What is endometrial hyperplasia. How is it diagnosed. What are the risk factors and prevention strategies. Can endometrial hyperplasia lead to cancer. What treatment options are available for this condition.

Understanding Endometrial Hyperplasia: An Overview

Endometrial hyperplasia is a condition characterized by an abnormal thickening of the endometrium, the lining of the uterus. This condition occurs when there is an imbalance between estrogen and progesterone hormones, leading to excessive growth of the endometrial tissue. While not cancerous itself, certain types of endometrial hyperplasia can increase the risk of developing endometrial cancer if left untreated.

Types of Endometrial Hyperplasia

There are four main types of endometrial hyperplasia, classified based on the presence of abnormal cells and their arrangement:

• Simple hyperplasia
• Complex hyperplasia
• Simple atypical hyperplasia
• Complex atypical hyperplasia

The severity and risk of progression to cancer increase from simple to complex atypical hyperplasia. Complex atypical hyperplasia carries the highest risk of developing into endometrial cancer and requires prompt medical attention.

Recognizing the Symptoms of Endometrial Hyperplasia

The primary symptom of endometrial hyperplasia is abnormal uterine bleeding. Women experiencing this condition may notice changes in their menstrual patterns or unexpected bleeding. It’s crucial to be aware of these signs and seek medical attention if they occur.

Common Symptoms to Watch For

• Heavier or longer-lasting menstrual bleeding than usual
• Shorter menstrual cycles (less than 21 days between periods)
• Intermenstrual bleeding (bleeding between periods)
• Absence of menstruation in premenopausal women
• Postmenopausal bleeding

Is abnormal bleeding always a sign of endometrial hyperplasia? While abnormal bleeding is a common symptom, it can also indicate other conditions. Therefore, it’s essential to consult a healthcare provider for proper diagnosis and evaluation.

Underlying Causes and Risk Factors of Endometrial Hyperplasia

Endometrial hyperplasia primarily results from hormonal imbalances, specifically an excess of estrogen without adequate progesterone to counterbalance its effects. This imbalance can occur due to various factors and medical conditions.

Common Causes and Risk Factors

• Obesity
• Polycystic ovary syndrome (PCOS)
• Diabetes mellitus
• Estrogen-only hormone therapy
• Late menopause
• Never having been pregnant
• Tamoxifen use for breast cancer treatment

How does obesity contribute to endometrial hyperplasia? Excess body fat can lead to increased estrogen production, as fat tissue converts androgens to estrogen. This excess estrogen can stimulate the endometrium, potentially leading to hyperplasia.

Diagnostic Procedures for Endometrial Hyperplasia

Diagnosing endometrial hyperplasia involves a combination of physical examination, imaging studies, and tissue sampling. Healthcare providers employ various techniques to accurately assess the condition of the endometrium and rule out other potential causes of abnormal bleeding.

Key Diagnostic Methods

1. Transvaginal ultrasound: This non-invasive imaging technique measures the thickness of the endometrium and can detect abnormalities in its structure.
2. Endometrial biopsy: A small sample of endometrial tissue is collected and examined under a microscope to identify cellular changes and rule out cancer.
3. Hysteroscopy: This procedure allows direct visualization of the uterine cavity using a thin, lighted telescope inserted through the cervix.
4. Dilation and curettage (D&C): In some cases, a more extensive tissue sample may be needed, which is obtained through this surgical procedure.

What is the significance of endometrial thickness in diagnosis? An endometrial thickness greater than 4-5 mm in postmenopausal women or 11 mm in premenopausal women may indicate hyperplasia and warrant further investigation.

Treatment Options for Endometrial Hyperplasia

The treatment approach for endometrial hyperplasia depends on the type of hyperplasia, the patient’s age, overall health, and desire for future fertility. The main goals of treatment are to alleviate symptoms, reverse the hyperplasia, and prevent progression to endometrial cancer.

Conservative Management

• Progestin therapy: Oral or intrauterine progestin can help balance hormones and induce regression of hyperplasia.
• Combination oral contraceptives: These can provide both estrogen and progestin to regulate the menstrual cycle and prevent hyperplasia.
• Lifestyle modifications: Weight loss and management of underlying conditions like diabetes can help improve hormonal balance.

Surgical Interventions

• Endometrial ablation: This procedure destroys the endometrial lining and may be suitable for women who have completed childbearing.
• Hysterectomy: In cases of complex atypical hyperplasia or when conservative treatments fail, removal of the uterus may be recommended.

How effective is progestin therapy in treating endometrial hyperplasia? Progestin therapy can be highly effective, with success rates of up to 80-90% for simple and complex hyperplasia without atypia. However, response rates may be lower for atypical hyperplasia.

Preventing Endometrial Hyperplasia: Strategies and Considerations

While it’s not always possible to prevent endometrial hyperplasia, certain lifestyle choices and medical interventions can help reduce the risk of developing this condition. Understanding and addressing the underlying risk factors is key to prevention.

Preventive Measures

• Maintaining a healthy weight through diet and exercise
• Managing underlying conditions such as PCOS and diabetes
• Using combination hormone therapy (estrogen with progestin) instead of estrogen-only therapy for menopausal symptoms
• Regular gynecological check-ups and prompt reporting of abnormal bleeding
• Considering the use of hormonal contraceptives, which can provide a protective effect

Can diet and exercise really help prevent endometrial hyperplasia? Yes, maintaining a healthy weight through proper nutrition and regular physical activity can help balance hormone levels and reduce the risk of developing endometrial hyperplasia.

Long-term Outlook and Follow-up Care for Endometrial Hyperplasia

The prognosis for endometrial hyperplasia varies depending on the type of hyperplasia and the effectiveness of treatment. Regular follow-up care is essential to monitor the condition and ensure that it doesn’t progress or recur.

Follow-up Recommendations

1. Regular endometrial biopsies to assess the response to treatment and monitor for any changes
2. Periodic transvaginal ultrasounds to evaluate endometrial thickness
3. Continued hormone therapy or other treatments as prescribed by the healthcare provider
4. Lifestyle modifications to address underlying risk factors
5. Vigilant monitoring for any recurrence of abnormal bleeding

What is the risk of endometrial hyperplasia progressing to cancer? The risk varies depending on the type of hyperplasia. Simple hyperplasia without atypia has a low risk of progressing to cancer (less than 5%), while complex atypical hyperplasia has a much higher risk (up to 29% in some studies).

Endometrial Hyperplasia and Fertility: Implications and Considerations

For women of reproductive age, endometrial hyperplasia can have significant implications for fertility. Understanding these effects and exploring available options is crucial for those who wish to preserve their fertility.

Fertility Considerations

• Impact on conception: Endometrial hyperplasia can make it more difficult to conceive naturally
• Treatment effects: Some treatments, such as progestin therapy, may temporarily affect fertility
• Fertility preservation: Options like egg freezing may be considered before certain treatments
• Pregnancy outcomes: Women with a history of endometrial hyperplasia may require closer monitoring during pregnancy

Can women with endometrial hyperplasia still have successful pregnancies? Yes, with proper treatment and management, many women with endometrial hyperplasia can go on to have successful pregnancies. However, close monitoring and collaboration with healthcare providers are essential.

Fertility-Sparing Treatment Approaches

For women who wish to preserve their fertility, healthcare providers may consider fertility-sparing treatment options, particularly for cases of simple or complex hyperplasia without atypia. These approaches aim to reverse the hyperplasia while maintaining the potential for future pregnancy.

• High-dose progestin therapy
• Levonorgestrel-releasing intrauterine device (IUD)
• Gonadotropin-releasing hormone (GnRH) agonists
• Combination of medical therapies

It’s important to note that fertility-sparing treatments require careful monitoring and may not be suitable for all types of endometrial hyperplasia, particularly those with atypical cells.

Endometrial Hyperplasia in Special Populations

Endometrial hyperplasia can affect women at various stages of life, and its management may differ depending on age and other factors. Understanding how this condition impacts different populations is crucial for appropriate care and treatment.

Postmenopausal Women

Postmenopausal women are at higher risk for endometrial hyperplasia due to hormonal changes. Any vaginal bleeding after menopause should be promptly evaluated, as it could indicate hyperplasia or even endometrial cancer.

• Increased vigilance for abnormal bleeding
• More aggressive treatment approaches may be considered
• Higher risk of progression to cancer, especially with atypical hyperplasia

Women with PCOS

Women with polycystic ovary syndrome (PCOS) have a higher risk of developing endometrial hyperplasia due to chronic anovulation and hormonal imbalances.

• Regular monitoring of endometrial thickness
• Progestin therapy or combination oral contraceptives may be recommended
• Importance of managing PCOS symptoms and associated metabolic issues

Women Taking Tamoxifen

Tamoxifen, a medication used in breast cancer treatment, can increase the risk of endometrial hyperplasia and cancer.

• Regular gynecological check-ups and endometrial monitoring
• Prompt evaluation of any abnormal bleeding
• Balancing the benefits of tamoxifen against the risk of endometrial effects

How often should women taking tamoxifen undergo endometrial screening? While there’s no universal consensus, many experts recommend annual gynecological exams and prompt evaluation of any abnormal bleeding for women taking tamoxifen.

Emerging Research and Future Directions in Endometrial Hyperplasia Management

The field of endometrial hyperplasia research is continually evolving, with new insights into its pathophysiology, diagnosis, and treatment emerging. These advancements hold promise for improved management strategies and outcomes for patients.

Areas of Ongoing Research

• Molecular markers for risk stratification and prognosis
• Novel targeted therapies for hormone-resistant hyperplasia
• Improved imaging techniques for more accurate diagnosis
• Personalized treatment approaches based on genetic profiles
• Long-term outcomes of conservative management strategies

What role might artificial intelligence play in diagnosing endometrial hyperplasia? AI-assisted image analysis of transvaginal ultrasounds and hysteroscopy images shows promise in improving the accuracy and consistency of endometrial hyperplasia diagnosis.

Potential Future Treatments

Researchers are exploring several innovative approaches to treating endometrial hyperplasia, particularly for cases that are resistant to current therapies:

• Selective progesterone receptor modulators (SPRMs)
• Metformin and other insulin-sensitizing agents
• Aromatase inhibitors
• Immunomodulatory therapies
• Combination therapies targeting multiple pathways

These emerging treatments aim to provide more effective and personalized options for managing endometrial hyperplasia, potentially reducing the need for surgical interventions and improving long-term outcomes.

Living with Endometrial Hyperplasia: Coping Strategies and Support

Receiving a diagnosis of endometrial hyperplasia can be challenging, both physically and emotionally. Developing effective coping strategies and seeking appropriate support can significantly improve quality of life and treatment outcomes.

Emotional Well-being

Dealing with endometrial hyperplasia and its potential complications can cause anxiety, depression, and stress. It’s important to address these emotional aspects of the condition:

• Seek counseling or therapy if needed
• Join support groups or online communities for women with similar experiences
• Practice stress-reduction techniques such as meditation or yoga
• Maintain open communication with family and friends

Lifestyle Adjustments

Making certain lifestyle changes can help manage symptoms and reduce the risk of recurrence:

• Adopt a balanced, nutritious diet rich in fruits, vegetables, and whole grains
• Engage in regular physical activity to maintain a healthy weight
• Quit smoking and limit alcohol consumption
• Manage stress through relaxation techniques and self-care practices

How can partners or family members support someone with endometrial hyperplasia? Partners and family members can offer emotional support, assist with lifestyle changes, accompany patients to medical appointments, and help research treatment options.

Patient Education and Self-Advocacy

Empowering patients with knowledge about their condition can lead to better treatment adherence and outcomes:

• Stay informed about endometrial hyperplasia and its management
• Keep a symptom diary to track changes and discuss with healthcare providers
• Ask questions and actively participate in treatment decisions
• Follow up regularly with healthcare providers and adhere to recommended screenings

By combining medical treatment with emotional support and lifestyle adjustments, women with endometrial hyperplasia can effectively manage their condition and maintain a good quality of life. Remember that each case is unique, and working closely with healthcare providers is crucial for developing an individualized management plan.

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 | familydoctor.org

What is endometrial hyperplasia?

Endometrial hyperplasia is a condition in which the endometrium (lining of the uterus) is abnormally thick. There are four types of endometrial hyperplasia. These vary by the amount of abnormal cells and the presence of cell changes. The types are:

• Simple
• Complex
• Simple atypical
• Complex atypical

Symptoms 

The primary symptom of endometrial hyperplasia is abnormal menstrual bleeding. Contact your doctor if you experience:

• Menstrual bleeding that is heavier or longer-lasting than usual
• Menstrual cycles (amount of time between periods) that are shorter than 21 days
• Menstrual bleeding between periods
• Not having a period (pre-menopause)
• Post-menopause bleeding

What causes of endometrial hyperplasia?

Endometrial hyperplasia is caused by too much estrogen and/or not enough progesterone. Both hormones play a role in the menstrual cycle. Estrogen makes the cells grow, while progesterone signals the shedding of the cells. A hormonal imbalance can produce too many cells or abnormal cells.

Diagnosis

Abnormal uterine bleeding can be a symptom for many things. Contact your doctor if you experience this. They can perform a physical exam and tests to diagnose the main condition. A transvaginal ultrasound measures your endometrium. It uses sound waves to see if the layer is average or too thick. A thick layer may indicate endometrial hyperplasia. Your doctor will take a biopsy of your endometrium cells to determine if cancer is present.

Prevention Tips

You cannot completely prevent endometrial hyperplasia. It is more common in people who have gone through menopause. This is because your body’s hormones and menstrual cycles change. Other risk factors for this condition include:

• Long-term use of medicines that contain high levels of estrogen or chemicals that act like estrogen
• Irregular menstrual cycles, which can be caused by infertility or polycystic ovary syndrome (PCOS)
• Obesity
• Tobacco use
• First menstrual cycle at an early age
• Menopause at an older age
• Never having been pregnant
• Family history of uterine, ovarian, or colon cancer

To help lower your risk, you can:

• Lose weight, if you are obese
• Take progestin (synthetic progesterone), if you already are taking estrogen, due to menopause or another condition
• Take birth control or another medicine to regulate your hormones or menstrual cycle

Treatment

Treatment options for endometrial hyperplasia depend on what type you have. The most common treatment is progestin. This can be taken in several forms, including pill, shot, vaginal cream, or intrauterine device (IUD).

Atypical types of endometrial hyperplasia, especially complex, increase your risk of cancer. If you have these types, you might consider a hysterectomy. This is a surgery to remove your uterus. Your doctor will only recommend this if you no longer want to become pregnant. There are more conservative treatments for younger women who do not wish to have a hysterectomy.

Talk to your doctor who will help you decide which treatment option is best for you.

Living with endometrial hyperplasia

In most cases, endometrial hyperplasia is very treatable. Work with your doctor to create a treatment plan. If you have a severe type or if the condition is ongoing, you might need to see your doctor more often to monitor any changes.

Questions to ask your doctor

• How do I know if my bleeding is caused by endometrial hyperplasia?
• What is the most common age to get endometrial hyperplasia?
• What is my best treatment option for endometrial hyperplasia?
• What are my chances of developing cancer?

Resources

American Congress of Obstetricians and Gynecologists: Endometrial Hyperplasia

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Endometrial hyperplasia. What is this? How can he manifest himself?

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Dear women!

I propose today to get acquainted with such a problem as endometrial hyperplasia .

What is it? Why does it occur and how does it proceed? What are its potential risks? And what treatment is needed?

So!

Endometrial hyperplasia – pathology of the uterine mucosa, which is characterized by the progression of manifestations from simple hyperplasia to atypical precancerous conditions of the endometrium and develops against the background of absolute or relative hyperestrogenism.

Sounds confusing and complicated, so I’ll try to explain in more detail.

Uterus is an organ that has 3 layers – serous membrane, myometrium (muscular layer) and endometrium.

Endometrium is an internal functional layer in which cyclical changes occur every month, manifested by its thickening. The thickness of the endometrium monthly increases from 1-2 mm to 15-16 mm and this cycle ends with the exfoliation of the endometrium – menstruation (if pregnancy does not occur).

Transformation and thickening of the endometrium occurs against the background of cyclic fluctuations of the hormones – estrogen and progesterone. In the first phase of the cycle, an increased level of estrogen ensures the proliferation of the endometrium. During the period of ovulation, a change in the benefits of hormones occurs – the level of progesterone rises – this causes secretory changes in the endometrium.

In the case of an absolute increase in estrogen in the blood (with a normal level of progesterone) or a relative increase (increased estrogen level against a background of a low level of progesterone), excessive stimulation of the endometrial glands begins – they grow and, accordingly, the thickness of the endometrium also grows. The thickened endometrium no longer corresponds to the phase of the menstrual cycle.

Endometrial hyperplasia , as I mentioned, may not be atypical and with signs of atypia.

How can endometrial hyperplasia manifest itself?

Abnormal uterine bleeding occurs in most cases. Intermenstrual bleeding of varying intensity in different phases of the menstrual cycle, heavy and prolonged menstruation, or bleeding in menopause. If you have these symptoms, you should immediately consult a gynecologist. Bleeding is often accompanied by aching pains in the lower abdomen of varying intensity.

The reference point for suspicion of endometrial hyperplasia is pelvic ultrasound, but the basis for the diagnosis of definite hyperplasia is the histological examination of endometrial tissue. The sampling of material, that is, the endometrium, can be carried out by pipel biopsy, vacuum aspiration or hysteroscopy.

Treatment will depend on the type of hyperplasia found and the age of the patient. In the case of simple endometrial hyperplasia, in which there are very low risks of malignancy, as a rule, drug therapy with the use of progestogens (intrauterine system or tablet preparations is selected individually) is recommended with mandatory monitoring of endometrial biopsy during treatment and at its end. Only with the ineffectiveness of conservative treatment, extremely rarely, the issue of surgical intervention is considered.

In the case of atypical endometrial hyperplasia, the risks of malignancy are much higher, so surgical methods of treatment will be preferred here.

However! Tactics also depends on the age and reproductive plans of the patient. If the patient is young and has plans for pregnancy and childbirth, drug therapy is possible with more frequent monitoring of endometrial biopsy.

The topic is certainly not very simple, but in a team with a doctor you trust, you will definitely find the right way to solve the problem!

Get in touch! Really happy to help!

Obstetrician-gynecologist: Pivovar A. V.

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Endometrial hyperplasia: causes, symptoms, diagnosis and treatment of endometrial hyperplasia in Moscow

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• Published: 20 July 2021

• Article updated: March 31, 2023

Author of the publication: Panova Lyudmila Yurievna, Obstetrician-gynecologist (adult), Obstetrician-gynecologist (children), Ultrasound (adult)
Editor: Belousova Victoria Gennadievna, Obstetrician-gynecologist (adult), Ultrasound (adult)

Contents of the article:
General information
Female reproductive system
Classification
Causes
Risk factors
Pathogenesis

Symptoms
Uterine cancer and hyperplasia
Diagnosis
Therapeutic treatment
Surgical treatment
Complications and prevention

Pathologies of the female reproductive system can be manifested by excessive tissue growth. So, gynecologists often diagnose hyperplasia of the uterine mucosa. According to the results of many studies, this condition can increase the risk of developing a malignant tumor, so timely treatment of hyperplasia is recommended. Due to the frequent absence of severe symptoms, not all women undergo examinations on time. Screening diagnostics allows you to detect the disease at an early stage.

General information

Endometrial hyperplasia is an abnormal growth of glands in the lining of the uterus, characterized by enlargement and thickening of the endometrium. In this case, there is a change in the ratio of glandular tissue and stroma in the organ. The disease can be manifested by heavy menstrual bleeding, infertility, anemia and other disorders. A significant proliferation of endometrial cells and a change in the morphological properties of tissues can provoke a malignant degeneration of the epithelium with the formation of endometrial carcinoma. Due to the latent course, the disease is often accidentally detected during a routine gynecological examination.

Endometrial hyperplasia usually occurs in women between 20 and 45 years of age. Doctors believe that the growth of glandular cells depends on the level of sex hormones in the body. Today, many doctors consider this condition as a precancerous tissue change, so the examination for endometrial hyperplasia is a screening method for uterine carcinoma. Laboratory studies allow you to quickly assess the state of altered tissues and exclude the presence of malignant cells. To eliminate the pathology, gynecologists prescribe therapeutic and surgical procedures.

Female reproductive system

The female reproductive system consists of the pelvic organs and mammary glands. The main function of these anatomical structures is the continuation of the genus. In addition, the internal sex glands secrete regulatory substances necessary for the development of the body. So, the ovaries, located in the pelvic cavity, secrete female sex hormones (estrogens) and eggs. Mature eggs during ovulation enter the fallopian tubes, where the fusion of female and male germ cells can occur. After cell fusion (fertilization), the germ of a new organism is introduced into the uterus and continues to develop. Pathologies of the female reproductive organs can cause infertility.

The uterus is a hollow smooth muscle organ necessary for bearing a child. This anatomical structure communicates with the external genitalia through the cervical canal and the ovaries. The inner lining of the uterus is represented by glandular epithelium (endometrium), which is necessary for the implantation of the embryo. The median (muscular) shell of the organ provides stretching of the uterus during pregnancy and facilitates the process of childbirth. The outer shell of the organ borders on the bladder and abdominal integument.

Endometrium consists of glandular epithelium, blood vessels and connective tissue fibers. This part of the body is more dependent on hormonal influence. During pregnancy, the overgrown blood vessels of the endometrium are part of the placenta, which is necessary for the nutrition of the embryo. Also, all women undergo regular renewal of the endometrium during the menstrual cycle. If the egg released during ovulation is not fertilized, the endometrium is destroyed. Tissue rejection is accompanied by uterine bleeding. At the end of the menstrual cycle, endometrial tissue is renewed. All of these processes occur due to changes in the hormonal background in the body of a sexually mature woman.

Endometrial hyperplasia is a condition in which the tissue of the inner layer of the uterus (endometrium) undergoes excessive thickening. This can be caused by changes in hormone levels, especially estrogen and progesterone. Endometrial hyperplasia can lead to menstrual irregularities, unusual bleeding, and an increased risk of endometrial cancer. Diagnosis is usually based on histological analysis of an endometrial biopsy. Treatment may include hormone therapy, surgical removal of excess tissue, or, in some cases, a hysterectomy. It is important to consult a gynecologist for an accurate diagnosis and appropriate treatment, taking into account the individual characteristics of each patient.

Obstetrician-gynecologist (adult)

Classification

Gynecologists have developed a classification of endometrial hyperplasia based on the characteristics of tissue growth and risk of complications. In medical practice, the first classification of this disease, adopted by the World Health Organization (WHO) in 1994, is most often used. Specialists who identified the types of hyperplasia described characteristic changes in glandular tissue, including atypical morphological changes. To date, this classification is used to assess the risk of malignant degeneration of tissues and prescribe treatment.

Types of growth of the endometrium:

1. Simple hyperplasia – an increase in the number of glands with the preservation of the morphological structure of the cells. In some cases, there is growth of cysts in the endometrium without disrupting the functions of the organ. According to studies, the risk of malignant degeneration with this type of hyperplasia does not exceed 2%.
2. Complex hyperplasia – the growth of glands is accompanied by a change in the structure of tissues. Areas of high density of glands appear in the endometrium. Morphological and functional changes in cells include an increase in the number of nuclei, an increase in mitotic activity, and an increase in individual structures of the cytoplasm. Like cancerous epithelial cells, such cells begin to divide rapidly, but the tumor structure is not yet formed. Also, invasion of altered tissues into the stroma is not observed. According to studies, the risk of malignant degeneration of such a structure is approximately 20%.

Like other types of hyperplastic disorders, endometrial hyperplasia initially represents a physiological tissue response to estrogen exposure. At the same time, the glandular cells of the overgrown endometrium may change over time due to the influence of unknown factors. It is possible to clarify the type of tissue change in a patient only after a biopsy, since the clinical manifestations of different types of hyperplasia practically do not differ.

Causes

As already mentioned, during the menstrual cycle there is a change in the hormonal background in the body and renewal of the endometrium. Endocrine changes are mainly manifested by fluctuations in the concentration of estrogen and progesterone. Estrogen binds to endometrial cell receptors and provokes an increased division of epithelial cells in this tissue, due to which the inner lining of the uterus thickens. The destruction of the endometrium against the background of the lack of fertilization occurs due to changes in the level of progesterone. When the ratio of these hormones is harmonious, menstrual cycles proceed without complications. Endocrine imbalance can cause abnormal endometrial cell division.

Possible causes:

1. Increased estrogen concentration and insufficient progesterone. This is the most common cause of endometrial hyperplasia. Violation of the hormonal background can occur with primary endocrine diseases, improper lifestyle, taking certain medications.
2. Medical procedures involving damage to the endometrium. We can talk about diagnostic curettage of tissues, abortion or other intervention.
3. Expression of genetic mutations. Violation of the DNA structure can contribute to the abnormal development of endometrial cells.

The exact causes of this change in cellular regulation are unknown.

Risk factors

In addition to the direct mechanisms of hyperplasia, doctors consider the role of certain forms of predisposition to this condition. The risk of proliferation of uterine tissues increases with primary diseases, an unhealthy lifestyle and the influence of other negative factors.

Known risk factors for endometrial hyperplasia:

1. Adverse family history. Genetic mutations can be passed on to children from parents. If a relative of the patient has been diagnosed with hyperplasia or a tumor of the uterus, the individual risk of morbidity increases.
2. The appearance of other complications of hormonal imbalance. It can be a smooth muscle tumor of the uterus (fibroids), an ectopic growth of the endometrium, inflammation of the lining of the uterus, and polycystic ovary syndrome. If these pathologies are identified, it is imperative to conduct a study to exclude endometrial hyperplasia.
3. The onset of menopause. After the onset of the last menstruation, hormonal changes occur in the body of a woman. A decrease in the concentration of progesterone can provoke the growth of glandular cells in postmenopausal women.
4. The onset of the perimenopausal period. This natural state does not yet lead to significant hormonal changes, however, irregular ovulation can be a risk factor for the disease.
5. Use of estrogen-based hormone therapy. Most often, women are prescribed such therapy after the onset of menopause.
6. No personal history of pregnancy and irregular menstruation.
7. Refusal to use hormonal contraception.
8. Identification of comorbidities such as obesity, diabetes, thyroid disease, adrenal disorders and mastopathy. Metabolic disorders can affect the risk of overgrowth of endometrial cells.

All of the listed risk factors can cause the occurrence of diseases of the reproductive system. Detection of a form of predisposition to uterine hyperplasia is an indication for prophylaxis.

Pathogenesis

An abnormal increase in the number of endometrial cells occurs as a result of continuous stimulation of the uterus by estrogens and a decrease in the concentration of progesterone. This may be an endogenous or external source of estrogen. An endogenous increase in the concentration of the hormone occurs with chronic anovulation associated with cystic ovary syndrome. Obesity also contributes to an increase in the concentration of estrogen, since the level of estradiol in the body rises. In rare cases, abnormal thickening of the glandular tissues of the uterus occurs due to estradiol-secreting ovarian tumors.

An external source of the hormone may be estrogen therapy. At the same time, the use of combined replacement therapy, including progesterone, does not lead to thickening of the endometrium. The exact mechanism of transformation of the uterine mucosa under the influence of the hormone is unknown. It is believed that benign tissue thickening is due to genetic mutations and the external factors already listed. Thus, a mutation of the gene that suppresses tumor growth of tissues was found in 55% of women with endometrial hyperplasia. In women suffering from uterine carcinoma, this mutation is found in 80%. Based on these data, scientists came to the conclusion that external influences increase the risk of abnormal division of endometrial cells only in the presence of a genetic predisposition to such an ailment.

Symptoms

In many women, changes in the glandular epithelium of the uterus do not cause any symptoms. At the same time, a significant proliferation of tissues is often accompanied by a menstrual cycle disorder. Patients complain of increased uterine bleeding, pain in the lower abdomen and a violation of the duration of individual periods of the cycle. A change in the nature of uterine bleeding may be manifested by a general increase in the volume of bleeding or episodic increased bleeding.

Additional symptoms and signs:

• delayed menses;
• frequent blood clots;
• weakness;
• pain spreading to the perineum;
• pale skin;
• dizziness;
• reduced performance;
• inability to conceive a child within 8-12 months of active sexual life.

If you experience persistent pain and uterine bleeding that is not related to menstruation, you should seek medical attention. These signs may indicate the development of uterine carcinoma.

Uterine cancer and hyperplasia

Endometrial cancer is a malignant neoplasm that develops from glandular cells in the lining of the uterus. Due to the influence of negative factors and violations of internal regulation, epitheliocytes begin to divide uncontrollably and form a pathological focus. Gradually, the tumor grows into deeper tissues, including the muscular and serous membranes. Also, cancer cells can enter the bloodstream and spread in the body, provoking the growth of secondary neoplasms (metastases) in other organs. This extremely dangerous disease is considered the most common type of cancer among women.

It is important to understand that uterine hyperplasia is not a malignant tumor. Unlike cancer, the epitheliocytes of the overgrown mucous membrane of the organ usually do not have specific changes in the structure. In addition, the focus of cell growth does not spread to other parts of the uterus and does not give metastases. At the same time, such a condition may be a direct precursor of carcinoma. The increased influence of hormonal imbalance, bad habits, inflammatory processes and other adverse factors on the thickened endometrium can ultimately lead to the growth of the neoplasm.

Diagnosis

To undergo all the necessary examinations, you must make an appointment with a gynecologist. The doctor will ask the woman about the complaints and examine the medical history to identify risk factors for the disease. The next step in the diagnosis is a general examination of the genital organs. Since such a study may not be enough to explain suspicious symptoms, the gynecologist prescribes additional diagnostic procedures.

Performed instrumental and laboratory tests:

1. Endoscopic examination of the uterine cavity (hysteroscopy). Before the examination, the doctor asks the woman to sit in the gynecological chair. After that, the doctor carefully expands the cervical canal and inserts a hysteroscope equipped with a light source and optics into the uterine cavity. This procedure allows the specialist to study in detail the state of the inner shell of the organ and carry out additional manipulations.
2. Biopsy – tissue sampling in the area of ​​the altered endometrium. The gynecologist inserts a special syringe into the uterine cavity. With the help of a piston, cells are taken from a suspicious area of ​​\u200b\u200bthe mucous membrane. The doctor can receive cells from several parts of the body at the same time. The ultrasound-guided procedure improves the accuracy of cell sampling. In the laboratory, specialists study the obtained material using staining, microscopy and other methods. Thus, a biopsy is the most reliable diagnostic method, which makes it possible to assess the morphology of tissues and exclude the presence of malignant cells in the organ. If necessary, scraping of cells is carried out.
3. Ultrasound diagnosis of the uterus. To obtain more accurate visual data, the doctor inserts the probe through the opening of the vagina. Reflected ultrasound waves create an image of the uterus on a monitor. This painless examination allows the doctor to assess the condition of the organ and exclude the presence of a tumor process.
4. Computed tomography or magnetic resonance imaging – auxiliary methods of visual diagnostics. Before the study, the woman is asked to remove all metal objects from herself. The results of tomography, presented in the form of volumetric images of organs, are necessary to search for even minor structural changes in tissues. If a tumor process is suspected, CT helps to assess the prevalence of pathology.
5. Blood test. In the treatment room, a nurse takes venous blood. The study of the material allows you to assess the level of sex hormones. The blood test is repeated during the treatment of the disease.

A gynecologist can get by with just a few diagnostic procedures. If necessary, a consultation with an oncologist or endocrinologist is appointed.

Therapeutic treatment

Accuracy of diagnostic data is essential for proper treatment based on the identified risk of tissue malignancy. After the diagnosis is made, the treatment chosen by the doctor depends on the biopsy data, the age of the woman, future pregnancy planning, and concomitant pathologies of the reproductive system. The doctor also needs to consider surgical risks, such as bleeding and organ damage. With moderate hyperplasia, the gynecologist may prescribe drug therapy that reduces the risk of tumor growth. Within 3-6 months of such treatment, the majority of patients experience the disappearance of signs of hyperplasia.

Methods of drug therapy:

1. Oral contraceptives and progestins. Such therapy usually involves taking drugs for several months and regular diagnostic monitoring of treatment results. The use of progestins is an excellent method of preventing relapse in patients with persistent risk factors for the disease.
2. Intrauterine administration of hormonal preparations. Such treatment is aimed at improving the condition of the endometrium.
3. Prescribing drugs based on gonadotropin-releasing hormone agonists. Usually these medicines are prescribed to women over the age of 35 years.

In parallel with the drug therapy of the disease, doctors prescribe drugs to eliminate the complications of hyperplasia. These can be vitamin supplements and iron-based preparations. Physiotherapy methods help to alleviate pathological processes in the uterus and reduce the intensity of uterine bleeding.

Surgery

If atypical hyperplasia is confirmed and complications occur, the gynecologist will definitely prescribe surgery. A specific operation is selected based on the diagnostic data and the age of the patient. An important task is to preserve the structure of the organ and completely eliminate the risk of malignant degeneration of tissues, but such a result is not always possible.

Operation options:

1. Endometrial ablation. With the help of laser exposure, the surgeon destroys the endometrial layer of the uterus and the surface layer of the muscular membrane of the organ. The result of the procedure is the complete elimination of the risk of malignant degeneration of the epithelium. Reproductive function after this method of treatment cannot be restored.
2. Resection of the endometrium – removal of the inner lining of the uterus using electricity. The surgeon inserts a special instrument through the cervical canal into the uterine cavity and removes tissue using a cutting electrode loop. The removed tissue is examined in the laboratory to rule out the presence of tumor cells.
3. Supravaginal amputation – removal of the body of the uterus while preserving the cervix and appendages of the organ. The operation is performed under general anesthesia using a laparotomy.

If indicated, the surgeon may perform a radical removal of the uterus and its appendages. This highly traumatic operation may be necessary if the spread of an already existing malignant process is suspected. After surgical treatment of hyperplasia, a long rehabilitation is carried out.

Complications and prevention

Without timely treatment, the disease can cause dangerous complications due to further changes in the epithelium and constant hemorrhages. Doctors diagnose complications after identifying the disease.

Common complications:

1. Anemia is a decrease in the concentration of hemoglobin in the patient’s blood.