Endometrial Hyperplasia | ACOG

Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Dilation and Curettage (D&C): A procedure that opens the cervix so tissue in the uterus can be removed using an instrument called a curette.

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Endometrial Biopsy: A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick.

Endometrial Intraepithelial Neoplasia (EIN): A precancerous condition in which areas of the lining of the uterus grow too thick.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hormones: Substances made in the body to control the function of cells or organs.

Hysterectomy: Surgery to remove the uterus.

Hysteroscopy: A procedure in which a lighted telescope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Menstrual Periods: The monthly shedding of blood and tissue from the uterus.

Menstruation: The monthly shedding of blood and tissue from the uterus that happens when a woman is not pregnant.

Obesity: A condition characterized by excessive body fat.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Ovulation: The time when an ovary releases an egg.

Perimenopause: The time period leading up to menopause.

Polycystic Ovary Syndrome (PCOS): A condition that leads to a hormone imbalance that affects a woman’s monthly menstrual periods, ovulation, ability to get pregnant, and metabolism.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Tamoxifen: An estrogen-blocking medication sometimes used to treat breast cancer.

Transvaginal Ultrasound Exam: A type of ultrasound in which the device is placed in your vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Endometrial Hyperplasia: Causes, Symptoms & Treatment

Overview

What is endometrial hyperplasia?

Endometrial hyperplasia is a condition of the female reproductive system. The lining of the uterus (endometrium) becomes unusually thick because of having too many cells (hyperplasia). It’s not cancer, but in certain women, it raises the risk of developing endometrial cancer, a type of uterine cancer.

How common is endometrial hyperplasia?

Endometrial hyperplasia is rare. It affects approximately 133 out of 100,000 women.

Who might have endometrial hyperplasia?

Women who are perimenopausal or menopausal are more likely to have endometrial hyperplasia. It rarely occurs in women younger than 35. Other risk factors include:

What are the types of endometrial hyperplasia?

Doctors classify endometrial hyperplasia based on the kinds of cell changes in the endometrial lining. Types of endometrial hyperplasia include:

• Simple endometrial hyperplasia (without atypia): This type of endometrial hyperplasia has normal-looking cells that aren’t likely to become cancerous. This condition may improve without treatment. Hormone therapy helps in some cases.
• Simple or complex atypical endometrial hyperplasia: An overgrowth of abnormal cells causes this precancerous condition. Without treatment, your risk of endometrial or uterine cancer increases.

Symptoms and Causes

What causes endometrial hyperplasia?

Women who develop endometrial hyperplasia produce too much estrogen and not enough progesterone. These female hormones play essential roles in menstruation and pregnancy. During ovulation, estrogen thickens the endometrium, while progesterone prepares the uterus for pregnancy. If conception doesn’t occur, progesterone levels drop. The progesterone drop triggers the uterus to shed its lining as a menstrual period.

Women who have endometrial hyperplasia make little, if any, progesterone. As a result, the uterus doesn’t shed the endometrial lining. Instead, the lining continues to grow and thicken.

Additionally, obesity contributes to the elevation of estrogen levels. The adipose tissue (fat stores in the abdomen and body) can convert the fat producing hormones to estrogen. This is the how obesity contributes to elevated circulating levels of estrogen and increases the risk of endometrial hyperplasia.

What are the symptoms of endometrial hyperplasia?

Women with endometrial hyperplasia may experience:

Diagnosis and Tests

How is endometrial hyperplasia diagnosed?

Many conditions can cause abnormal bleeding. To identify what’s causing symptoms, your healthcare provider may order one or more of these tests:

• Ultrasound: A transvaginal ultrasound uses sound waves to produce images of the uterus. The images can show if the lining is thick.
• Biopsy: An endometrial biopsy removes tissue samples from the uterus lining. Pathologists study the cells to confirm or rule out cancer.
• Hysteroscopy: Your provider uses a thin, lighted tool called a hysteroscope to examine the cervix and look inside the uterus. Your provider may perform this procedure along with a dilation and curettage (D&C) or biopsy. It’s most advantageous to couple this with a visually directed dilation and curettage of the endometrium. With hysteroscopy, your provider can see abnormalities within the endometrial cavity and take a targeted (directed) biopsy of any suspicious areas.

Management and Treatment

What are the complications of endometrial hyperplasia?

All types of hyperplasia can cause abnormal and heavy bleeding that can make you anemic. Anemia develops when your body doesn’t have enough iron-rich red blood cells.

Untreated atypical endometrial hyperplasia can become cancerous. Endometrial or uterine cancer develops in about 8% of women with untreated simple atypical endometrial hyperplasia. Close to 30% of women with complex atypical endometrial hyperplasia who don’t get treatment develop cancer.

How is endometrial hyperplasia managed or treated?

If you’re at increased risk of cancer due to atypical endometrial hyperplasia, your healthcare provider may recommend a hysterectomy to remove the uterus. After a hysterectomy, you won’t be able to get pregnant. Many people see symptoms improve with less invasive progestin treatments. Progestin comes in many forms:

Prevention

How can I prevent endometrial hyperplasia?

Certain steps may reduce your chances of developing endometrial hyperplasia:

• Use progesterone along with estrogen after menopause (if you use hormone therapy).
• Take the birth control pill.
• Quit smoking.
• Maintain a healthy weight.

Outlook / Prognosis

What is the prognosis (outlook) for people who have endometrial hyperplasia?

Endometrial hyperplasia responds well to progestin treatments. Atypical endometrial hyperplasia can lead to endometrial or uterine cancer. Your healthcare provider may recommend more frequent direct (hysteroscopic) assessment or a hysterectomy to eliminate cancer risk.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

What questions should I ask my doctor?

If you have endometrial hyperplasia, you may want to ask your healthcare provider:

• Why did I get endometrial hyperplasia?
• What type of endometrial hyperplasia do I have?
• Am I at increased risk for endometrial or uterine cancer? If so, how can I lower that risk?
• If I’m overweight, can I be referred to a weight management consultant?
• What is the best treatment for the type of endometrial hyperplasia I have?
• What are the treatment risks and side effects?
• Are my family members at risk for developing endometrial hyperplasia? If so, what can they do to lower that risk?
• What type of follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Endometrial hyperplasia is a condition that causes abnormal uterine bleeding. These symptoms can be uncomfortable and disruptive. Many women find relief through progestin hormone treatments. Women who have atypical endometrial hyperplasia have a higher risk of developing uterine cancer. A hysterectomy stops symptoms and eliminates cancer risk. Talk to your healthcare provider about the best treatment for you.

Female Reproductive System (for Parents)

What Is Reproduction?

Reproduction is the process by which organisms make more organisms like themselves. But even though the reproductive system is essential to keeping a species alive, unlike other body systems, it’s not essential to keeping an individual alive.

In the human reproductive process, two kinds of sex cells, or gametes (GAH-meetz), are involved. The male gamete, or sperm, and the female gamete, the egg or ovum, meet in the female’s reproductive system. When sperm fertilizes (meets) an egg, this fertilized egg is called a zygote (ZYE-goat). The zygote goes through a process of becoming an embryo and developing into a fetus.

The male reproductive system and the female reproductive system both are needed for reproduction.

Humans, like other organisms, pass some characteristics of themselves to the next generation. We do this through our genes, the special carriers of human traits. The genes that parents pass along are what make their children similar to others in their family, but also what make each child unique. These genes come from the male’s sperm and the female’s egg.

What Is the Female Reproductive System?

The external part of the female reproductive organs is called the vulva, which means covering. Located between the legs, the vulva covers the opening to the vagina and other reproductive organs inside the body.

The fleshy area located just above the top of the vaginal opening is called the mons pubis. Two pairs of skin flaps called the labia (which means lips) surround the vaginal opening. The clitoris, a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra (the canal that carries pee from the bladder to the outside of the body) and vagina. When girls become sexually mature, the outer labia and the mons pubis are covered by pubic hair.

A female’s internal reproductive organs are the vagina, uterus, fallopian tubes, and ovaries.

The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. Because it has muscular walls, the vagina can expand and contract. This ability to become wider or narrower allows the vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina’s muscular walls are lined with mucous membranes, which keep it protected and moist.

The vagina serves three purposes:

1. It’s where the penis is inserted during sexual intercourse.
2. It’s the pathway (the birth canal) through which a baby leaves a woman’s body during childbirth.
3. It’s the route through which menstrual blood leaves the body during periods.

A very thin piece of skin-like tissue called the hymen partly covers the opening of the vagina. Hymens are often different from female to female. Most women find their hymens have stretched or torn after their first sexual experience, and the hymen may bleed a little (this usually causes little, if any, pain). Some women who have had sex don’t have much of a change in their hymens, though. And some women’s hymens have already stretched even before they have sex.

The vagina connects with the uterus, or womb, at the cervix (which means neck). The cervix has strong, thick walls. The opening of the cervix is very small (no wider than a straw), which is why a tampon can never get lost inside a girl’s body. During childbirth, the cervix can expand to allow a baby to pass.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls — in fact, the uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. When a woman isn’t pregnant, the uterus is only about 3 inches (7.5 centimeters) long and 2 inches (5 centimeters) wide.

At the upper corners of the uterus, the fallopian tubes connect the uterus to the ovaries. The ovaries are two oval-shaped organs that lie to the upper right and left of the uterus. They produce, store, and release eggs into the fallopian tubes in the process called ovulation (av-yoo-LAY-shun).

There are two fallopian (fuh-LO-pee-un) tubes, each attached to a side of the uterus. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn’t completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the fallopian tube, tiny hairs in the tube’s lining help push it down the narrow passageway toward the uterus.

The ovaries (OH-vuh-reez) are also part of the endocrine system because they produce female sex

hormonessuch as estrogen (ESS-truh-jun) and progesterone (pro-JESS-tuh-rone).

How Does the Female Reproductive System Work?

The female reproductive system enables a woman to:

• produce eggs (ova)
• have sexual intercourse
• protect and nourish a fertilized egg until it is fully developed
• give birth

Sexual reproduction couldn’t happen without the sexual organs called the gonads. Most people think of the gonads as the male testicles. But both sexes have gonads: In females the gonads are the ovaries, which make female gametes (eggs). The male gonads make male gametes (sperm).

When a baby girl is born, her ovaries contain hundreds of thousands of eggs, which stay inactive until puberty begins. At puberty, the

pituitary gland (in the central part of the brain) starts making hormones that stimulate the ovaries to make female sex hormones, including estrogen. The secretion of these hormones causes a girl to develop into a sexually mature woman.

Toward the end of puberty, girls begin to release eggs as part of a monthly period called the menstrual cycle. About once a month, during ovulation, an ovary sends a tiny egg into one of the fallopian tubes.

Unless the egg is fertilized by a sperm while in the fallopian tube, the egg leaves the body about 2 weeks later through the uterus — this is menstruation. Blood and tissues from the inner lining of the uterus combine to form the menstrual flow, which in most girls lasts from 3 to 5 days. A girl’s first period is called menarche (MEH-nar-kee).

It’s common for women and girls to have some discomfort in the days leading to their periods. Premenstrual syndrome (PMS) includes both physical and emotional symptoms that many girls and women get right before their periods, such as:

PMS is usually at its worst during the 7 days before a girl’s period starts and disappears after it begins.

Many girls also have belly cramps during the first few days of their periods caused by prostaglandins, chemicals in the body that make the smooth muscle in the uterus contract. These involuntary contractions can be dull or sharp and intense.

It can take up to 2 years from menarche for a girl’s body to develop a regular menstrual cycle. During that time, her body is adjusting to the hormones puberty brings. On average, the monthly cycle for an adult woman is 28 days, but the range is from 23 to 35 days.

What Happens If an Egg Is Fertilized?

If a female and male have sex within several days of the female’s ovulation, fertilization can happen. When the male ejaculates (when semen leaves the penis), a small amount of semen is deposited into the vagina. Millions of sperm are in this small amount of semen, and they “swim” up from the vagina through the cervix and uterus to meet the egg in the fallopian tube. It takes only one sperm to fertilize the egg.

About 5 to 6 days after the sperm fertilizes the egg, the fertilized egg (zygote) has become a multicelled blastocyst. A blastocyst (BLAS-tuh-sist) is about the size of a pinhead, and it’s a hollow ball of cells with fluid inside. The blastocyst burrows itself into the lining of the uterus, called the endometrium. The hormone estrogen causes the endometrium (en-doh-MEE-tree-um) to become thick and rich with blood. Progesterone, another hormone released by the ovaries, keeps the endometrium thick with blood so that the blastocyst can attach to the uterus and absorb nutrients from it. This process is called implantation.

As cells from the blastocyst take in nourishment, another stage of development begins. In the embryonic stage, the inner cells form a flattened circular shape called the embryonic disk, which will develop into a baby. The outer cells become thin membranes that form around the baby. The cells multiply thousands of times and move to new positions to eventually become the embryo (EM-bree-oh).

After about 8 weeks, the embryo is about the size of a raspberry, but almost all of its parts — the brain and nerves, the heart and blood, the stomach and intestines, and the muscles and skin — have formed.

During the fetal stage, which lasts from 9 weeks after fertilization to birth, development continues as cells multiply, move, and change. The fetus (FEE-tis) floats in amniotic (am-nee-AH-tik) fluid inside the amniotic sac. It gets oxygen and nourishment from the mother’s blood via the placenta (pluh-SEN-tuh). This disk-like structure sticks to the inner lining of the uterus and connects to the fetus via the umbilical (um-BIL-ih-kul) cord. The amniotic fluid and membrane cushion the fetus against bumps and jolts to the mother’s body.

Pregnancy lasts an average of 280 days — about 9 months. When the baby is ready for birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to pass into and through the vagina. Mucus has formed a plug in the cervix, which now loosesn. It and amniotic fluid come out through the vagina when the mother’s water breaks.

When the contractions of labor begin, the walls of the uterus contract as they are stimulated by the pituitary hormone oxytocin (ahk-see-TOE-sin). The contractions cause the cervix to widen and begin to open. After several hours of this widening, the cervix is dilated (opened) enough for the baby to come through. The baby is pushed out of the uterus, through the cervix, and along the birth canal. The baby’s head usually comes first. The umbilical cord comes out with the baby. It’s clamped and cut close to the navel after the baby is delivered.

The last stage of the birth process involves the delivery of the placenta, which at that point is called the afterbirth. After it has separated from the inner lining of the uterus, contractions of the uterus push it out, along with its membranes and fluids.

What Does the Uterus Do?

The uterus is the medical term for the womb. It is the Latin word for womb. It is about the size and shape of an inverted pear. The uterus sits quite low in the abdomen and is held in position by muscles, ligaments and fibrous tissues. The uterus is joined to the vagina by the cervix that is also called the neck of the womb.

Uterus and periods

Each month in women of the reproductive age group the female body secretes hormones that causes ovulation (release of an egg from the ovary) and periods (menstruation). The lining of the uterus is called the endometrium. It is made of several layers that include surface epithelium, blood vessels, glands and other tissues.

Each month the endometrium grows thicker to prepare for pregnancy. This is synchronized with the ovulation. If a woman does not become pregnant, the top layers of the endometrium with blood from the blood vessels are shed. These flow out through the vagina in the monthly period. When a woman has her menopause the body stops production of hormones that cause ovulation and periods.

Functions of the uterus

Functions of the uterus include nurturing the fertilized ovum that develops into the fetus and holding it till the baby is mature enough for birth. The ferlized ovum gets implanted into the endometrium and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and develops until childbirth.

The uterus provides structural integrity and support to the bladder, bowel, pelvic bones and organs as well. It separates the bladder and the bowels.

The networks of blood vessels and nerves of the uterus direct the blood flow to the pelvis and to the external genitalia, including the ovaries, vagina, labia, and clitoris for sexual response. The uterus is needed for uterine orgasm to occur.

Anatomy of the uterus

Uterus may be of several anatomical types. For example, some mammals like deer, moose, cats etc. have bipartite uterus, pigs and dogs have bicornuate uteri, single uterus with a single cavity is found in humans, horses and apes.

The uterus lies in the pelvis behind the urinary bladder and in front of the rectum. The uterus is a pear shaped muscular organ. It has four segments – the fundus (top of the uterus), corpus (body), cervix (mouth) and the internal os (opening).

The uterus has numerous nerves, and networks of arteries and veins as well as ligaments such as the round ligaments, cardinal ligaments, broad ligaments, and uterosacral ligaments of uterus.

Diseases involving the uterus

There may be several pathologies and disease conditions involving the uterus. These include:

• Uterine prolapse
• Congenital abnormality of the uterus including congenital absence of the uterus Rokitansky Syndrome and others like Uterine Didelphys, bicornuate uterus and septate uterus
• Benign or non-malignant tumors of the uterus or uterine fibroids
• Adenomyosis
• Cervix cancer
• Cancer of the endometrium or uterine cancer
• Pyometra – infection of the uterus
• Adhesions within the uterus or Asherman’s syndrome

Further Reading

Endometrial Ablation (Uterine Lining Removal) | ColumbiaDoctors

What is endometrial ablation?

Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete.

Endometrial ablation may be recommended to destroy the lining of the uterus. Because the endometrial lining is destroyed, it can no longer function normally, and bleeding is stopped or controlled. In most cases, a woman cannot become pregnant after endometrial ablation because the lining that nourishes a fetus has been removed. However, after ablation, a woman still has her reproductive organs. In some cases, endometrial ablation may be an alternative to hysterectomy.

There are several techniques used to perform endometrial ablation including the following:

• Electrical or electrocautery: Electric current travels through a wire loop or rollerball that is applied to the endometrial lining to cauterize the tissue
• Hydrothermal: Heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature
• Balloon therapy: A balloon at the end of a catheter is inserted into the uterus and filled with fluid, which is then heated to the point that the endometrial tissues are eroded away
• Radiofrequency ablation: A triangular mesh electrode is expanded to fill the uterine cavity. The electrode delivers electrical current and destroys the endometrial lining.
• Cryoablation (freezing): A probe uses extremely low temperatures to freeze and destroy the endometrial tissues
• Microwave ablation: Microwave energy is delivered through a slender probe that has been inserted into the uterus and destroys the endometrial lining.

Some endometrial ablation procedures are performed using a hysteroscope, a lighted viewing device inserted through the vagina for a visual examination of the canal of the cervix and the interior of the uterus. Ablation instruments can be inserted through the opening and a camera or video camera can be used to record findings through the hysteroscope.

A resectoscope may be used instead of the hysteroscope. This device is similar to the hysteroscope but has a built-in wire that uses electrical current for resecting (removing) endometrial tissue.

Other ablation techniques use ultrasound to guide the instrument to the areas for treatment. Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

What can I expect from the procedure?

An endometrial ablation may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices. The type of anesthesia will depend upon the specific procedure being performed.

Generally, ablations using a hysteroscope or resectoscope follow this procedure:

1. You will be asked to undress completely and put on a hospital gown.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on an operating or examination table, with your feet and legs supported as for a pelvic examination.
4. A urinary catheter may be inserted.
5. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
6. Your cervix may be cleansed with an antiseptic solution.
7. A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure.
8. The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that the hysteroscope or resectoscope can be inserted.
9. The hysteroscope or resectoscope will be inserted through the cervical opening into the uterus.
10. A liquid solution or carbon dioxide gas may be used to fill the uterus for better viewing.
11. The ablation instrument will be inserted through the hollow opening of the hysteroscope. A rollerball or wire loop with electrical current will be passed across the endometrial tissues, destroying the tissues.
12. For hydrothermal ablation, a heated liquid is placed into the uterus through a catheter and circulated with a computer-controlled pump until the endometrial tissues are destroyed by the high temperatures.
13. After the procedure has been completed, any fluid will be pumped out from your uterus and the instruments will be removed.

Generally, other types of ablation techniques follow this procedure:

1. You will be asked to undress completely and put on a hospital gown.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on an examination table, with your feet and legs supported as for a pelvic examination.
4. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
5. Your cervix may be cleansed with an antiseptic solution.
6. The physician will numb the area using a small needle to inject medication.
7. A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus and cervical canal. This may cause some cramping. The sound will then be removed.
8. With balloon ablation, a silicone balloon will be inserted through the cervical opening into the uterine cavity and will be connected by a catheter to a computer console. Hot liquid will be circulated inside the balloon to destroy the endometrial tissues. The pressure, temperature, and time of the treatment will be controlled by the computer. This may cause some mild to strong cramping.
9. With radiofrequency ablation, a triangular mesh electrode will be inserted through the cervical opening and expanded to fill the uterine cavity. Radio-frequency energy will be passed into the mesh to destroy the tissues it contacts. Suction helps remove liquids, steam, and other gases that will be produced during ablation. This may cause some mild to strong cramping.
10. For cryoablation, a special probe that produces very cold temperatures will be inserted through the cervical opening into the uterus. An ultrasound transducer will be placed on your abdomen to guide the cryoablation probe to the appropriate areas in the uterus for freezing. This may cause some mild to strong cramping.
11. The instruments will be removed.

Are there any risks?

As with any surgical procedure, complications may occur. Some possible complications of endometrial ablation may include, but are not limited to, the following:

• Bleeding
• Infection
• Perforation of the uterine wall or bowel
• Overloading of fluid into the bloodstream

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Endometrial ablation during pregnancy may lead to miscarriage.

After the procedure

The recovery process will vary depending upon the type of ablation performed and the type of anesthesia that was administered. You may want to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for a few days after the procedure. You may also have a watery-bloody discharge for several weeks.

You may experience strong cramping, nausea, vomiting, and/or the need to urinate frequently for the first few days after the procedure. Cramping may continue for a longer time.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after an endometrial ablation, or for the period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Take a pain reliever for cramping or soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

• Notify your physician if you have any of the following:
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe abdominal pain
• Excessive bleeding, or heavy bleeding longer than two days after the procedure
• Difficulty urinating

Stages in the Menstrual Cycle

A girl’s ovaries at birth contain about two million balls of cells. The immature egg in the center of each cell is called a follicle. The ovaries absorb more than half of these follicles during childhood. Of the 400,000 follicles still present at puberty, between 300 and 500 will eventually develop into mature eggs.

During the reproductive years, follicles develop throughout the cycle, but each month, under the influence of hormones, usually only one follicle develops fully. (Sometimes two or more follicles develop fully, in which case a twin or other multiple pregnancy can result.)

The follicle with the maturing egg inside moves toward the surface of the ovary. At ovulation, the follicle and the ovarian surface open, allowing the tiny egg to float out. About this time, you may feel a twinge or cramp in the lower abdomen or back (called mittelschmerz).

I never knew the word ‘mittelschmerz’ until I was in nursing school. I thought it was such a cool word but was sure I wasn’t one of those women who actually experienced it. A year or so later I began tracking all of my fertility signs when I decided to try to get pregnant. I felt a funny cramp on my left side that was a familiar sensation but I had never put two and two together to recognize that it was my body ovulating. I actually exclaimed out loud, “Mittelschmerz!”

Headaches, stomach pains, or sluggishness are not uncommon at the time of ovulation, but you might also feel fantastic.

The Egg After Ovulation

After ovulation, the fingerlike ends (fimbria) of the nearby fallopian tube sweep the released egg into the tube’s funnel-shaped end. Each tube is lined with microscopic hair-like projections (cilia) that constantly move back and forth. As the egg begins its several-day journey to the uterus, wavelike movements of the muscles in the tube (peristalsis) and the movements of the cilia help it along.

If sperm enter the vagina, pass through the cervix, and travel through the uterus into the fallopian tubes, the cilia propel the sperm toward the egg. If the egg and sperm meet, they may join. (This is fertilization, when the sperm “fertilizes” the egg.) The fertilized egg then travels the rest of the way along the fallopian tube to the uterus.

Whether or not fertilization takes place, the empty follicle that just released the egg from the ovary becomes a corpus luteum (Latin for “yellow body” because of its color). The corpus luteum continues to make estrogen and also begins making progesterone.

If a fertilized egg implants into the uterus, it sends a signal to the ovary to keep making progesterone, which will help sustain a pregnancy by keeping the uterine lining thick and nourishing. If no pregnancy occurs, the corpus luteum is reabsorbed into the ovary after two weeks and the hormone levels drop; this is the trigger that causes menstruation. The egg disintegrates or flows out with the vaginal secretions.

The Cervix

The kind of mucus or fluid produced by your cervix changes throughout the menstrual cycle in response to fluctuations in estrogen and progesterone. While there are general patterns of fluid secretion, everyone’s pattern is unique.

You can track your cervical fluid and other signs to help you prevent pregnancy or help you conceive. Find out more. The cervical fluid is a kind of gatekeeper for the uterus. At ovulation, the cervical fluid becomes slippery and thin, like egg white. It coats the vagina and protects sperm from the vagina’s relatively acidic environment. The cervical fluid also nourishes the sperm and changes their structure to prepare them to fertilize an egg. Sperm can live up to five days in midcycle cervical fluid.

After ovulation, as progesterone levels increase, cervical fluid thickens into a kind of plug that makes it difficult for sperm to enter the uterus. The vagina gradually becomes drier, too.

If you look at your cervix with a speculum or feel it with your fingers, you may notice that at about the time of ovulation, the cervix is pulled up high into the vagina. It may also enlarge and soften, and the os (the opening to the uterus) may open a little.

The Endometrium

The lining of the uterus, called the endometrium, thickens and then thins over the course of a menstrual cycle and thickens considerably during pregnancy. Embedded in this lining are glands that can secrete a fluid that will help nourish a pregnancy until a placenta is formed.

In a typical menstrual cycle, estrogen made by the maturing ovarian follicle causes the glands to grow and the endometrium to thicken (partly through an increased blood supply). This thickening of the uterine lining is called the proliferative phase of the menstrual cycle. It can vary in length, generally lasting between six and 20 days.

Progesterone, made by the corpus luteum (ruptured follicle) after the egg is released, stimulates the glands in the endometrium to begin secreting their nourishing substance. This is the secretory phase of the cycle and is the only time when a fertilized egg can implant in the lining. In the case of irregular periods, it is the proliferative phase that is variable; for example, if you have 28-day cycles, you ovulates on day 14; if you have 35-day cycles, you ovulate on day 21.

If conception does not occur, the corpus luteum produces estrogen and progesterone for about 12 days, with the amount lessening in the last few days. As the estrogen and progesterone levels drop, the tiny arteries bringing blood supply to the endometrium close off. The lining, deprived of nourishment and oxygen, collapses and breaks off starting about 14 days after ovulation. This is menstruation: the menstrual period or flow.

During menstruation, most of the lining is shed, but the bottom third remains to form a new lining. Then, as a new follicle starts growing and secreting estrogen, the uterine lining thickens, and the cycle begins again.

It is possible to have what may appear to be a menstrual period even if you haven’t ovulated that month. These anovulatory cycles often occur when menstruation starts and your cycles are getting established. Anovulatory cycles become more common again as menopause approaches.

What Is Endometrial Cancer?

Endometrial cancer starts when cells in the endometrium (the inner lining of the uterus) start to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other parts of the body. To learn more about how cancers start and spread, see What Is Cancer?

About the uterus and endometrium

The uterus is a hollow organ, normally about the size and shape of a medium-sized pear. The uterus is where a fetus grows and develops when a woman is pregnant. It has 2 main parts (see image below):

• The upper part of the uterus is called the body or the corpus. (Corpus is the Latin word for body.)
• The cervix is the lower end of the uterus that joins it to the vagina.

When people talk about cancer of the uterus, they usually mean cancers that start in the body of the uterus, not the cervix. (Cervical cancer is a separate kind of cancer.)

The body of the uterus has 2 main layers:

• The myometrium is the outer layer. This thick layer of muscle is needed to push the baby out during birth.
• The endometrium is the inner layer. During a woman’s menstrual cycle, hormones cause the endometrium to change. Estrogen causes the endometrium to thicken so that it could nourish an embryo if pregnancy occurs. If there is no pregnancy, estrogen is produced in lower amounts and more of the hormone called progesterone is made. This causes the endometrial lining to shed from the uterus and become the menstrual flow (period). This cycle repeats until menopause.

There is also a layer of tissue called the serosa which coats the outside of the uterus.

Types of endometrial cancer

Endometrial cancer (also called endometrial carcinoma) starts in the cells of the inner lining of the uterus (the endometrium). This is the most common type of cancer in the uterus

Endometrial carcinomas can be divided into different types based on how the cells look under the microscope.
(These are called histologic types. ) They include:

• Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer — see below)
• Uterine carcinosarcoma or CS (covered below in the grading section)
• Squamous cell carcinoma
• Small cell carcinoma
• Transitional carcinoma
• Serous carcinoma

Clear-cell carcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and serous adenocarcinoma are less common types of endometrial adenocarcinomas. They tend to grow and spread faster than most types of endometrial cancer.
They often have spread outside the uterus by the time they’re diagnosed.

Endometrioid cancer

Most endometrial cancers are adenocarcinomas, and endometrioid cancer is the most common type of adenocarcinoma, by far. Endometrioid cancers start in gland cells and look a lot like the normal uterine lining (endometrium). Some of these cancers have squamous cells (squamous cells are flat, thin cells), as well as glandular cells.

There are many variants (or sub-types) of endometrioid cancers including:

• Adenocarcinoma, (with squamous differentiation)
• Adenoacanthoma
• Adenosquamous (or mixed cell)
• Secretory carcinoma
• Ciliated carcinoma
• Villoglandular adenocarcinoma

Grading endometrial cancer

The grade of an endometrial cancer is based on how much the cancer cells are organized into glands that look like the glands found in a normal, healthy endometrium.

In lower-grade cancers (grades 1 and 2), more of the cancer cells form glands. In higher-grade cancers (grade 3), more of the cancer cells are disorganized and do not form glands.

• Grade 1 tumors have 95% or more of the cancer tissue forming glands.
• Grade 2 tumors have between 50% and 94% of the cancer tissue forming glands.
• Grade 3 tumors have less than half of the cancer tissue forming glands. Grade 3 cancers tend to be aggressive (they grow and spread fast) and have a worse outlook than lower-grade cancers.

Grades 1 and 2 endometrioid cancers are type 1 endometrial cancers. Type 1 cancers are usually not very aggressive and they don’t spread to other tissues quickly. Type 1 endometrial cancers are thought to be caused by too much estrogen.
They sometimes develop from atypical hyperplasia, an abnormal overgrowth of cells in the endometrium. (See Endometrial Cancer Risk Factors for more on this.)

A small number of endometrial cancers are type 2 endometrial cancer. Type 2 cancers are more likely to grow and spread outside the uterus, they have a poorer outlook (than type 1 cancers). Doctors tend to treat these cancers more aggressively. They don’t seem to be caused by too much estrogen. Type 2 cancers include all endometrial carcinomas that aren’t type 1, such as papillary serous carcinoma, clear-cell carcinoma, undifferentiated carcinoma, and grade 3 endometrioid carcinoma. These cancers don’t look at all like normal endometrium and so are called poorly differentiated or high-grade.

Uterine carcinosarcoma (CS) starts in the endometrium and has features of both endometrial carcinoma and sarcoma. (The sarcoma is cancer that starts in muscle cells of the uterus.) In the past, CS was considered a different type of uterine cancer called uterine sarcoma (see below), but doctors now believe that CS is an endometrial carcinoma that’s so abnormal it no longer looks much like the cells it came from (it’s poorly differentiated).

Uterine CS is a type 2 endometrial carcinoma. CS tumors are also known as malignant mixed mesodermal tumors or malignant mixed mullerian tumors (MMMTs). They make up about 3%
of uterine cancers.

Other types of cancer in the uterus

Uterine sarcomas start in the muscle layer (myometrium) or supporting connective tissue of the uterus. These include uterine leiomyosarcomas and endometrial stromal sarcomas. These cancers are not covered here, but are discussed in detail in Uterine Sarcoma.

Cancers that start in the cervix and then spread to the uterus are different from cancers that start in the body of the uterus. They’re described in Cervical Cancer.

90,000 – 1.2.3.

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1.2.3. Uterus

Uterus (lat. – uterus, gr. – metra) is a thick-walled, cavity, membranous-mucous-muscular organ in which the embryo develops and the fetus ripens. The non-pregnant uterus is located in the pelvic and abdominal cavities. It lies under the rectum and above the bladder.

In domestic animals, the uterus is two-horned: horns, body and cervix are distinguished in it. Animals have two horns of the uterus – left and right (cornua uteri dextrum et sinistrum), which in their back are connected by an inter-horn ligament (lig.intercornuale uteri). The horns of the uterus gradually pass in the cranial direction, narrowing, into the oviducts, and in the caudal, uniting, into the unpaired body of the uterus (corpus uteri), which, in turn, continues caudally into the cervix (cervix uteri). On each horn, the upper mesenteric (margo mesentericus) and the lower free edge (margo liber) are distinguished. The horns of the uterus are in close proximity to the ovaries and are connected to them with the help of the mesentery of the oviduct. The location of the uterine horns in domestic animals has specific features (Fig.39).

On the body of the uterus, the upper and lower surfaces (fades dorsalis et ventralis) and the right and left edges (margo uteri dextrum et sinistrum) are distinguished. In the body of the uterus there is a cavity (cavum uteri), which cranially passes into the cavity of the horns of the uterus, and caudally continues into the cervical canal (canalis cervicis uteri).

The cervix is ​​divided into two portions – the cranial pre-vaginal (portio prevaginalis cervicis) and the caudal vaginal (portio vaginalis cervicis), which protrudes into the vagina in the form of a rosette. The cervical canal contains two openings: the internal opening of the uterus (ostium uteri internum), which opens into the body cavity of the uterus, and the external (ostium uteri externum), which opens into the vagina. The mucous membrane of the cervical canal has many cervical glands (gll.cervicales) and is collected in longitudinal folds (plicae longitudinales).

The wall of the uterus consists of three membranes: inner – mucous (tunica mucosa, endometrium), middle – muscular (myometrium) and outer – serous (perimetrium).

The mucous membrane of the uterus is lined with a cylindrical epithelium, which has cilia at certain functional periods. The mucous membrane contains numerous tubular uterine glands (glandulae uteri), which not all domestic animals have in the cervical region. At the beginning of its development, the embryo feeds on the secretion of the uterine glands.The folds of the endometrium in different species of domestic animals have characteristic differences. The submucosa is absent (Fig. 40).

The muscular membrane (tunica muscularis, myometrium) consists of two layers: the inner layer of the circular and the outer layer of longitudinal bundles of smooth muscle cells.In the cervical region, circular bundles form a sphincter. The presence of a powerful sphincter and folds of the mucous membrane in the cervix ensures a tight closure of the lumen of the cervical canal during pregnancy. The cervical canal opens only during estrus and during childbirth. By the end of pregnancy, the muscular membrane of the uterus grows very much, since it is it that provides the pushing out of the fetus through the birth canal during childbirth. In the thickness of the muscular membrane there is a vascular layer (stratum vasculosum), which, as a rule, lies between the circular and longitudinal layers, or (in cows and pigs) in the thickness of the circular layer.These vessels deliver nutrients to the developing fetus during pregnancy.

The serous membrane (tunica serosa, perimetrium) surrounds the uterus from the outside and has a well-developed sub-serous base. From the lateral surfaces of the horns and the body of the uterus, the serous membrane continues into the uterine mesentery (mesometrium), or the wide uterine ligament (lig. Latum uteri). It follows dorsolaterally and is anchored to the psoas muscles. The mesentery holds the uterus in the abdomen. It contains arteries, veins, nerves.The uterine mesentery contains a significant number of smooth muscle cells. Cranially, the uterine mesentery passes into the mesentery of the oviduct and ovary. From the lateral surface of the wide uterine ligament to the area of ​​the inner inguinal ring in a special fold there is a round ligament of the uterus (lig. Teres uteri), homologous to the guiding ligament of the testis. At the level of the body of the uterus and the upper wall of the vagina, between the leaves of the wide uterine ligament, there is a large accumulation of loose connective tissue with fat cells that forms the uterine membrane (parametrium).

© Novosibirsk State Agrarian University, 2012

© State Scientific Institution Institute of Experimental Veterinary Medicine of Siberia and the Far East of the Siberian Branch of the Russian Agricultural Academy, 2012

Signed for publication 03/05/2012 (UDC 619: 611.019: 591.463 / 465, BBK 45.260, C 729)

90,000 causes, symptoms, diagnosis and treatment methods on the website “Alpha Health Center”

Benign proliferation of the inner mucous membrane of the uterus, accompanied by a violation of the menstrual cycle, anovulatory uterine bleeding, infertility

Signs of endometrial hyperplasia are observed in 5-25% of women.This term denotes a pathological increase in the endometrium – the inner mucous layer of the uterine cavity. Normally, it grows every monthly cycle. Thickening under the influence of the sex hormones estrogen and progesterone, the mucous membrane prepares to receive the egg. If conception does not occur, then the decrease in hormone levels causes tissue rejection. After menstruation, the process starts over. With hormonal failure, the level of estrogen rises, which triggers the process of pathological growth of the epithelium.

Causes and symptoms of endometrial hyperplasia

Forms of hyperplasia are distinguished:

• glandular – the glandular tissue of the mucous membrane thickens;
• glandular cystic – benign cysts are formed;
• focal – glandular and fibrous polyps appear;
• atypical (adenomatous) – altered cells appear, it is dangerous to degenerate into an oncological form (adenocarcinoma).

The main causes of the disease are hormonal disruptions. The likelihood of encountering signs of endometrial hyperplasia during puberty and at the beginning of menopause, when hormonal changes occur in the female body. A number of related problems increase the risks of pathology:

• inflammation in the genitourinary system;
• abortions, gynecological operations on the uterus;
• heredity;
• overweight;
• endocrine diseases;
• diseases of poppies and appendages – fibroids, polycystic ovaries;
• unfavorable ecological situation;
• hormone therapy.

It is difficult to determine the pathology only by the patient’s complaints. Many gynecological diseases manifest themselves in a similar way. The main symptoms of endometrial hyperplasia include:

• Irregular, frequent (more often than 21 days), prolonged menstruation, with smearing discharge between them;
• cramping pain in the abdomen;
• spotting during menopause.

The disease may be asymptomatic, especially with menopause.

How to treat endometrial hyperplasia

Treatment begins with an accurate diagnosis. This will require:

• gynecological examination;
• Ultrasound to assess the size, thickness, structure of the uterine mucosa, cysts, polyps;
• histological examination of tissue;
• hysteroscopy – examination of the uterus with a special sensor;
• laboratory tests for hormones.

How endometrial hyperplasia is treated is decided by the doctor. For simple forms, hormonal treatment is effective using:

• gestagens – hormones of the ovaries and adrenal glands;
• intrauterine device;

90,069 oral contraceptives that normalize cyclical growth and tissue rejection;

• hormone therapy for menopause.

If the form is focal, then endometrial hyperplasia will have to be treated surgically to remove polyps. In adenomatous form, the uterus is removed due to the risk of a cancerous tumor.

Treatment of endometrial hyperplasia is not effective using alternative methods. Postponing therapy until “later” can lead to irreversible consequences: infertility, anemia, oncology. With early detection and adherence to the recommendations, the chances of recovery are high.

Endometrioid cancer of the uterus and endometrium

What is endometrioid carcinoma?

Endometrioid carcinoma is a type of endometrial cancer.It starts with a gland usually found in the tissues that cover the inside of the uterus. It is the most common type of endometrial cancer among adult women.

How does endometrioid carcinoma begin?

Endometrioid carcinoma is thought to develop from a precancerous condition called atypical endometrial hyperplasia. The cells in atypical endometrial hyperplasia are not cancerous, but they are abnormal and, if left untreated, can develop into cancers such as endometrioid carcinoma.

Uterus and endometrium

The uterus is a pear-shaped hollow organ located in a woman’s pelvis between the rectum (end of the colon) and the bladder. The upper part of the uterus (fundus) attaches to the fallopian tubes, and the lower part connects to the vagina through the cervix.

The walls of the uterus consist of three layers:

• uterine lining – The endometrium is the tissue that covers the lining of the uterus. The endometrium is made up of the endometrium.The glands are lined with a single layer of cells that form a barrier called the epithelium. The epithelium is surrounded by a supporting tissue called the endometrium. stroma.
• Myometrium – The myometrium is the middle layer of smooth muscle that allows the uterus to resize and contract.
• Perimetry – The perimetry is the thin layer of tissue that surrounds the uterus from the outside.

How do pathologists make this diagnosis?

Endometrioid carcinoma is usually diagnosed after taking a small sample of endometrial tissue in a procedure called a biopsy or curettage.Once diagnosed, the tumor is removed using a surgical procedure called a hysterectomy.

Histological grade (FIGO grade)

Pathologists use the word class to describe how cancer cells in endometrioid carcinoma differ from cells commonly found in the endometrium. Because normal endometrial cells form glands, the degree of endometrioid carcinoma depends on the number of cancer cells that form the glands.

Pathologists divide the assessment into three categories based on how cancer cells look when examined under a microscope.Cancer cells that do not form glands are described as having a continuous growth pattern, which means that there is very little space between cancer cells.

• Grade 1 – Most of the tumor forms glands. The tumor shows less than 5% solid growth.
• Grade 2 – Part of the tumor forms glands. The tumor shows a solid growth pattern of 6 to 50%.
• Grade 3 – Very few glands are visible. The tumor shows more than 50% solid growth. Grade 3 tumors are associated with a poorer prognosis compared to lower grade tumors (1 or 2).

What to look for in your report after tumor removal

Myometrium invasion

Myometrium is a thick muscle band just below the endometrium. The movement of cancer cells from the endometrium to the myometrium is called the myometrium. invasion. The extent of myometrial invasion will be described in millimeters and as a percentage of the total thickness of the myometrium.

Tumors with more myometrial invasion are more likely to spread to other parts of the body.The extent of myometrial invasion is also used to determine the stage of the tumor (see Pathologic Staging below).

Involvement of the cervical stroma

The cervix is ​​a structure at the very bottom of the uterus. The cervix is ​​directly connected to the endometrium. The wall of the cervix is ​​made up of a tissue called the stroma.

Endometrioid carcinoma can grow from the endometrium into the cervix. After the tumor has been completely removed, your pathologist will take a close look at the cervical tissue to see if there are cancer cells in the cervical stroma.Finding cancer cells in the cervical stroma increases the stage of the tumor (see Pathologic Stage below).

Other tissues or organs involved

Several other organs and tissues are attached directly to or very close to the uterus, including the ovaries, fallopian tubes, vagina, bladder, and rectum. Cancer cells directly invading any of these structures with endometrial carcinomas increase the tumor stage (see Pathologic Stage below) and are associated with a poor prognosis.

Lymphovascular invasion

Blood moves through the body through long, thin tubes called blood vessels. Another type of fluid called lymph, which contains waste products and immune cells, travels through the body through the lymphatic channels.

Cancer cells can use blood vessels and lymph vessels to travel from the tumor to other parts of the body. Moving cancer cells from a tumor to another part of the body is called metastasis.

Before cancer cells can metastasize, they must enter a blood or lymph vessel. This is called lymphovascular invasion. Lymphovascular invasion increases the risk of cancer cells being found in a lymph node or distant part of the body, such as the lungs.

Fields

A margin is the normal tissue that surrounds the tumor and is removed along with the tumor during surgery. The fields will be described only in cases where the tumor has spread to the cervical spine.stroma or other tissue surrounding the uterus and after removal of the entire tumor.

The limit is called positive if the tumor cells are at the very edge of the cut tissue. A positive margin is associated with a higher risk of tumor recurrence at the same site after treatment. A negative margin means that tumor cells were not observed at any of the cut edges of the tissue.

Lymph node

The lymph node is a small immune organ located throughout the body.Cancer cells can travel from the tumor to the lymph node through lymphatic channels located in and around the tumor (see Lymphovascular invasion above). The movement of cancer cells from a tumor to a lymph node is called metastasis.

Your pathologist will carefully examine all lymph nodes for cancer cells. Lymph nodes that contain cancer cells are often called positive, and those that do not contain cancer cells are often called negative.Most reports indicate the total number of lymph nodes examined and the number of cancer cells, if any.

The lymph nodes that are examined are usually divided into those in the pelvis and those around a large blood vessel in the abdomen called the aorta. The lymph nodes around the aorta are called paraaortic lymph nodes. The lymph nodes on the same side as the tumor are called ipsilateral, and the lymph nodes on the opposite side of the tumor are called contralateral.

If cancer cells are found in a lymph node, the size of the area affected by cancer will be measured and described in your report.

• Isolated tumor cells – The area inside a lymph node containing cancer cells is less than 0.2 millimeters.
• Micrometastases – The area within a lymph node containing cancer cells is more than 0.2 millimeters but less than 2 millimeters in size.
• Macrometastases – The area inside the lymph node with cancer cells is more than 2 millimeters.

Cancer cells found in a lymph node are associated with a higher risk of cancer cells being found in other lymph nodes or in a distant organ such as the lungs. The number of lymph nodes with cancer cells is also used to determine the nodal stage (see Pathologic Stage below).

Pathological stage

Pathologic endometrioid carcinoma staging is based on the TNM staging system, an internationally recognized system originally established by the American Joint Committee on Cancer.

This system uses information about the primary tumor (T), lymph node (N) and distant metastatic disease (M) to determine the complete pathological stage (pTNM). Your pathologist will examine the tissue presented and assign a number to each part. In general, a higher number means more advanced disease and worse. forecast.

Stage of tumor (pT)

Endometrioid carcinoma has a tumor stage from 1 to 4, depending on the depth of the myometrium. invasion and growth of a tumor outside the uterus.

• T1 – The tumor affects only the uterus.
• T2 – The tumor has grown and has affected the cervical stroma.
• T3 – The tumor has grown through the wall of the uterus and is now located on the outer surface of the uterus. OR it has grown to involve the fallopian tubes or ovaries.
• T4 – The tumor grows directly into the bladder or colon.

Nodal stage (pN)

Endometrioid cancer is assigned to nodal stage from 0 to 2 on the basis of examination.lymph node from the pelvis and abdomen.

• N0 – No cancer cells were found in any of the lymph nodes examined.
• N1mi – Cancer cells were found in at least one lymph node from the pelvis, but the area with cancer cells did not exceed 2 millimeters (only isolated cancer cells or micrometastases).
• N1a – Cancer cells were found in at least one lymph node in the pelvis, and the cancer cells were larger than 2 millimeters (macrometastasis).
• N2mi – Cancer cells were found in at least one lymph node outside the pelvis, but the area with cancer cells did not exceed 2 millimeters (only isolated cancer cells or micrometastases).
• N2a – Cancer cells have been found in at least one lymph node outside the pelvis, and the cancer cells are larger than 2 millimeters (macrometastasis).
• NX – No lymph nodes were sent for examination.

Metastatic stage (nM)

Endometrioid carcinoma is assigned metastatic stage 0 or 1, depending on the presence of cancer cells in a distant part of the body (for example, in the lungs).The metastatic stage can only be determined if tissue from a distant site is sent for pathological examination. Because this tissue is rarely present, the metastatic stage cannot be identified and designated as MX.

Testing nonconformance fix

Every cell in your body contains a set of instructions that tell the cell how to behave. These instructions are written in a language called DNA, and they are stored on 46 chromosomes in each cell.Because the instructions are so long, they are broken down into sections called genes, and each gene tells the cell how to make a part of the machine called a protein.

If the DNA is damaged or cannot be read accurately, the cell will not be able to make the proteins it needs to function properly. An area of ​​damaged DNA is called a mutation, and mutations are one of the most common causes of cancer in humans.

In most patients, endometrioid carcinoma results from both environmental and genetic factors.These tumors are called “sporadic” because they cannot be fully predicted.

Lynch syndrome

However, some patients inherit certain genes that put them at a much higher risk of developing endometrioid carcinoma. These people are said to have the syndrome and the most common syndrome associated with endometrial carcinoma is called Lynch.

Lynch Syndrome is caused by the loss of one of 4 special proteins (MSh3, MSH6, MLh2, and PMS2) that normally work to remove errors in the genetic material (DNA) in your cells.When one of these proteins is lost, mutations begin to accumulate and a normal cell can eventually turn into cancer.

As a precaution, pathologists test all endometrial carcinomas for Lynch. a syndrome using a test called elimination of the discrepancy. This test checks the activity of MSh3, MSH6, MLh2, and PMS2, and if one or more of them are lost, additional testing can be done to assess your risk of Lynch syndrome.

The diagnosis of Lynch syndrome is important not only for the patient, but also for his family, who may also be at risk of cancer as a result of the syndrome.

Jason Wasserman, MD, FRCPC (September 20, 2021)

Biopsy of the endometrium of the uterus (pipel): price, indications, preparation

Endometrial biopsy is a procedure during which samples of the lining of the uterus (endometrium) are taken for histological analysis to detect the presence of atypical signs in the cells. In some cases, endometrial biopsy is a therapeutic and diagnostic manipulation.

Pipel endometrial biopsy involves the use of the Pipel instrument – a soft elastic narrow tube with a special tip.There is a piston inside the tube. The tube is inserted into the uterine cavity. In this case, it is not required to carry out the expansion of the neck with the help of a special device. The method is effective and low-traumatic, it is carried out on an outpatient basis

Pipel endometrial biopsy is included in the complex of examinations before IVF. It allows you to assess the state of the endometrium, to reduce the risks that are possible in the process of implantation of the ovum, thereby ensuring a positive IVF result.

Indications for endometrial pipe biopsy:
– infertility of unknown origin, cases of spontaneous miscarriages or non-developing pregnancies in anamnesis;
– menstrual irregularities, absence of menstruation;
– bleeding due to the use of hormonal drugs;
– suspicion of acute or chronic endometritis;
– endometrial hyperplasia;
– suspicion of an oncological process;
– the period of menopause;
– endometrial polyps or uterine fibroids;
– preparation for the operation;
– preparation for IVF.

Pipel biopsy reveals:
– atypical endometrial hyperplasia, in which the cells of the overgrown mucous membrane do not correspond in their morphofunctional characteristics to normal endometrial cells. Some forms of atypical hyperplasia are referred to as precancer.
– malignant degeneration of tissues;
– atrophy or hypoplasia of the uterine mucosa;
– endometrial inflammation;
– discrepancy between the thickness of the functional layer of the endometrium to the current phase of the ovarian-menstrual cycle.

Timing of endometrial biopsy:
On any day of the cycle – if you suspect endometrial cancer;
After the completion of menstruation – with endometrial polyps, endometrial hyperplasia;
On any day of bleeding with uterine bleeding, not associated with menstruation – to determine the causes of this phenomenon;
On the 7-10th day of bleeding – with prolonged heavy menstruation;
On the 17-24th day of the cycle to determine the sensitivity of the endometrium to hormones;
2-3 days before the expected menstruation with infertility, insufficiency of the corpus luteum, with a large number of anovulatory cycles (when ovulation does not occur).

Medical Center FEFU

The uterus is an organ whose tissues consist of two layers: the myometrium and the endometrium. The endometrium is the inner layer of tissue that grows every month in women of reproductive age in preparation for a possible pregnancy. If conception does not occur, then the functional layer of the endometrium is rejected and removed to the outside by menstruation. But in the presence of risk factors, rejection of this layer does not occur and a state of precancerous diseases (endometriosis, hyperplasia, polyps) arises.

Endometrial cancer risk factors:

Obesity

· Diabetes

Reproductive and menstrual history: women who have never had children and women who start menstruating before age 12 and last beyond 55 are automatically at risk

Women whose close relatives have had endometrial cancer, colon cancer and breast cancer

Multiple abortions

Inflammatory diseases of the uterus (endometritis)

Promiscuous sex life

Main symptoms

The most common symptom of endometrial cancer is abnormal (intermenstrual, during menopause) bleeding from the vagina, which can be accompanied by pain in the lower abdomen.

ATTENTION! In the early stages, uterine cancer is asymptomatic! The only correct method of prevention is a regular (1-2 times a year) visit to the gynecologist and transvaginal ultrasound of the pelvic organs.

Stages of the disease

Stage 0 – Cancer cells are located only on the lining of the inner layer of the uterus. This tumor is called carcinoma in situ.

Stage I – The tumor has grown through the mucous membrane into the endometrium.Sometimes the tumor grows into the myometrium

Stage II – The tumor has grown into the cervix

Stage III – The tumor has grown through all layers of the uterus and invaded adjacent organs

Stage IV – The tumor has grown into the bladder or intestines. Or cancer cells have spread to distant parts of the body: liver, lungs, bones. That is, metastasis has begun.

Diagnostic curettage of the cervix in gynecology of the Litfond polyclinic

Before the separate diagnostic curettage , after the expansion of the cervical canal of the cervix, a hysteroscope (a thin tube with a camera at the end) is inserted into the uterine cavity.The walls of the uterine cavity and cervical canal are examined. After that, curettage of the mucous membrane of the uterine cavity and cervical canal is performed. If the woman has had polyps, they are removed during the scraping process. After the end of curettage, a hysteroscope is again inserted and a control hysteroscopy is performed to achieve a positive result.

Separate curettage means that curettage of the cervical canal of the cervix is ​​performed first, then the uterine cavity. Curettage can be diagnostic, when the removed mucous membrane is subjected to histological examination, and therapeutic, when the pathologically altered mucous membrane of the uterus or the remains of the ovum lingering in its spongy layer are removed for therapeutic purposes.

The scraping is collected in a sterile container and, after processing, is sent to the laboratory for histological examination, indicating the date of operation, the name of the patient, her age, day of the menstrual cycle, clinical diagnosis and the place where the tissue was taken.

After the operation, the patient stays in the ward for 1-3 hours, depending on the type of pain relief and the patient’s well-being.

Contraindications for the procedure are:

• general infectious diseases
• diseases of the heart, liver, kidneys in the stage of decompensation
• genital diseases

Before curettage, the patient should undergo the following tests:

• Complete blood count
• Biochemical blood test
• Blood group and Rh factor
• Coagulogram (assessment of the blood coagulation system)
• ECG
• Tests for hepatitis B and C, RW (syphilis) and HIV
• Vaginal swab (there should be no signs of inflammation)
• Smear for oncocytology from the uterine cheek

Make an appointment with a gynecologist by phone +7 (495) 150-60-01

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Ablation of the endometrium of the uterus

Endometrial ablation is a minimally invasive surgery to remove a thin layer of the lining of the uterus (endometrium).As a result of the procedure, uterine bleeding, which can lead to large blood loss and the development of iron deficiency anemia, is significantly reduced or stopped.

When is endometrial ablation used

Most often, surgery is used to correct menorrhagias (heavy periods longer than the physiological norm) and abnormal uterine bleeding between periods.

Studies have been carried out that have shown the effectiveness of the use of ablation for the treatment of endometrial hyperplasia, especially in pre- and postmenopausal women.

Endometrial ablation is performed with the ineffectiveness of conservative medication, including hormonal treatment. The age and the presence of children in a woman are also taken into account (after ablation, the chances of getting pregnant are significantly reduced).

When is endometrial ablation not performed

• If pregnancy is planned.

• In case there is a histologically confirmed precancerous condition of the endometrium or uterine cancer.

• With an acute infectious or other inflammatory process in the pelvic organs.

• If an intrauterine device is installed.

• If the thickness of the muscular layer of the uterus (myometrium) is less than 10 mm.

• If the length of the uterine cavity is too small (up to 4 cm) or large (more than 12 cm).

• In the event that an endometrial polyp or uterine myoma is diagnosed.

The last three contraindications are removed when it comes to microwave ablation.

Types of endometrial ablation

Endometrial ablation techniques can be divided into 2 groups.

• First generation methods require continuous monitoring with hysteroscopy (visualization of the uterine cavity): laser ablation, transcervical resection of the endometrium, roller ablation of the endometrium.

• Second generation methods are non-hysteroscopic. They are considered the least traumatic. The destruction of the endometrium occurs with thermal, radio wave, microwave, or bipolar radio frequency electrical energy.

Preparation for procedure

Before the operation, the doctor conducts a gynecological examination and prescribes the following additional examinations:

1.Laboratory: a detailed blood test, assessment of the blood coagulation system, biochemical tests, tests for latent infections, general urine analysis, vaginal smears, cytology.

2. Instrumental: ultrasound of the pelvic organs, endometrial biopsy, colposcopy (examination of the cervix) and hysteroscopy to assess the condition of the endometrium, as well as the size of the uterine cavity.

It is recommended not to eat or drink on the day of surgery.

How is endometrial ablation performed

The procedure is performed under aseptic conditions using general or epidural anesthesia.