperplasia much more often. In addition, the sharp increase in the percentage of somatic diseases in women also has a significant impact on the functioning of the organs of the reproductive system.

The frequency of pathology depends on the patient’s age and physical fitness. Thus, obese women are at a much higher risk of developing this pathology than those who watch their figure. The overall incidence of the disease is about 10-30%, with the highest prevalence observed in patients during menopause.

But endometrial hyperplasia often develops in younger women (35-40 years old). Late pregnancy and childbirth are also factors that can cause pathological growths of the uterine mucous membranes.

What it is?

Endometrial hyperplasia is a gynecological pathology, during the development of which there is a benign proliferation of tissues that form the mucous membrane of the reproductive organ. As a result, the endometrium thickens and increases in volume.

The main phase of the pathological process is the proliferation of the stromal and glandular components of the uterine endometrium.

Causes of endometrial hyperplasia

Hyperplasia of the uterine endometrium develops under the influence of certain factors. However, the trigger that gives rise to the pathological process is, in most cases, hormonal imbalance.

An excess of the female sex hormone estrogen in the body leads to uncontrolled division of cells that form the uterine mucosa. As a result, disruptions occur in the menstrual cycle and more. Thus, we can say with confidence that any diseases or unfavorable processes occurring in the female body and affecting the level of hormones can sooner or later provoke the development of endometrial hyperplasia.

Factors predisposing to the occurrence of the disease are:

• diseases of the central nervous system, in particular the hypothalamic-pituitary system;
• ovarian tumors leading to active production of female sex hormones;
• pathologies of the adrenal cortex, pancreas and thyroid gland;
• failure of lipid metabolism, which leads to obesity;
• negative changes in a woman’s immune status that were not stopped in a timely manner;
• chronic;
• long-term hormone therapy;
• long-term uncontrolled use of oral hormonal contraception);
• surgical abortions;
• curettage of the uterine mucosa, etc.

Often, endometrial hyperplasia develops against the background of infertility, when the ovaries do not fully perform their functions. As a result, the ovulation process does not occur, progesterone levels decrease and estrogen concentration increases.

Problems with the liver, which utilizes excess estrogens in the blood, can lead to a gradual accumulation of these hormones in the body, resulting in hyperestrogenism. A third of patients with endometrial hyperplasia are diagnosed with disorders of the liver and biliary tract. Another factor in the development of pathology is genetic predisposition.

It is possible to identify the exact cause of the development of endometrial hyperplasia only during special diagnostic procedures. They are also necessary because not all of the above anomalies and factors can lead to hormonal imbalance and, as a result, cause the development of a hyperplastic process in the uterus.

Can hyperplasia turn into cancer?

Hyperplastic processes in the uterus are a precancerous condition. This is due to:

1. Atypical hyperplasia, which can develop regardless of the patient’s age. In 40% of cases, the pathology turns into a malignant process.
2. Frequent relapses of glandular hyperplasia during postmenopause.
3. Glandular hyperplasia due to hypothalamic dysfunction or metabolic syndrome (regardless of the patient’s age).

Metabolic syndrome is a specific condition of the body characterized by a decrease in the ability of the immune system to attack and neutralize cancer cells. This leads to an increased risk of developing hyperplastic processes. This condition is accompanied by a lack of ovulation, the development of diabetes and obesity.

Is it possible to get pregnant if this pathology develops?

If we take into account the etiology and features of the development of the pathological process, we can say with confidence that the possibility of becoming pregnant with this pathological process occurring in the layers of the endometrium is minimal. Moreover, this is due not only to the presence of changes in the tissues of the mucous membrane of the reproductive organ, due to which the fertilized egg cannot attach to its wall. The reasons lie in hormonal imbalance, which is one of the main factors predisposing to the development of infertility.

In addition to a natural pregnancy, a woman is unlikely to be able to successfully carry and give birth to a baby after an IVF procedure. But if you undergo a course of therapy in a timely manner, this will reduce the risk of miscarriage, whatever the process of conception - natural or artificial.

Uterine endometrial hyperplasia is a rare occurrence in women who have given birth, unless, of course, they suffered from an atypical form of this disease at a young age. in such a situation, a relapse of the pathology after the birth process is possible. This type of disease, especially if it recurs frequently, can lead to the development of an oncological process. To prevent this, women who have given birth and are at risk should undergo regular preventive examinations with a gynecologist.

Classification

The forms of uterine endometrial hyperplasia depend on pathomorphological and cytological features. According to these classification criteria, the disease is divided into the following types.

1. Simple glandular hyperplasia is not accompanied by cystic enlargement of the glands. However, it may well occur against the background of active growth of the uterine mucous membranes, and be focal in nature. In this case, it is advisable to talk about the glandular-cystic nature of hyperplasia.
2. Glandular-stromal hyperplasia. Depending on the intensity of the growth of endometrial tissue, this form of pathology can be active or dormant. Under the influence of the surface layer of the endometrium, its underlying areas also thicken.
3. Atypical hyperplasia, which is also called adenomatous or glandular. This form of pathology is characterized by a pronounced proliferation process and, as a consequence, a clinical picture.

The pathology has 3 degrees of severity: mild, moderate and severe. Each of them is determined depending on the intensity of endometrial growth. Classification of hyperplasia according to its prevalence implies its division into diffuse and focal forms.

The WHO classification divides the disease into 2 types:

1. Non-atypical, in which atypical endometrial cells are not detected during a cytological examination.
2. Typical, in which atypical endometrial cells are detected during a cytological examination.

Non-atypical hyperplasia of the uterine endometrium, in turn, occurs:

1. Simple, which is synonymous with the concept of “glandular cystic hyperplasia”. This form is characterized by an increase in the mucous membrane in volumes without atypia of the cell nucleus. The difference between the pathological state of the endometrium and the healthy one is the active, uniform growth of its stromal and glandular structures. The distribution of blood vessels in the stroma is uniform, however, the glands are located unevenly. The cystic enlargement of some glands is moderate.
2. Complex, or complex (synonym - hyperplasia of the 1st degree), which in other classifications is called adenomatosis. This form is characterized by the proliferation of glandular components in combination with a change in the structure of the glands. This is the main difference between this type of hyperplasia and the previous one. The glandular component grows more intensively than the stromal component, and the structure of the glands takes on an irregular shape. This type of endometrial hyperplasia is also not accompanied by atypia of cell nuclei.

Atypical proliferation occurs:

1. Simple, which, according to another classification, is also called hyperplasia of the 2nd degree. It differs from the simple non-atypical form by the intensive proliferation of glandular components and the presence of atypical cells in them. There is no cell-nuclear polymorphism.
2. Complex, or atypical complex. Changes in the structures of glandular and stromal tissues correspond to those characteristic of the non-atypical form. The main difference between them is the presence of atypical cells. With their atypia, cell polarity is disrupted, the epithelial multirow acquires irregular features, and changes in its size also occur. There is cellular-nuclear polymorphism, the cell nuclei are enlarged, and they are excessively stained. Cytoplasmic vacuoles expand.

According to the WHO classification, local hyperplasia is not an independent pathological condition. This is due to the fact that polyposis (the most common term widely used by practicing gynecologists is “polyposis hyperplasia”) is not considered as a variant of endometrial hyperplasia that develops as a result of hormonal dysfunction. To a greater extent, it is attributed to belonging to the productive process that occurs during chronic endometritis. Such a deviation requires mandatory bacteriological examination and appropriate treatment with the use of anti-inflammatory and antimicrobial drugs.

Symptoms of endometrial hyperplasia

One of the most common symptoms of this disease is the opening of uterine bleeding. In addition to it, patients often complain of:

• amenorrhea (delay of menstruation for several months), followed by heavy bleeding from the genital tract;
• the presence of spotting – brown or brownish – vaginal discharge;
• painful and longer periods with heavy bleeding (rare);
• disturbance of the menstrual cycle, its shift to one side or the other.

A frequent companion to uterine endometrial hyperplasia is metabolic syndrome, which, in addition to intense bleeding, is accompanied by:

• obesity;
• increased insulin levels in the blood;
• hormonal disruption, leading to a symptom complex of male traits (it is accompanied by the appearance of vegetation in those parts of the female body where it should not be, as well as a decrease in the timbre of the voice, etc.).

In addition to the above deviations, women with endometrial hyperplasia complain of:

• development of secondary infertility;
• inability to bear fruit;
• the occurrence of chronic inflammatory processes in the reproductive organs;
• development of mastopathy or uterine myomatosis.

More rare accompanying symptoms of hyperplasia include:

• spotting during sexual intercourse or hygiene procedures;
• in the presence of polyps in the area of ​​the reproductive organ, cramping pain in the lower segment of the abdomen may periodically occur.

Diagnostics

To begin with, a visual gynecological examination is carried out, followed by a series of laboratory and instrumental diagnostic procedures, among which the most informative are:

1. Ultrasound of the uterus and appendages using a special intravaginal sensor;
2. Hysteroscopy – clinical examination of a sample of endometrial tissue;
3. Aspiration biopsy is performed when it is necessary to differentiate one type of hyperplasia from others.

An important role is played by a biochemical blood test to determine the level of sex hormones, as well as hormones produced by the thyroid gland and adrenal glands.

Atypical hyperplasia

How to treat endometrial hyperplasia?

Endometrial hyperplasia requires mandatory treatment at any age.

If the patient is of reproductive age or is on the eve of menopause, as well as with heavy and frequent bleeding caused by polyposis, she must undergo surgical intervention. The operation is performed exclusively in a hospital setting.

Surgical treatment

Using a special instrument - a curette - the gynecologist carefully scrapes out hyperplastic areas of the uterine endometrium. A special device, a hysteroscope, allows you to control the manipulation.

When removing polyps, special scissors or forceps are used. With their help, the doctor carefully dissects and removes growths from the uterine cavity. This procedure is called polypectomy.

After the operation is completed, a sample of the excised tissue is sent for additional histological examination. To consolidate the results, the patient is prescribed hormone therapy, the purpose of which is to prevent pathological growth of the endometrium in the future.

Drug treatment

Conservative therapy for endometrial hyperplasia involves the use of oral hormonal contraception, gestagens and gonadotropin-releasing hormone agonists.

COOK

Combined oral contraceptives (COCs) are prescribed to patients of all ages (including adolescent girls) suffering from cystic or glandular-cystic hyperplasia or polyps located in the uterine cavity. COCs are also used for hormonal homeostasis. This therapy process involves taking large doses of the drug to stop uterine bleeding. Due to this, it is possible to avoid curettage of the uterine cavity.

The most effective oral hormonal contraceptives are: Yarina, Zhanin, Regulon. At first, the daily dosage is 2-3 tablets, but over time it decreases to 1 tablet. The course of therapy is designed for 3 months. In the absence of positive dynamics, or in the event of heavy bleeding, the gynecologist is nevertheless forced to resort to emergency surgery.

Gestagens

Gestagens (Utrozhestan, Duphaston) are prescribed by a doctor from the 16th to the 25th day of the menstrual cycle. These drugs are approved for use for all types of endometrial hyperplasia in adult women and young girls.

The Mirena intrauterine device, which acts exclusively on the endometrium, has a good effect in the fight against pathology. They put it on for 5 years, but the doctor must notify the patient about possible side effects. The most common of these is the occurrence of intermenstrual bleeding, which appears after insertion of the IUD and can last from 3 to 6 months.

Gonadotropin releasing hormone agonists

This group of hormonal drugs is considered the most effective. The drugs Zoladex and Buserelin are used for various types of hyperplasia in women over 35 years of age and during perimenopause. The course of therapy can last 3-6 months.

The disadvantage of using this group of hormonal drugs is their ability to cause symptoms of early menopause (in particular, hot flashes). This is explained by the fact that gonadotropic releasing hormones have a negative effect on the functioning of the hypothalamic-pituitary system, which, in turn, causes a decrease in the production of sex hormones by the ovaries. This phenomenon is also called “medical castration.” However, this deviation is reversible, and normal ovarian functions are restored within 2-3 weeks after discontinuation of the drug.

Medications in this group are administered once every 4 weeks. The course of treatment lasts from 3 months to six months. The dosage and duration of therapy is calculated and adjusted (if necessary) by the attending physician.

It is important

Women suffering from atypical forms of hyperplasia should be closely monitored by a gynecologist. Preventive ultrasounds are performed every 3 months for a year after surgery and the start of hormone therapy. If adenomatosis recurs, hysterectomy is indicated.

If uterine polyposis or cystic glandular hyperplasia has re-developed and hormone therapy does not produce any results, endometrial ablation is performed. This is a procedure that involves the complete destruction of the tissues of the mucous membrane of the reproductive organ. However, this is an extreme measure, since after resection the woman loses the ability to conceive and give birth to a child.

During the procedure, a special electrosurgical knife with a cutting loop is used. Different types of laser beams can also be used, which have a destructive effect on pathological endometrial cells. The operation is performed under general intravenous anesthesia.

After surgery, in the absence of complications, the patient is discharged home the next day. For 3-10 days after surgery, a woman may experience bloody vaginal discharge of varying intensity. If the patient has undergone endometrial ablation, then particles of resected tissue may be released from the genital tract along with blood. However, this is an absolutely normal phenomenon that should not confuse or cause panic.

In parallel with hormones, the patient is also prescribed vitamin therapy. Ascorbic acid and B vitamins (in particular, folic acid) play a particularly important role for the female body.

With heavy bleeding that accompanies hyperplasia, women often develop iron deficiency anemia. To replenish iron reserves, the doctor prescribes special drugs - Gino-Tardiferon, Sorbifer, Maltofer, etc. Sedatives are also prescribed (alcohol tincture of valerian or motherwort roots, drugs Sedavit, Bifren, Novopassit, etc.).

Physiotherapeutic procedures are also prescribed, in particular electrophoresis. Acupuncture also gives excellent results.

To speed up the recovery process, a woman should eat right. It is also necessary to maintain a balance between stress and rest. The average duration of the recovery course after surgery is 2-3 weeks.

Is it possible to cure endometrial hyperplasia using traditional methods?

The use of alternative medicine in the fight against hyperplasia often does not produce any results, and sometimes can even cause harm.

So many herbs are capable of causing powerful allergic reactions, the consequences of which are extremely problematic to predict. In addition, some medicinal plants contain phytoestrogens, which can cause the onset or progression of the process of growth of the internal uterine layer.

Diet and nutrition

With endometrial hyperplasia, it is necessary to give preference to low-calorie fractional nutrition. The main components of the menu should be:

• fresh vegetables and fruits;
• white meat;
• milk and dairy products.

It is best to steam dishes, avoiding the use of large amounts of vegetable oils. Proper nutrition helps restore the functions of the entire body and normalize hormonal levels. In addition, it eliminates the risk of weight gain, because women with varying degrees of obesity are most susceptible to endometrial hyperplasia.

Prognosis of endometrial hyperplasia

The prognosis of the disease is influenced by the patient’s age, the form of pathology and the presence of concomitant diseases.

1. If endometrial hyperplasia was diagnosed in a woman during menopause, the prognosis for treatment is unfavorable. However, the pathology does not threaten the patient’s life, but her health condition may deteriorate significantly.
2. Severe course or the presence of an atypical form of hyperplasia also has an unfavorable prognosis. Moreover, this concerns not only the health, but also the life of a woman.
3. With a stable course of the pathology requiring surgical intervention, the prognosis is also unfavorable. And although the woman’s life is not in danger, she will lose the opportunity to become a mother.
4. Hypertension that accompanies hyperplasia worsens the prognosis of the disease, as it can cause relapses. The same applies to the presence of endocrine pathologies and failures in the metabolic process.

Uterine endometrial hyperplasia is a disease that occurs in different forms and has different manifestations. And although today there are effective methods of treating it, it is better to prevent its development. Regular preventive examinations by a gynecologist, timely treatment of pathologies of the genital organs, and most importantly, maintaining a healthy lifestyle - these are the basic rules that will help avoid the development of endometrial hyperplasia, and, therefore, avoid consequences dangerous to the health (and sometimes life) of a woman.