glandular endometrial hyperplasia
glandular endometrial hyperplasia - a benign overgrowth of endometrial glandular structures, leading to disruption of the normal structure of the inner layer of the uterus and an increase in its volume.Glandular endometrial hyperplasia can be and girls and older women.When this state pathological processes affect the outer layer of the endometrium.
glandular hyperplasia refers to a form of a large group of endometrial hyperplasia and is not a separate disease.
endometrium is represented by two layers - inner and outer.They are similar in composition, have a common circulatory system and perform the main task - to provide conditions for carrying a pregnancy and childbirth.The inner layer (basal layer of the endometrium) is composed of dense and elastic structures providing extensibility and strength of the endometrium.Basal layer hardly reacts to hormonal changes in uterine tissues and has a constant composition of the cell.After menstrual bleeding cellula
outer layer (functional layer of the endometrium), contains many blood vessels, and glands that is highly sensitive to quantitative cyclic hormonal changes, able to change their cellular structure and size depending on the phase of the menstrual cycle.
All hormonal and structural changes in the uterus provide a two-phase menstrual cycle and enable women to become pregnant and bear a child.All processes in the endometrium in the first half of the cycle are controlled by estrogen and are accompanied by an intense proliferation of cells of the functional layer.The outer layer expands, grows blood vessels and glands - as the uterus prepares to "accept" the potential of the child.In parallel with these changes in the ovaries matures and grows female sex cell (ovum).The process of oocyte maturation is completed by the middle of the menstrual cycle and is within an hour leaves the ovary (ovulation).If the next two days, the egg is not fertilized, it dies.The amount of estrogen decreases, and in the womb the reverse process, which aims to eliminate all previous changes.It ends with rejection overgrown functional layer, ie menstruation.The second phase of the menstrual cycle is controlled by progestins.
process of cyclic changes in the structure and volume of the endometrium is the physiological as long as it is "right" is controlled by hormones and has a phase character.When endometrial hyperplasia these conditions are violated - the uncontrolled proliferation of the endometrium occurs against hyperestrogenism, anovulatory menstrual cycle becomes single-phase character.
nature of hormonal changes in the glandular endometrial hyperplasia (anovulation) almost always indicates the presence of infertility.
glandular endometrial hyperplasia is benign, but there is always the risk of an unfavorable outcome, particularly in the case of long-term course of the disease and age-related hormonal changes.The uncontrolled proliferation of endometrial glandular structures in conjunction with the unpredictable hormonal changes can trigger unwanted finals when simple glandular hyperplasia of the endometrium is transformed into a malignant process.If you have a form of glandular hyperplasia, this probability is very small and is only 2%.
glandular cystic endometrial hyperplasia
fundamental difference between glandular and glandular cystic hyperplasia not.When glandular cystic hyperplasia of the expansion of the lumen of glands occurs with the formation of nodules (cysts).As glandular endometrial hyperplasia is also accompanied by an expansion of the lumen of the glands, the processes are considered equivalent, in fact they are different degrees of the same process.
Patients with cystic glandular and cystic endometrial hyperplasia are similar examination and treatment.
reasons glandular endometrial hyperplasia
Increasing the amount of estrogen is the leading cause of onset of pathologic changes in the uterus, which means that the glandular endometrial hyperplasia - a hormone-dependent diseases.
hormonal imbalance (much estrogen and not enough progesterone) leads to a violation of the mechanism of ovulation: the egg or die prematurely or can not leave the ovary and continues to exist in the underdeveloped state.The first phase of the cycle ends, the amount of estrogen increases and the uterus under their influence continues to grow uncontrollably inside layer.
normal level of sex hormones and the relative constancy supported by the interaction of many body systems.Center of regulation of these processes is the brain (the hypothalamus-pituitary system).Malfunctions of any part of this complex mechanism may be the cause of hormonal dysfunction.
glandular endometrial hyperplasia is not a rare disease.It can occur in any age group.The highest incidence of hyperplasia of the girls - teenagers and women in premenopaze (periods of hormonal changes) prove its close relationship with the hormonal changes in the body.
reasons glandular endometrial hyperplasia may be in the pituitary - hypothalamus.In this case, the brain will "give the wrong team", and the hormonal system crashed.
pathological process in the ovaries may contribute to glandular hyperplasia: polycystic ovarian tumors and cysts provoke anovulation and hyperestrogenia.
adverse effect on the endometrium in terms of the appearance of hyperplastic processes have mechanical damage to the inner layer of the uterus: abortion, diagnostic curettage, intrauterine contraception.
often hyperplastic processes accompany (or may even provoke) exchange-endocrine or immune disorders: diseases of the adrenal cortex, pancreas and thyroid.Violation of fat metabolism provokes glandular endometrial hyperplasia in patients with severe obesity increases the risk of its occurrence by 10 times.This is due to the fact that adipose tissue is capable of synthesizing estrogen.
Every third patient with endometrial glandular hyperplasia found liver disease and biliary tract.The liver is responsible for the disposal of estrogen, if this process is disrupted, there hyperestrogenia.
Uncontrolled prolonged use of hormonal drugs can cause systemic hormonal disorders and promote menstrual disruptions.
Absolute causes of glandular hyperplasia does not exist.The probability of the disease increases with the accumulation of adverse factors and precipitating causes.Thus, for example, diabetes combined with obesity and hypertension is more likely to cause pathological changes in the uterus.
traced a genetic link between the relative glandular endometrial hyperplasia in the mother and daughter.
symptoms of glandular endometrial hyperplasia
Menstrual irregularities noted by all patients with endometrial glandular hyperplasia.Monophasic cycle, estrogen levels higher than normal.There have anovulatory uterine bleeding after a delay of the next menstruation.Blood loss is significant, and sometimes the blood comes out with clots.Excessive bleeding can cause anemia.Appears pale skin, weakness, dizziness.
intermenstrual uterine bleeding are less common, there are not abundant.In postmenopausal women due to physiological decline in estrogen levels highlight smearing.
Sometimes patients perceive bleeding hyperplasia long as normal menstruation, and a specialist for the first time complain about the infertility.If hyperplastic processes in the uterus occur against the backdrop of anovulation, infertility is an indispensable companion glandular endometrial hyperplasia.
Pain rarely bothers patients with endometrial glandular hyperplasia.Uterine cramping pain responds to the emergence of large polyps (greater than 2 cm).When the body of a polyp necrosis or disturbed nutrition, pain can wear intensive.
development pregnancy with glandular endometrial hyperplasia is very rare, due to the possibility of a two-phase ovulatory cycle and due to non-hormonal nature of the disease.Fertilized egg can grow only in an unaltered endometrium, so a combination of pregnancy and glandular hyperplasia is possible only in the case of focal forms of the disease.Glandular polyps during pregnancy complicated by extremely rare, and physiological changes in the number of estrogen and progesterone can help reduce them.Large and complicated polyps can cause premature labor and uterine bleeding.
should be noted that even if a woman in the presence of glandular endometrial hyperplasia retains the ability to conceive, develop pregnancy is not guaranteed.This applies to situations where the uterus is not enough "free" from the disease process space for the development of the fetus, or when a polyp is found in the way of a fertilized egg to the point of attachment to the endometrium.
diagnosis of glandular endometrial hyperplasia
Any hyperplastic process develops as a result of a complex series of changes in the uterus and the patient's body.There are many classifications, definitions and terms to refer to all the changes in the endometrial hyperplasia, some of them are outdated or not quite correct, some are used to improve readability, they are confusing patients and sometimes even scare them.During each diagnostic procedure is given conclusion - clinical, laboratory, histological or hysteroscopic.To better navigate in a variety of diagnoses and terms and avoid confusion in complex classifications need to know the basics.For convenience, let us consider the example of their glandular endometrial hyperplasia:
- Type of hyperplastic changes characterized, above all, those by public agencies is an increase in the inner layer of the uterus.If easier - that is growing and is called hyperplasia.If it is cancer, used the term "glandular" if there is thickening of the glands (cyst), suggest glandular cystic hyperplasia.Both types of endometrial hyperplasia developed by glandular component of the endometrium, in one case, there is thickening of the glands in the other - they look like a straight tube.
- The restructuring process of the endometrium can capture the entire uterus and called diffuse and can occur in a limited area (focal).The latter category includes endometrial polyps.When the amount of overgrown endometrial cells within a limited area becomes too large protrusions formed in the direction of the uterine cavity of different sizes, so grow polyps.Focal glandular hyperplasia - this is glandular endometrial polyp.
- If the swollen tissues of endometrial cells appear abnormal, hyperplasia any type called atypical.Atypical glandular endometrial hyperplasia is able to provoke a malignant process, it can also be diffuse and local (polyp) and combined in the term "adenomatosis".
- active glandular endometrial hyperplasia is the result of intensive estrogen exposure and develops against the backdrop of anovulation.If the effect of estrogen is a long and wordless character talking about resting glandular hyperplasia, to highlight its slow character.Active glandular endometrial hyperplasia is diagnosed with primary infertility.
- Simple glandular endometrial hyperplasia looks like a uniform mucosal thickening.Separately allocated complex (complex) forms of hyperplasia.The complex glandular endometrial hyperplasia implies the presence of atypia, focal process, or polyp.The complex glandular endometrial hyperplasia as a diagnosis has no independent value.
Diagnosis "endometrial hyperplasia" is a result of consistent application of clinical, instrumental, laboratory and functional methods of examination.
Laboratory diagnosis of glandular hyperplasia not only determines the content of sex hormones in the blood of patients, but also allows you to track the quantitative cyclic hormonal changes, confirm or deny the presence of ovulation.
If you suspect a hyperplastic process in the initial stage of the diagnostic study to ultrasound scan of the uterus with transvaginal probe.We estimate the thickness of the endometrium and its structure, the condition of the uterine wall.The main US - criterion hyperplasia is an increase in endometrial thickness in excess of 16 - 18 mm in the second phase of the cycle, and more than 5 mm for postmenopausal women.The endometrium looks uneven - traced thickening and areas of high density zones can be visualized focal glandular hyperplasia of the endometrium (the glandular polyps).Ultrasound scans reveals a well-related hyperplasia of uterine fibroids and adenomyosis.Ultrasonography is not able to distinguish from atypical glandular hyperplasia and examine structural changes.The accuracy of ultrasound - diagnostic is 60 - 70%.
most informative (97%) is considered by hysteroscopy - visual examination of the endometrium using special equipment.The method allows to examine the surface of the uterus, to evaluate all the processes occurring in it and take a piece of modified tissue for histological examination (biopsy sighting) in the presence of focal changes in the mucous.In the case of diffuse glandular hyperplasia when changes occur on the entire surface of the endometrium, there is a need to explore the whole mucosa.To this end, under control performed diagnostic hysteroscopy scraping the uterine cavity.The resulting material is sent for histological examination, it "puts the last point" in the diagnostic finding and is the most reliable method of research.
Sometimes diagnostic monitoring after therapy used endometrial aspiration biopsy - the removal of material from the uterine cavity for subsequent laboratory analysis.In contrast to the target biopsy material for research (aspirate) "aspirated" from the uterus.The method is not very informative, and plays the role of screening (clinical examination) of the female population.
In order to correctly identify therapies glandular endometrial hyperplasia, you must set its causes.Since this process does not have the same faith and reason is developed under the influence of many factors, the patient should be examined by doctors related specialties - endocrinologist, neurologist, internist.
Treatment glandular endometrial hyperplasia
Since there is a risk of malignant transformation, the treatment of glandular endometrial hyperplasia is mandatory.
If a patient with hyperplasia has infertility, reproductive function recovery is not possible without the elimination of hyperplastic process.
Choice of treatment tactics depends on the age of the patient, the nature of hormonal disorders, presence of comorbidities and adverse background processes.Carried out not only the treatment of glandular hyperplasia, eliminated its causes and consequences.
Held for diagnostic hysteroscopy with curettage has a unique feature: with the affected mucosa it liquidates itself and hyperplasia, in fact being a small surgical therapeutic and diagnostic procedures.The procedure is performed under strict indications in the hospital with obligatory adequate anesthesia.
liquidation of pathological process can not provide a complete cure.