Endometrial hyperplasia

Endometrial hyperplasia is a benign proliferation of the endometrium (the inner layer of the uterus). Let's look at the types, dangers of this pathology, methods of treatment and prevention.

Endometrial hyperplasia leads to thickening and increase in the volume of the uterus. The entire pathological process is the proliferation of stromal and glandular elements of the endometrium. That is, it is an excessive growth of the membrane of the walls and tissues. The cause of such pathology can be hormonal disorders, chronic inflammatory processes and other diseases. The danger of endometrial hyperplasia is that without proper treatment, the disease takes the form of a cancerous tumor, that is, an oncological disease.

If a woman is diagnosed with endometrial hyperplasia, this is one of the reasons for the development of infertility. Advanced stages of the disease lead to the inability to have children, hormonal disorders and oncological diseases. There are several types of pathology, which differ in the type of course, symptoms and methods of treatment. Most often, glandular hyperplasia occurs, which causes the proliferation of glandular tissue, cystic - accompanied by the appearance of cysts of different sizes. The most dangerous type is atypical. This type is considered a precancerous condition. Timely diagnosis and treatment is the ideal option for preventing the onset of the disease.

Endometrial hyperplasia of the uterus is a disease characterized by pathological proliferation of the endometrium, i.e. the inner mucous membrane of the uterus. It is this part of the uterus that is subject to regular cyclic changes during the menstrual cycle. Due to hormonal changes, the endometrium grows only if the egg is fertilized. But if conception does not occur, the endometrium returns to normal size and leaves the uterus with discharge during menstruation. A new endometrium begins to grow in place of the removed endometrium, i.e. a new cycle of endometrial changes begins.

There are several types of pathology: glandular, glandular-cystic, focal or polyp, and atypical. Very often the disease is asymptomatic. Therefore, hyperplasia can only be recognized after a preventive examination or ultrasound. In some cases, the disease manifests itself as anovulatory uterine bleeding, which occurs after a delay in menstruation or against the background of an irregular cycle. Many women receive a diagnosis after an examination due to the inability to conceive a child. The disease causes infertility.

The causes of the disease are varied. Endometrial hyperplasia of the uterus may appear against the background of hormonal disorders, pathologies of lipid, carbohydrate and other types of metabolism, due to gynecological diseases and surgical intervention. Very often the disease appears in women with disorders of lipid metabolism, hypertension, high blood sugar, uterine fibroids and liver diseases.

ICD-10 code

ICD 10 is the International Classification of Diseases, Tenth Revision. That is, ICD 10 is a single normative document for recording morbidity, which simplifies the process of diagnosis.

According to the international classification of diseases, it refers to diseases of the genitourinary system (N00-N99). Under N85.0 is glandular hyperplasia of the endometrium, and under N85.1 is adenomatous hyperplasia of the endometrium. This section also includes other pathologies and diseases of the female genital organs, such as: hypertrophy of the uterus, eversion of the uterus, malposition and subinvolution of the uterus.

Causes of endometrial hyperplasia

The causes of endometrial hyperplasia are varied. There are many factors that provoke the disease. As a rule, the pathology develops against the background of hormonal disorders and failures, with diseases of the endocrine system, arterial hypertension and obesity.

Hyperplasia can occur simultaneously with chronic inflammatory diseases of the reproductive system. Only a gynecologist can accurately determine the cause and prescribe treatment after examination and study of test results.

[ 1 ]

Symptoms of endometrial hyperplasia

Symptoms of endometrial hyperplasia do not always manifest. Thus, in some women the disease is asymptomatic, and it can only be detected after examination. The main clinical symptoms manifest as anovulatory bleeding, bloody vaginal discharge between periods, and cycle irregularities.

Women experience irregular bloody discharge and blood clots, that is, particles of overgrown mucous membrane that has peeled off, menstruation becomes painful. And the most dangerous symptom of endometrial hyperplasia is infertility.

Discharge in endometrial hyperplasia

Discharges with endometrial hyperplasia appear as non-cyclic spotting bleeding. This is the main symptom of the pathology. The disease is accompanied by a delay in menstruation. Hyperplasia does not cause pain during sex, but after sexual intercourse, spotting bloody discharge appears.

As a rule, women rarely consult a gynecologist because of the unclear nature of the discharge. But it is during a preventive examination that the doctor can determine the presence of the disease. In some cases, the discharge is accompanied by pain in the groin and in the ovarian area. In any case, bloody discharge in the middle of the menstrual cycle is considered a pathology. The woman's task is to pass all the necessary tests to diagnose the disease and undergo appropriate treatment.

[ 2 ], [ 3 ]

Bleeding in endometrial hyperplasia

Bleeding with endometrial hyperplasia is quite common. As a rule, instead of bleeding, spotting appears. But the presence of bleeding may indicate not only pathology, but also other, concomitant diseases. The nature of the bleeding depends on the woman's age and the proliferative process.

• Cyclic bleeding occurs during menstruation and lasts for 2-3 weeks. This type of bleeding with endometrial hyperplasia occurs in women of reproductive age.
• Acyclic bleeding – not related to the menstrual cycle, begins between periods, has varying duration and intensity (from 2-3 weeks to several months). Typical for women of reproductive age.
• During menopause, bleeding caused by endometrial hyperplasia of the uterus manifests itself as heavy and irregular menstruation. After such menstruation, bloody spotting appears.
• After menopause, with endometrial hyperplasia, bloody discharge becomes scanty, but is of a prolonged nature.
• Heavy bleeding with clots is typical for young girls during the period of formation of the ovulatory and menstrual cycles.

Please note that spotting indicates polyposis, while bloody discharge indicates glandular hyperplasia and adenomatosis.

[ 4 ], [ 5 ], [ 6 ], [ 7 ]

Menstruation with endometrial hyperplasia

Menstruation with endometrial hyperplasia can be both regular and irregular. It depends on the hyperplastic process of the endometrium and the periods of fading-establishment of menstrual functions. As a rule, irregular menstruation occurs in women over 40 years old and in young girls 15-16 years old. If the disease occurs in women of reproductive age, it may not disrupt the menstrual cycle. Everything depends on the type and degree of expression of endocrine-metabolic disorders (diabetes mellitus, hypertension, obesity).

If the pathology is combined with metabolic and endocrine disorders, then the menstruation becomes irregular. If there are no disorders, then the menstrual cycle is regular. The menstruation also depends on the type of pathology. So, with some types of disease, menstruation disappears completely or becomes irregular with spotting. And with other types, menstruation becomes abundant with blood clots. That is, it is difficult to say for sure whether the regularity of menstruation depends on endometrial hyperplasia, since it is necessary to determine the type of disease and consider other types of pathological lesions.

Pain in endometrial hyperplasia

Pain with endometrial hyperplasia is the first signal for a woman to urgently go to a gynecologist for an examination. As a rule, pain appears when the disease has been asymptomatic for a certain period of time. In this case, the appearance of pain indicates the progression of the disease.

To identify the cause of pain and diagnose endometrial hyperplasia, the gynecologist conducts a histological examination of the endometriotic tissue. The procedure is painless and is performed in an outpatient setting. If the examination does not give a positive result, the woman is sent for an ultrasound examination. Based on the histology and ultrasound readings, the gynecologist diagnoses the cause of pain and gives an accurate assessment of the endometrium in the female body.

Endometrial hyperplasia and pregnancy

Endometrial hyperplasia and pregnancy are phenomena that are extremely rarely observed simultaneously. This is due to the fact that this pathology provokes female infertility, since the embryo cannot attach to the altered walls of the uterus. That is, it is not often that one can talk about pregnancy and endometrial hyperplasia at the same time. Modern medicine considers hyperplasia as a precancerous condition. Infertility and an increase in the thickness of the endometrium lead to the fact that a benign tumor degenerates into oncology.

Pregnancy with endometrial hyperplasia occurs very rarely. If this does happen, then, as a rule, the woman is diagnosed with a focal form of pathology. This allows the egg to develop on a healthy area of the mucous membrane. It is focal hyperplasia that is the type of disease that is an exception to the rule and allows a woman to become pregnant. But such cases are isolated, so they require observation by a gynecologist and gentle treatment.

The most dangerous form of pathology for women's health is atypical. This type of disease is related to malignant tumors and is a precancerous condition. Atypical hyperplasia can also degenerate from the focal form of the disease. Any form is an indication for infertility. The woman's task is to regularly undergo preventive examinations by a gynecologist to prevent the disease.

[ 8 ], [ 9 ], [ 10 ]

Pregnancy after endometrial hyperplasia

Pregnancy after endometrial hyperplasia is a question that interests many women who have suffered from this disease and want a child. Infertility and endometrial hyperplasia go hand in hand, so a woman cannot become pregnant at the time of the disease. But after successful treatment and a certain rehabilitation period, there is every chance to conceive and bear a healthy baby.

Pregnancy and endometrial hyperplasia have two development options. In the first option, a woman who does not plan to become pregnant in the near future is treated with hormonal drugs (oral contraceptives). In the second option, when a woman is ready to become pregnant, the doctor conducts gentle treatment and prevention of infertility. This allows you to prevent the pathological complication of the disease - infertility, and after the rehabilitation period, bear a healthy baby.

Despite the fact that endometrial hyperplasia excludes the possibility of having children during the disease. Complete recovery, which involves timely diagnosis and treatment, allows you to get pregnant after endometrial hyperplasia.

Endometrial hyperplasia after childbirth

Endometrial hyperplasia after childbirth is not common, but in some cases, the disease begins to recur after the birth of the child. This happens with focal and atypical pathology.

The possibility of a relapse of the disease after childbirth is possible, but not so dangerous. Since the woman has already carried and given birth to a healthy baby, minor ailments recede into the background. Recurrent hyperplasia is recommended to be treated with surgical curettage and hormonal therapy. In particularly difficult cases, radical surgical intervention is possible, which involves complete removal of the uterus.

[ 11 ], [ 12 ], [ 13 ], [ 14 ]

Classification of endometrial hyperplasia

The classification of endometrial hyperplasia is a system that includes all types and forms. With the help of the classification, the gynecologist can easily determine the form based on the results of tests and the symptoms that appear. Thanks to this, it is possible to prescribe effective and timely treatment. Let's look at the main types of pathology.

• Simple - the peculiarity of this species is that there is a significant increase in the glands, but their architecture is preserved.
• Complex – heterogeneous clusters of glands appear in the endometrium.
• Simple and complex with atypia - in addition to the enlargement of the glands, signs of nuclear atypia appear in the endometrium.

Atypia processes are destruction of the structure of the cell nucleus. Such division into types has clinical and prognostic significance. Thus, simple accounts for 1% of all cases of the disease transition to uterine cancer, complex - 3%. In cases with simple hyperplasia with atypia, uterine cancer occurs in 8% of cases, with complex with atypia - in 29%. According to the data of the conducted studies, in 42.6% of cases the atypical form develops into uterine cancer.

There are several forms of endometrial hypertrophy, which are also included in the classification. Let's look at the main ones:

1. The glandular form is the mildest and most benign form. The probability of developing cancerous tumors is 2-6%. In this form, the cells actively divide, and the endometrium thickens. The glands are unevenly located, can be pressed against each other, but there is no stroma between them. From straight, tubular glands turn into tortuous and significantly expand. But, despite such changes, the contents of the glands come out freely.
2. Glandular-cystic form - the cells grow strongly and block the outflow of mucus. Because of this, the mouth of the gland takes the form of a cyst - a bubble with liquid. As a rule, such changes occur due to the action of estrogens.
3. Cystic form - glandular cells grow and increase in size, which makes them look like bubbles. At the same time, the inner part of the gland has normal epithelium, so this form does not degenerate into a cancerous tumor.
4. Focal form - endometrial cells do not grow uniformly, but in separate foci. The foci are sensitive to the action of hormones. Elevations with altered glands-cysts appear on the endometrium. If the cells divide in a polyp, it increases in size, from several millimeters to 2-5 centimeters. There is a risk of developing a cancerous tumor at the site of the lesion. If the changes are not uniform, this form is called diffuse.
5. The atypical form or adenomatosis is the most dangerous form of endometrial hyperplasia, which leads to cancer. The only method of treating the atypical form is removal of the uterus.

The choice of treatment depends entirely on the form of the disease. Thus, in case of simple glandular hyperplasia, hormonal drugs are used for therapeutic purposes, and in case of atypical hyperplasia, uterine removal is used.

[ 15 ], [ 16 ], [ 17 ]

Glandular hyperplasia of the endometrium

Glandular hyperplasia of the endometrium is a pathological process of deviation of the structure of the endometrium tissue from the norm. Glandular cells grow, increase in volume and contribute to the thickening of the endometrium tissue. The basis of such a disorder is the intensive processes of proliferation in the glandular uterine layer. The danger of this disorder is that there is a risk of degeneration of the pathology into oncology. Timely diagnosis and treatment allow preserving the reproductive functions of the female reproductive system.

Cystic endometrial hyperplasia

Cystic hyperplasia of the endometrium is a form of damage that represents changes in the endometrium at the cellular level. Cystic and glandular-cystic forms are practically the same. Cystic hyperplasia is the process of cyst formation due to disturbances in the endometrial layer. In addition to cysts, large stromal nuclei begin to form in the endometrial layer. With the basal cystic form, the thickness of the basal layer of the endometrium increases.

To diagnose the disease, in addition to examination, the doctor takes tissue for histological analysis. In some cases, a biopsy is used, which gives more accurate results. Another method for diagnosing the cystic form is an ultrasound examination.

Cystic hyperplasia can have recurrent forms, i.e. recurrent. As a rule, hormonal drugs are used for treatment, which do not cure the disease completely and give relapses. In such cases, resection is used for treatment, i.e. excision of the endometrium, which is carried out with a laser. The doctor removes the inner surface of the endometrium. Because of this, the wound heals, and the disease does not recur. Endometrial damage can occur in women who suffered from inflammation of the appendages in their youth.

[ 18 ], [ 19 ], [ 20 ]

Glandular cystic hyperplasia of the endometrium

Glandular cystic hyperplasia of the endometrium occurs due to hormonal imbalances and failures. Lack of progesterone and excess estrogen, which occur during puberty, cause endometrial hyperplasia in young girls. Hormonal imbalances can also occur due to improper use of progestogen contraceptives. Sexually transmitted infections can also cause endometrial growth, as can untreated diseases of the female genital organs. Treatment depends on the woman's age, weight, endocrine disorders, chronic diseases and desire to have children in the future.

Focal endometrial hyperplasia

Focal endometrial hyperplasia is a disease caused by hormonal disorders. The pathology leads to changes in the uterine cavity and causes menstrual cycle failures. The focal form occurs because the endometrial cells grow unevenly, causing polyps to enlarge. Polyps develop into cysts, which without proper treatment can degenerate into malignant neoplasms. In this case, we are talking about an atypical form, the treatment of which can be a complete removal of the uterus.

[ 21 ]

Simple endometrial hyperplasia

Simple endometrial hyperplasia is accompanied by a characteristic increase in the number of glands. Despite the pathological processes, the architecture of the endometrium is preserved. This form accounts for about 1% of the disease developing into uterine cancer.

• Simple typical causes an increase in stromal and glandular structures. This leads to the endometrium increasing in volume, cystic expansion of active glands occurs. At the same time, the vessels in the stroma are evenly distributed, there is no atypia of the nuclei.
• Simple typical causes changes in the normal arrangement of gland cell nuclei. Also, it contributes to the modification of the cell shape, forming round cells with nuclei, causing the expansion of vacuoles and anisicytosis. In 20 out of 100 cases, the disease takes a malignant form.

Atypical endometrial hyperplasia

Atypical endometrial hyperplasia is the most dangerous form of this disease. Atypicality indicates malignant processes in the endometrium. The cause of the disease can be regular hormonal imbalances, advanced diseases, endocrine system disorders, inflammatory diseases, infectious diseases of the genitals, etc.

Treatment is long-term and, as a rule, radical. Surgical removal of the uterus allows preventing relapses of the disease and does not allow the possibility of metastasis of the malignant neoplasm.

[ 22 ], [ 23 ], [ 24 ]

Complex endometrial hyperplasia

Complex endometrial hyperplasia is a disease characterized by profound disturbances in the structure and architectonics of the endometrium, which leads to the proliferation of mucous membrane elements over its entire surface. Complex pathology can be with or without atypia.

• A complex form without atypia indicates that the woman does not have degenerated cells in the endometrium that can transform into cancer cells and actively multiply.
• Complex with atypia is a disease in which cells transform and become cancerous. Atypical cells in 40% of cases form malignant tumors.

Complex endometrial hyperplasia involves several treatment methods. If the disease is uncomplicated, then drug-based hormonal treatment is used for treatment. If hyperplasia is with atypia, then curettage is performed, and in particularly severe cases, surgical removal of the uterus.

[ 25 ]

Polypoid hyperplasia of the endometrium

Polypoid hyperplasia of the endometrium is a pathological process characterized by accelerated growth of the endometrium, which takes on a pathological structure. Polyps are clots of endometriotic tissue with pale pink bubbles. Ultrasound is used for diagnosis, in which the polypoid form is an uneven surface with multiple cysts, grooves and pits. Polyps vary in size and shape. Moreover, the deeper they are located to the bottom of the uterus, the more they increase in size. Hysteroscopy can be used for detailed diagnosis of polyps.

Polypoid hyperplasia may be asymptomatic in the early stages. However, if painful symptoms appear, you should consult a gynecologist. For treatment, the doctor may prescribe hormonal therapy and perform curettage. In rare cases, the disease recurs.

Adenomatous hyperplasia of the endometrium

Adenomatous hyperplasia of the endometrium is a disease, the second name of which is adenomatosis, that is, a synonym for atypical hyperplasia. The disease is a precancerous pathology, since there is a high risk of developing oncology. According to the results of studies, this type of pathology in 30% of cases degenerates into cancer.

The main clinical symptom is dysfunctional uterine bleeding. In addition to bleeding, women experience menstrual, reproductive, and sexual dysfunction. The disease is diagnosed using a histological examination. To do this, the gynecologist takes endometrial tissue samples from different parts of the uterus and examines them under a microscope. The characteristic signs of a histological examination are:

• Incorrect location of the endometrial glands and their large number.
• There are no epithelial cells between the glands; the glands are located close to each other.
• The endometrial glands, instead of being tubular, acquire a branched appearance.
• Iron structures appear within the gland, protrusions, and bridges of epithelial cells may form inside the glands.

All the above-described signs may have varying degrees of expression and are confirmation of atypical adenomatous hyperplasia of the endometrium. Hyperplasia can be considered adenomatous due to the large number of glands that are located close to each other. Atypia of cells is that they are rejuvenated, that is, they are subject to anaplasia. This leads to the fact that such cells actively multiply and develop into cancerous ones.

[ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ]

Basal hyperplasia of the endometrium

Basal hyperplasia of the endometrium is very rare. The characteristic symptom of this disease is thickening of the basal layer of the endometrium due to the proliferation of glands of the compact layer, the appearance of polymorphic nuclei of stromal cells of a fairly large size. Pathology of the basal layer is an extremely rare variant of pathology, which most often occurs in women after 35 years of age and has a focal nature.

The thickened hyperplastic layer usually has a dense stroma with tangles of blood vessels that have thickened walls. This pathology is characterized by long, painful and heavy menstruation. This is explained by the fact that the hyperplastic parts of the basal layer are rejected very slowly. For treatment, a combined method is used, curettage is done and hormonal therapy is administered.

[ 31 ], [ 32 ], [ 33 ]

Diffuse endometrial hyperplasia

Diffuse endometrial hyperplasia is a pathology that implies proliferative processes. Diffuseness covers the entire surface of the endometrial tissue. That is, it indicates a pathological process throughout the entire mucous membrane of the uterus. Diffuseness can take the form of attic, that is, adenomatous or glandular-cystic hyperplasia. This depends on the type of pathological growths.

• Diffuse glandular-cystic hyperplasia manifests itself as the growth and appearance of cysts and glands that spread and grow throughout the entire surface of the uterine mucosa.
• Adenomatous diffuse form is a pathological proliferation of glandular cells and epithelial cells throughout the entire surface of the uterine mucosa. This form can grow into the muscular layer of the uterus. Atypical diffuse hyperplasia is a precancerous condition.

As a rule, the diffuse type of pathology appears due to chronic inflammatory processes in the uterine cavity. The disease can be provoked by multiple abortions, increased levels of estrogens in the blood, inflammatory diseases of the genitals, endocrine disorders. In 70% of cases, the disease is accompanied by obesity, diabetes, liver disease or hypertension.

[ 34 ], [ 35 ], [ 36 ]

Localized endometrial hyperplasia

Local endometrial hyperplasia is a limited form of the disease called a polyp. According to histological studies, there are several forms that depend on the cells that predominate in their structure: fibrous polyps, glandular, glandular-fibrous.

Polyposis is characterized by rapid proliferation of endometrial cells in the uterine cavity. Polyps may have a stalk or be attached directly to the endometrium. Local hyperplasia may consist of one or more polyps, which are benign neoplasms. This type often recurs, especially with age of the woman.

Symptoms manifest themselves in the form of cramping pains, which intensify as the next polyp grows. Women begin to experience menstrual cycle irregularities, heavy discharge of leucorrhoea and heavy bleeding. Timely diagnosis is the key to successful treatment and a favorable outcome of the disease.

Endometrial hyperplasia in menopause

Endometrial hyperplasia in menopause is one of those problems that lies in wait for a woman. It occurs due to hormonal changes in the body. It is during menopause that a woman should be especially attentive to her health. Since during menopause, there is a danger of developing many diseases, both benign and malignant.

Endometrial hyperplasia in menopause develops due to excessive growth of the uterine mucosa. During this period, a woman may experience heavy uterine bleeding. The occurrence of pathology is facilitated by excess weight, endocrine diseases, hypertension. The danger of the disease is that during menopause it can degenerate into malignant tumors and lead to uterine cancer.

Regular examinations by a gynecologist help prevent the development of the disease. Normally, the endometrium should not exceed 5 mm in thickness. Any increase is a prerequisite for an ultrasound examination. If the thickness of the endometrium reaches 8 mm, then this is a pathology and the woman undergoes diagnostic curettage. If during menopause, the endometrium has reached 10-15 mm in size, then the gynecologist performs separate curettage and histology of the obtained material. As for treatment during menopause, there are several methods, let's consider them:

• Hormonal therapy – drugs contribute to a positive outcome of the disease and are an excellent prevention of oncology.
• Surgical intervention - the gynecologist performs scraping of the uterine mucosa, removes foci of pathology, stops bleeding and conducts diagnostics of the obtained tissues. Laser cauterization (ablation) is used for surgical treatment. In case of atypical endometrial hyperplasia during menopause, the woman undergoes hysterectomy.
• Combination treatment – this type of treatment involves a combination of hormonal therapy and surgery. In some cases, this prevents relapses of the disease.

[ 37 ]

Postmenopausal endometrial hyperplasia

Endometrial hyperplasia in postmenopause is not uncommon. It is during this period that involutional changes begin in the female body, and especially in the reproductive system. Secretion of the hormone estrogen is sharply reduced, which leads to pathogenetic disorders.

The main symptom is bloody discharge. This is the first alarm signal that should make a woman see a gynecologist. Untimely diagnosis and treatment can cause a precancerous condition, which under favorable conditions will quickly take the form of cancer.

Hormonal therapy, surgical treatment or a combined method are used for treatment.

• Hormonal therapy - since the pathology is a hormone-dependent disease, taking hormonal drugs is not only one of the effective methods of treatment, but also the prevention of oncology.
• Surgical treatment – most often, patients undergo curettage, that is, removal of foci of endometrial growth. After curettage, the obtained tissues are sent for cytological examination. Laser cauterization is popular and effective. This method involves the destruction of foci of pathologies and is completely bloodless, since the blood vessels are cauterized. Radical surgical treatment is considered to be removal of the uterus. Removal is carried out in the case when all the above-mentioned methods have not given a positive effect.
• Combined treatment is a comprehensive approach that allows to significantly reduce the volume of the enlarged endometrium before surgery and to carry out preventive treatment of the disease.

[ 38 ], [ 39 ]

What is the danger of endometrial hyperplasia?

What is dangerous about endometrial hyperplasia – this is the first question of women who have been diagnosed with this disease. The most important and very deplorable consequence of the disease is infertility, that is, the inability to have children. Due to the pathology, the fetus cannot attach to the walls of the altered mucous membrane of the uterus. But hyperplasia is dangerous not only for those who want to experience the charm of motherhood. Without proper treatment, the disease takes the form of a malignant neoplasm, the treatment of which negatively affects the functioning of the entire body.

As a rule, diagnosis is possible with ultrasound examination (transvaginal or abdominal). In some cases, the gynecologist gives a referral for a uterine biopsy or echohysterosalpingography. The most accurate method that allows you to accurately determine hyperplasia is hysteroscopy. This method involves performing a biopsy under the control of an optical system.

Recurrence of endometrial hyperplasia

Recurrence of endometrial hyperplasia is one of the clinical problems that requires a solution during the period of choosing the type of treatment for the disease. As a rule, surgical tactics are used to prevent relapses. But even this type of treatment does not guarantee that endometrial hyperplasia will not recur.

The course of the disease depends on the type of pathology and the age of the patient. Thus, when treating simple endometrial hyperplasia, i.e. polyps, conservative treatment methods are used, which in 40% of cases lead to relapses of the disease. If the pathology takes an atypical form, then hormone therapy and surgical intervention are used for its treatment. But this is also not a guarantee that the disease will not recur.

• In case of relapses of atypical endometrial hyperplasia, the woman is sent for an ultrasound examination to determine the extent of the lesion. The patient undergoes curettage and is prescribed hormonal therapy. But if after such a treatment process, hyperplasia recurs, then the woman is shown a hysterectomy.
• In case of relapses of simple, glandular, cystic or glandular-cystic form, hormone therapy is used. If a woman plans to give birth in the near future, then for treatment and normal conception, ablation is used, that is, resection of the endometrium (a procedure of complete destruction). Electrosurgical and laser methods are used for these purposes. Treatment is carried out under anesthesia and under the control of a hysteroscope.

That is, relapses of complex forms of endometrial hyperplasia are a direct indication for hysterectomy. In case of relapses of other forms of the disease, the woman undergoes hormone therapy and regular curettage.

Diagnosis of endometrial hyperplasia

Diagnostics of endometrial hyperplasia is a set of methods that allow to identify the disease, determine its type, causes and carry out all diagnostic measures necessary for successful treatment. Diagnostics consists of:

• Gynecological examination – allows to identify the presence of inflammatory processes and other diseases that accompany the pathology or have caused the disease.
• Ultrasound examination of the pelvic organs using a vaginal sensor – determines endometrial thickening, the presence of polyps and other neoplasms in the uterine cavity. With this method, you can visually see the changes that occur in the uterine cavity.
• Hysteroscopy is a method of examining the uterine cavity using a special optical sensor. In addition to examination, hysteroscopy involves separate scraping of the uterine cavity for diagnostic purposes. The resulting scraping is sent for examination to determine the type of pathology. This diagnostic method is carried out on the eve of the expected menstruation, to obtain reliable data.
• Hormonal studies and aspiration biopsy – a piece of endometrial tissue is sent for histological examination. To study the hormonal background, the work of the adrenal glands, thyroid gland, as well as the level of progesterone and estrogen are checked.
• Biopsy – a tissue sample is taken from the uterine cavity using an endoscope and examined under a microscope. This method is used to study changes in cells and determine the risk of cancer. The biopsy is performed in the second half of the cycle.
• Echosalpingography – a sterile isotonic solution or contrast agents are introduced into the uterine cavity. The doctor uses a special scanner and observes what is happening in the uterus and fallopian tubes. This method allows you to determine the patency of the fallopian tubes and the condition of the mucous membrane. During the study, it is possible to determine foci of hyperplasia, cysts, nodes, polyps.
• Radioisotope examination of the uterus using radioactive phosphorus - the substance is injected into a vein, and it accumulates in the overgrown tissues of the endometrium. The substance practically does not penetrate into healthy tissues. This allows us to determine the foci of hyperplasia. Thus, areas with an increased concentration of phosphorus correspond to the foci of endometrial cell growth.

[ 40 ], [ 41 ], [ 42 ]

Endometrial hyperplasia on ultrasound

Endometrial hyperplasia on ultrasound - allows you to visually trace changes in the uterine cavity, determine their scale and severity. Ultrasound examination allows you to determine the thickening of the endometrium, the presence of polyps, cysts, nodes and other neoplasms that have appeared. The advantage of this diagnostic method is that based on the results of ultrasound, you can make early conclusions about the treatment procedure and make a prognosis for the course of the disease.

Ultrasound examination reveals characteristic echo signs that correspond to one or another type. That is, ultrasound not only determines the presence of the disease, but also the form of hyperplasia. Ultrasound examination makes it possible to assess the condition of neighboring organs that may be the cause of pathology.

[ 43 ], [ 44 ], [ 45 ], [ 46 ]

Treatment of endometrial hyperplasia

Treatment of endometrial hyperplasia depends on the form of the disease and its stage. There are basic treatment methods, including:

• Separate diagnostic curettage and hysteroscopy.
• Hormonal therapy (based on the results of histological examination).
• Surgical removal of the uterus (performed when the above-described treatment methods are ineffective or when the disease is recurrent).

Timely diagnosis and identification of the causes of the disease allow for the most effective course of treatment with minimal complications and side effects.

Tampons for endometrial hyperplasia

Tampons for endometrial hyperplasia are one of the methods of treating the disease. Today, there are tampons on the pharmaceutical market that treat a number of women's diseases. Tampons are prescribed by the attending physician, who specifies the duration of use of tampons and the frequency of their use.

The most popular medicinal tampons are Beautiful Life tampons, which are officially recognized by traditional medicine and are an effective medication. The tampons contain natural plant extracts that have a therapeutic effect. Particles of the endometrium come out painlessly, tampons absorb harmful bacteria and prevent inflammatory diseases against the background of endometrial hyperplasia. The tampons contain soothing agents that relieve spasms and other painful manifestations of the disease. Medicinal tampons help slow down the development of the disease in the early stages and are an excellent preventative for relapses.

Diet for endometrial hyperplasia

The diet for endometrial hyperplasia is aimed at restoring reproductive functions and maintaining the body and immune system weakened by the disease. Patients are advised to follow a low-calorie diet. Such nutrition is one of the methods of treating not only hyperplasia, but also polyps in the uterus.

The low-calorie diet is explained by the fact that most often, endometrial hyperplasia affects overweight women who lead an unhealthy lifestyle and move little. Due to lipid metabolism disorders, there is a high probability of developing diabetes and hypertension. As a result, this leads to hormonal disorders, against which endometrial hyperplasia or polyps appear. A low-calorie diet is the key to a healthy body and a beautiful figure.

[ 47 ], [ 48 ], [ 49 ], [ 50 ]

Nutrition for endometrial hyperplasia

Nutrition for endometrial hyperplasia should be healthy and low-calorie. The diet should be based on vegetables, lean meat, milk, and fruit. Meals should be prepared with a minimum amount of fat and oil. Green salads, vegetable soups, and dishes made from seasonal products, low-fat broths will be healthy.

Nutrition is aimed at restoring the normal functioning of the body. Following the diet normalizes deviations in the endocrine and cardiovascular systems, which can provoke the development of pathology. It is necessary to exclude alcohol and harmful products from the diet, which are saturated with trans fats and genetically modified organisms.

It is recommended to eat fractionally, every 2-3 hours. This will help maintain metabolic processes in the body at a high level, speed up metabolism and give a feeling of satiety. In addition to nutrition, it is necessary to lead an active lifestyle, move more and spend time in the fresh air.

Prevention of endometrial hyperplasia

Prevention of endometrial hyperplasia implies timely treatment of any diseases of the female reproductive system. Particular attention is paid to anovulation, that is, infertility. Advanced forms can once and for all deprive you of the chance to experience the joy of motherhood. Do not forget about a very radical treatment of the disease - removal of the uterus.

Preventive measures to prevent pathology include the use of hormonal contraception, which slows down the process of proliferation of the endometrium in the uterine cavity. Preventive examinations by a gynecologist are mandatory. Any menstrual cycle disorders, pain during sex, heavy discharge and much more require treatment and determination of the cause of their occurrence.

A mandatory preventive measure is proper nutrition and maintaining normal weight. Taking birth control pills should be agreed with a gynecologist. When using hormonal drugs, it is necessary to undergo an examination of the uterus once a month.

The methods of prevention are as follows:

• Preventive examinations by a gynecologist every six months.
• Refusal of abortion and use of hormonal contraceptives.
• Timely treatment of inflammatory diseases of the genital area and any other gynecological diseases.
• Treatment of extragenital diseases and endocrine system disorders.
• Regular exercise and physical activity.

Prognosis of endometrial hyperplasia

The prognosis of endometrial hyperplasia depends on the form of the disease and the stage of its development. That is, the prognosis can be both favorable and unfavorable. A favorable prognosis indicates that the diagnosed form of endometrial hyperplasia is treatable, and the risks of recurrence and degeneration into cancer are minimal. As a rule, after a course of treatment with a favorable prognosis, women's reproductive, menstrual and sexual functions are completely restored. A favorable prognosis is possible with simple, glandular, glandular-cystic, cystic forms, as well as with the appearance of polyps.

But the prognosis of the disease worsens as the patient ages. That is, the younger the woman, the more favorable the prognosis. If a simple type of pathology is accompanied by endocrine and metabolic disorders (obesity, diabetes, hypertension), the prognosis worsens. If the disease recurs, the prognosis for health is unfavorable, since the woman undergoes surgical treatment, which involves removal of the uterus and disruption of a number of functions that cannot be restored.

• If endometrial hyperplasia is diagnosed after menopause, then, as a rule, the prognosis for health is unfavorable, but for life - positive. This is due to the fact that in old age, hyperplasia very often becomes malignant and is considered a precancerous condition.
• In case of complex or atypical endometrial hyperplasia, the prognosis is unfavorable, both in terms of health and life. This is explained by the fact that both forms of the disease are considered a precancerous condition, in which the disease quickly transforms into a malignant tumor.
• If the disease is resistant to conservative therapy, then surgical methods are used for treatment - curettage, removal of the uterus. In this case, the prognosis is unfavorable for the woman's health, since some of the functions of the genitals will never be restored.
• The prognosis is also affected by concomitant diseases and pathologies. For example, in case of hypertension, the prognosis of endometrial hyperplasia worsens, as the risk of recurrence of the disease increases significantly. This also applies to any endocrine-metabolic disorders (reduced glucose tolerance, increased cholesterol concentration, diabetes mellitus).

Endometrial hyperplasia is a disease that has several types, differing from each other in their course, nature, treatment methods and prognosis for recovery. Regular examinations by a gynecologist, timely treatment of sexually transmitted diseases and a healthy lifestyle are the key to women's health.

Sex with endometrial hyperplasia

Sex is not prohibited with endometrial hyperplasia. Many gynecologists recommend that patients do not refuse sexual intercourse. Unpleasant sensations that arise during sexual intercourse can be eliminated with the help of a long foreplay, carefulness of the partner and selection of the most acceptable position. With severe pain and heavy bleeding, sex becomes impossible.

Dyspareunia or pain during sex is one of the symptoms of the pathology. According to statistics, unpleasant and even painful sensations during sexual intercourse are experienced by about 50% of women who have been diagnosed with the disease. In addition to pain, minor bloody discharge may appear after sex, which is accompanied by aching paroxysmal pain in the ovaries.

Many women ignore these symptoms, letting the disease take its course. But it is pain during sex and pathological discharge that are a sign of the disease and require immediate medical attention. Do not forget that the absence of pain during sex indicates the health of the woman and her reproductive system.