Endometrial hyperplasia is an insidious disease that does not cause pain and can develop in women at any age. Why does endometrial hyperplasia occur, who is at risk and how to treat this disease, says Oresta Marishchuk, МЦ «obstetrician-gynecologist» at Bogoliuby MC.
What is endometrial hyperplasia and why does it occur?
Endometrial hyperplasia - excessive proliferation (i.e. growth) of the uterine mucosa (endometrium) or its local change under the influence of certain factors.
Pathogenetically, hyperplasia is divided into hormone-dependent and hormone-independent.
A factor that in most cases leads to hyperplasia is hormonal imbalance in the body, namely hyperestrogenia (an excessive amount of estrogen in the absence of progesterone).
Hormone-independent hyperplasia usually develops in postmenopausal women. In this case, atypical changes in the endometrium are often diagnosed.
I note that endometrial hyperplasia has certain stages: proliferation, glandular hyperplasia, glandular cystic, adenomatous without atypia and the stage of atypical hyperplasia.
Which women are more at risk for endometrial hyperplasia?
Factors that can cause hyperplasia are:
- obesity: adipose tissue contains an increased amount of aromatase enzyme, which turns testosterone into estrone. Excessive accumulation of estrogen occurs, which leads to hyperestrogenia;
- menstrual irregularities over a long period (more than 12 years), namely irregular periods (when they are rare);
- ovarian scleropolicystosis (in this disease, ovulation is blocked through an increased amount of androgens and estrogens);
- type II diabetes mellitus, insulin resistance;
- history of childbirth.
At risk are also women who do not use oral contraceptives.
It is worth noting that hyperplasia can be at any age: juvenile, reproductive, perimenopause and postmenopause.
What are the symptoms of this disease?
Symptoms of hyperplasia include acyclic uterine bleeding (they are not associated with the menstrual cycle), excessive spotting during menstruation. These symptoms can lead to anemia. In this case, hyperplasia usually does not cause pain or physical discomfort.
Since patients with an irregular menstrual cycle (absence of menstruation for 2-3 months) do not always consult a gynecologist on time, this leads to a prolonged anovulation. The risk of endometrial hyperplasia is increasing.
How is endometrial hyperplasia diagnosed?
For diagnosis, first of all, an ultrasound of the pelvic organs is performed. We can talk about hyperplasia, when the thickness of the M-echo of the endometrium is more than 15 mm. Echopositive and echo-negative inclusions in it, heterogeneity of the structure and increased blood supply are also taken into account.
In the postmenopausal period, the thickness of the endometrium should not exceed 5 mm. As a rule, hyperplasia in older women is detected by chance. Menstruation is absent and, accordingly, there are no cycle disorders.
So there is no cause for concern. If hyperplasia is suspected, additional examinations are performed to find out the cause. Separate diagnostic curettage of the uterine cavity and cervical canal is performed.
In some cases, a biopsy is performed: a plastic catheter is inserted into the uterine cavity and its content (endometrial particles) is aspirated. But with this method of diagnosis, one can not get into the area that is changed. Therefore, the result of such a study does not always show the real picture.
The third diagnostic method is - hysteroscopy, when the uterine cavity is looked around and an endometrial sample is purposely taken from the area that causes suspicion.
Further, the material obtained by one of the methods is sent to histological examination. According to its result, treatment is prescribed.
How is endometrial hyperplasia treated?
The method of treatment depends on:
- the result of histological examination;
- woman's age;
- metabolic disorders;
- concomitant gynecological and extragenital diseases;
- contraindications and drug tolerance.
If this is a woman under the age of 40, she is usually prescribed oral contraceptives for a period of 3-6 months, and then changed to low-dose.
If estrogens are contraindicated (for example, if a woman smokes or is obese), progestogens are used for therapeutic purposes for 3-6 months.
After a course of drugs, a follow-up examination is mandatory.
If endometrial hyperplasia is treated at 40-50 years old, progestogens are usually used. Also, for therapeutic purposes, an intrauterine releasing system is installed, which inhibits growth and leads to endometrial atrophy. To prevent relapse of hyperplasia, a hormonal vaginal ring can be recommended.
At the age of 45-55 years, in addition to progestogens, antigonadotropins can be used. If histology has shown that this is atypical hyperplasia or adenomatous with atypia, surgical treatment is necessary, that is, removal of the uterus with appendages. Monitoring the effectiveness of therapy is an ultrasound (to determine the thickness of the endometrium) and the result of a biopsy.
What are the consequences of endometrial hyperplasia?
At a young age, this is the absence of pregnancy, infertility, miscarriage. Hyperplasia can be combined with uterine myoma, adenomyosis.
Endometrial hyperplasia in perimenopause and menopause is a particularly formidable disease, because it can lead to endometrial cancer.
Is it possible to get pregnant with endometrial hyperplasia?
Theoretically, this is possible. It all depends on concomitant pathologies and the severity of the hyperplastic process. If a woman does not have ovulation and has hyperplasia, she, of course, will not become pregnant.
How can endometrial hyperplasia be prevented?
It is necessary to lead a healthy lifestyle, eat right, treat the menstrual irregularities on time, visit a gynecologist not only when complaints appear, but also for preventive purposes.