Endometrial hyperplasia - benign changes in the uterus in the form of excessive proliferation and thickening of the inner layer (endometrium) due to the enhanced reproduction of stromal cells and / or iron component.Endometrial hyperplasia occurs in 5% of women with gynecological diseases.Endometrial hyperplasia in different age groups is found unevenly.In premenopausal women the probability of its occurrence is much higher and varies from 2 to 10%.
increased number hyperplasia in recent years due to the change in the rhythm of life and an increase in its duration, with the number of neuroendocrine and hormonal disorders, lower immunity and an increased growth of somatic pathology.
in the endometrium, there are two layers - an inner (basal) and outer (functional).The basal layer of dense and elastic, characterized by quantitative and qualitative constancy of cellular composition, it is formed by connective tissue cells and collagen fibers.The basal layer is very we
Internal (functional) layer of the endometrium sensitive to hormones, it undergoes cyclic changes in thickness and structure.The functional layer is thicker than many full-blooded vessels and glands.During the first half of the menstrual cycle are actively functional layer expands and prepares for a potential pregnancy.The second phase of the menstrual cycle is designed to ensure that all previous changes have been eliminated.The culmination of these processes is a complete rejection of the functional layer that is menstruating.Then, the cells of the basal layer to help restore structural damages.
Endometrial hyperplasia is not an independent disease.The leading role in the formation of hyperplastic processes owned by abnormal hormone regulation.All processes in the uterus, are under the control of female sex hormones, and depend on their proper ratio.If this relationship is broken, the processes of maturation and rejection of the endometrium occur in the change of pace, distorted menstrual cycle.
Endometrial hyperplasia variety of forms and different clinical manifestations.Despite the high quality of the process, with endometrial hyperplasia have a probability of occurrence of atypical changes.
phrase "endometrial hyperplasia of the uterus" is incorrect.The inner layer is called the endometrium of the uterus.In any other sense, it is not used, therefore, the process of endometrial hyperplasia can be only in the uterus and can not be formulated as endometrial hyperplasia of the uterus.
reasons endometrial hyperplasia
Endometrial hyperplasia is formed under certain conditions and precipitating factors.
trigger in the development of hyperplastic changes is hormonal dysfunction.Excess estrogen stimulates the pathological proliferation (proliferation) of the inner layer of the endometrium and leads to cyclical irregularities.
Thus, it can be said that any process in the body, leading to hormonal disorders may provoke occurrence of endometrial hyperplasia.Development hyperestrogenism contribute:
- pathological conditions in the organs of the central nervous system, regulating hormonal function (of the pituitary - hypothalamus);
- polycystic ovary syndrome;
- hormone producing tumors of the ovary;
- diseases of the adrenal cortex, pancreas and thyroid glands;
- disorders of fat metabolism (the risk of hyperplasia in patients with severe obesity increases 10 times);
- disorders of the immune system;
- long-term use of hormonal preparations;
- traumatic intrauterine manipulation: abortion, diagnostic curettage.
endometrial hyperplasia develops infertility.Since the hormonal ovarian function lead to anovulation, the deficit increase in the number of progesterone and estrogen provoke giperpalastichesky process in the endometrium.
liver is responsible for the disposal of estrogen in the body, violations in the work lead to hyperestrogenism.Diseases of the liver and biliary tract is diagnosed in one third of patients with hyperplasia endomentriya.
exist regarding the link between the presence of diseases associated with giperestrogeniey maternal (uterine fibroids, adenomyosis, endometrial polyps) and the appearance of endometrial hyperplasia at the daughter.This suggests a genetic predisposition to hyperplastic processes.
All these causes endometrial hyperplasia are not absolute, since their presence or the combination does not always lead to the hormonal dysfunction.For example, the combination of diabetes with severe obesity and essential hypertension is more favorable for the development of endometrial hyperplasia than all of these conditions alone.
Endometrial hyperplasia is the result of a complex multi-stage process of interaction between general and local changes.
Symptoms and signs of endometrial hyperplasia
Structural changes in endometrial hyperplasia is not always the same.Hyperplastic processes can be implemented by various elements of the proliferation of the endometrium, so all hyperplastic processes are divided into four types:
1. Glandular endometrial hyperplasia.Endometrial growth is mainly due to the increase of the glandular component.The glands become tortuous type and uniformly increased.
2. glandular cystic endometrial hyperplasia.Some sources are classified as simple endometrial hyperplasia, and, in fact, tantamount to ferriferous type hyperplasia, differing from it only in that the expansion of the lumen of the endometrial glands occurs with the formation of cysts.
3. atypical hyperplasia endometrial sometimes poses a threat to life and health, since it refers to precancerous diseases.It has synonym for "adenomatosis".Different appearance of atypical cells in the endometrium.There are focal (adenomatous polyp) or diffuse form.It is believed that the cancer process is preceded by a long-term simple endometrial hyperplasia.Hazardous cellular changes may occur on a limited portion of the mucosa, for example, polyps, or distributed throughout the endometrium.Atypical hyperplasia of the endometrium is transformed into cancer in 10% of patients.
4. Focal endometrial hyperplasia (another name - endometrial polyp).The growth of endometrial cells occurs in certain areas (foci), which are more sensitive to hormonal changes.The endometrium grows vigorously at such sites, but can not go beyond the boundaries of the hearth, so increases in height.First formed in the endometrium of a small hill, and then formed endometrial polyp.Polyps are prone to recurrence and malignancy.
clinical picture of endometrial hyperplasia is the result of hormonal disorders, namely hyperestrogenism.The severity of symptoms in patients with different, some of them the process may be asymptomatic.
characteristic symptom for patients with endometrial hyperplasia are anovulatory uterine bleeding.They start after a delay of regular menstruation, usually abundant and long, in some cases - with clotted blood.Intermenstrual uterine bleeding are less common, are moderate.In postmenopausal women are more frequent spotting.
Pain is not a common symptom of endometrial hyperplasia.Sometimes patients may appear moderately severe pain in the abdomen, including during menstruation.When endometrial polyps, patients may complain of cramping associated with an increase in the size of the polyp or necrotic changes within it.
Infertility is the most common companion of endometrial hyperplasia, and sometimes it may be his only symptom.However, the immediate cause of endometrial hyperplasia infertility is not.We can say that these are two related symptoms that accompany one reason - anovulatory menstrual cycle.
With heavy uterine bleeding patients may develop anemia.Appears pale skin, weakness, dizziness.
endometrial hyperplasia during pregnancy
most frequent companion of endometrial hyperplasia is infertility.During the examination of patients with primary infertility endometrial hyperplasia is diagnosed in one in five of them.Pregnancy in the diffuse background of endometrial hyperplasia hormonal nature is impossible.
pregnancy to take place, you need two essential conditions:
- The presence of ovulation, meaning the willingness to fertilize;
- «prepared» for the development of a fertilized egg endometrium.In the first phase of the cycle takes place under the control of estrogen endometrial proliferation functional layer but, unlike hyperplasia, these changes are physiological.It is their patients sometimes mistakenly called endometrial hyperplasia.
pregnancy occurred only in the presence of a two-phase cycle with a physiological change in the dominant hormone.Endometrial hyperplasia in the majority of cases develop in severe deficiency hyperestrogenism and progestogen, there is no ovulation, and endometrial abnormalities occur, precluding the development of pregnancy.
rare exception is when endometrial hyperplasia is a non-hormonal causes and occurs on a background of a two-phase ovulatory cycle.This applies to cases of focal hyperplasia, when the functional layer unchanged arises hotbed of pathological proliferation of endometrial tissue - polyps.A further scenario of events has two directions:
1. The fertilized egg gets implanted in the uterus and (survives) in its healthy part.If a polyp is not is large and does not interfere with the development of pregnancy, followed by the observation set, and after childbirth it must be removed.Do not exclude the situation when a polyp is threatening the normal course of ongoing pregnancy, then it may be decided to delete it.Such situations are rare.Remove endometrial polyp can be only in the early stages of pregnancy.
2. If a polyp is located in the path of a fertilized egg in the uterus, pregnancy will not occur.The same will happen in the finale when the fertilized egg will try to "stay" in the zone of the polyp - implantation does not occur, and pregnancy does not occur.
large endometrial polyps can cause premature labor and uterine bleeding in pregnancy.
To avoid undesirable situations, you must take a gynecological examination before the onset of a wanted pregnancy.
diagnosis of endometrial hyperplasia does not mean the sentence of reproductive function, with timely and adequate therapy eliminating the causes endometrial hyperplasia regresses.
Focal endometrial hyperplasia
focal hyperplasia of the endometrium presented polypoid growths inside the uterus.Polyps of the uterus formed by sprawl areas of the basal layer of the endometrium.A polyp is composed of epithelial cells, and has a leg body.Depending on the cellular composition of endometrial polyps are divided into:
- gland polyps, in which the amount of iron exceeds the amount of other cells;
- glandular-fibrous polyps are formed by connective tissue, glands in their composition is much less;
- fibrous polyps, consisting exclusively of connective tissue.Additionally
isolated atypical lobular hyperplasia, representing adenomatous polyps - glandular polyp with signs of atypia (precancer).
The largest number of cases of diagnosed endometrial polyps account for 35-50 years.In reproductive age often appear glandular polyps, and older patients - adenomatous and fibrotic.Lobular hyperplasia of glandular-fibrous structure can be diagnosed at any age.
development of polyps in the uterus leading role for the same violations as in diffuse endometrial hyperplasia: hormonal disorders hyperestrogenia and, as a consequence - anovulatory cycle single phase.
far fewer cases of focal hyperplasia develops in the stored two-phase cycle.
to the pathological process in the endometrium in such cases result:
- trauma of the uterus during the abortion, dilatation and curettage, a long presence of an intrauterine device;
- miscarriage, termination of pregnancy in the later stages, pathological delivery;
- endocrine disruption;
- extragenital pathology;
- immune disorders.
Polyps may be formed on the background of unchanged endometrial or background diffuse hyperplastic process.Women with metabolic and endocrine diseases, hypertension, obesity are at risk of developing endometrial polyps.Polyps in these patients are more prone to malignancy (acquire signs of malignancy).
most common complaints of patients with endometrial polyps are menstrual disorders, bleach (for large size of the polyp), abdominal pain and infertility.
If a polyp develops against the background of unchanged functional layer of the endometrium, the young women scant sukrovichnye allocation, not associated with menstruation, blood loss during menstruation increases.In premenopausal age (45 years) endometrial polyps appear intermenstrual bleeding.In postmenopausal women may appear one-time spotting or moderate lean character.
When polyps reach a length of 2 cm, the uterus reacts to these abbreviations (like foreign body reaction), in which case patients notice cramping mostly lower abdomen.Similar pains occur in the case of necrotic processes in the polyp.
significant influence on the course of the disease have background processes in the uterus (uterine fibroids, adenomyosis, inflammatory diseases), the state of hormonal function and age of the patient.
endometrial polyp symptoms are similar to those in the uterine fibroids and endometriosis.In order to establish a definite diagnosis requires additional diagnostic techniques.
diagnosis of endometrial hyperplasia
diagnosis of endometrial hyperplasia is the result of consistent application of clinical, instrumental, laboratory and functional methods of examination.
After reviewing patient complaints and gynecological examination the doctor can only suspect the presence of endometrial hyperplasia.Laboratory diagnosis helps to understand the nature of hormonal disorders, to identify the presence of inflammatory diseases.Quantitative data on the content of sex steroids help to determine the presence or absence of ovulation, hormonal identify the cause of infertility.
Ultrasound scanning using transvaginal probe is held in the first week after menstruation and allows:
- evaluate the size and configuration of the uterus.When endometrial hyperplasia in the uterus is rendered expanded and / or deform the cavity;
- estimate the thickness of the endometrium.When hyperplasia usually it exceeds 15mm, postmenopausal its value exceeds 5 mm;
- identify structural changes in the endometrium, the inherent hyperplasia: oval formation increased density or uniform thickening of the endometrium;
- polyps of the endometrium;
- During ultrasonic scanning can be found associated pathological conditions - uterine fibroids, adenomyosis, and so on.
from the arsenal of instrumental methods of examination are considered the most informative:
- Hysteroscopy.If visual examination you can see the entire cavity of the uterus and detect changes in the structure of the glands, mucosal thickening or polyps.