What is endometrial hyperplasia. How is it diagnosed. What are the risk factors for developing this condition. What treatment options are available for endometrial hyperplasia. How can you prevent endometrial hyperplasia.

Understanding Endometrial Hyperplasia: An Overview

Endometrial hyperplasia is a condition characterized by an abnormal thickening of the endometrium, which is the lining of the uterus. This condition can be a precursor to endometrial cancer if left untreated. It primarily affects women who have gone through menopause or are in the perimenopausal stage, typically in their 50s and 60s.

There are four types of endometrial hyperplasia, varying in severity based on the presence of abnormal cells:

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

Complex atypical hyperplasia poses the highest risk of developing into endometrial cancer. Understanding the nature of this condition is crucial for early detection and effective management.

Recognizing the Symptoms of Endometrial Hyperplasia

The primary symptom of endometrial hyperplasia is abnormal uterine bleeding. Women experiencing this condition may notice:

• Heavier or longer-lasting menstrual periods than usual
• Shorter menstrual cycles (less than 21 days between periods)
• Bleeding between periods
• Absence of periods in pre-menopausal women
• Post-menopausal bleeding

Is abnormal bleeding always indicative of endometrial hyperplasia? Not necessarily, as it can be a symptom of various conditions. However, it’s crucial to consult a healthcare provider if you experience any of these symptoms to determine the underlying cause.

The Root Causes of Endometrial Hyperplasia

Endometrial hyperplasia primarily results from a hormonal imbalance in the body. Specifically, it occurs when there’s an excess of estrogen without adequate progesterone to counterbalance it. This imbalance leads to overgrowth of the endometrial lining.

What role do estrogen and progesterone play in the menstrual cycle? Estrogen stimulates the growth of endometrial cells, while progesterone signals the shedding of these cells during menstruation. When this delicate balance is disrupted, it can result in the excessive growth of endometrial tissue, potentially leading to the development of abnormal cells.

Common Factors Contributing to Hormonal Imbalance

• Long-term use of estrogen-only hormone therapy
• Obesity (excess fat tissue can produce additional estrogen)
• Polycystic ovary syndrome (PCOS)
• Certain estrogen-secreting tumors

Diagnosing Endometrial Hyperplasia: What to Expect

Accurate diagnosis of endometrial hyperplasia is crucial for appropriate treatment and management. The diagnostic process typically involves several steps:

1. Physical examination
2. Transvaginal ultrasound
3. Endometrial biopsy

How does a transvaginal ultrasound help in diagnosis? This imaging technique uses sound waves to measure the thickness of the endometrium. An abnormally thick endometrial lining may indicate hyperplasia.

Why is an endometrial biopsy necessary? While ultrasound can detect thickening, only a biopsy can determine the presence of abnormal cells and the specific type of hyperplasia. This information is crucial for determining the most appropriate treatment plan.

Risk Factors for Developing Endometrial Hyperplasia

Several factors can increase a woman’s risk of developing endometrial hyperplasia:

• Age (more common in women over 35)
• Obesity
• Never having been pregnant
• Late onset of menopause
• Early onset of menstruation
• Diabetes
• Polycystic ovary syndrome (PCOS)
• Family history of uterine, ovarian, or colon cancer
• Use of tamoxifen for breast cancer treatment

Can lifestyle factors influence the risk of endometrial hyperplasia? Yes, certain lifestyle choices can impact your risk. Maintaining a healthy weight, regular exercise, and a balanced diet can help regulate hormones and potentially reduce the risk of developing this condition.

Treatment Options for Endometrial Hyperplasia

The treatment approach for endometrial hyperplasia depends on several factors, including the type of hyperplasia, the patient’s age, overall health, and desire for future fertility. Common treatment options include:

Hormonal Therapy

Progestin therapy is often the first-line treatment for endometrial hyperplasia without atypia. It can be administered in various forms:

• Oral pills
• Injections
• Intrauterine devices (IUDs)
• Vaginal creams

How does progestin therapy work? Progestin counteracts the effects of excess estrogen, helping to thin the endometrial lining and regulate cell growth.

Surgical Interventions

For more severe cases, particularly those with atypical hyperplasia or in women who have completed childbearing, surgical options may be considered:

• Hysteroscopy with D&C (dilation and curettage)
• Endometrial ablation
• Hysterectomy

When is a hysterectomy recommended? A hysterectomy, which involves the removal of the uterus, is typically recommended for women with atypical hyperplasia who are at high risk of developing endometrial cancer and have completed childbearing.

Preventing Endometrial Hyperplasia: Proactive Measures

While it’s not always possible to prevent endometrial hyperplasia, certain measures can help reduce the risk:

• Maintaining a healthy weight
• Regular exercise
• Balanced diet rich in fruits and vegetables
• Using combination hormone therapy (estrogen with progesterone) if hormone replacement is needed
• Regular gynecological check-ups

How effective is weight management in preventing endometrial hyperplasia? Maintaining a healthy weight is crucial, as excess fat tissue can produce additional estrogen. Studies have shown that women who are overweight or obese have a significantly higher risk of developing endometrial hyperplasia and endometrial cancer.

Living with Endometrial Hyperplasia: Long-term Management

For many women, endometrial hyperplasia is a manageable condition with proper treatment and follow-up care. Long-term management typically involves:

• Regular follow-up appointments with your healthcare provider
• Periodic endometrial biopsies to monitor for any changes
• Adherence to prescribed treatments
• Lifestyle modifications to support overall health

What is the prognosis for women with endometrial hyperplasia? With appropriate treatment and management, the prognosis is generally good. Most cases of simple and complex hyperplasia without atypia respond well to progestin therapy. However, cases with atypical cells require more aggressive treatment and closer monitoring due to the increased risk of progression to endometrial cancer.

Can endometrial hyperplasia recur after treatment? Yes, there is a possibility of recurrence, especially if the underlying hormonal imbalance is not adequately addressed. This is why ongoing monitoring and follow-up care are essential components of long-term management.

Emotional and Psychological Support

Dealing with endometrial hyperplasia can be emotionally challenging for some women, particularly if fertility is a concern or if there’s anxiety about the potential risk of cancer. It’s important to address these emotional aspects as part of comprehensive care:

• Open communication with your healthcare provider about concerns and questions
• Seeking support from family, friends, or support groups
• Considering counseling or therapy if needed to cope with anxiety or stress

Advances in Research and Future Directions

Ongoing research in the field of gynecologic oncology continues to enhance our understanding of endometrial hyperplasia and improve treatment options. Some areas of current research include:

• Molecular markers for better risk stratification
• Novel targeted therapies
• Improved diagnostic techniques for early detection

How might future research impact the management of endometrial hyperplasia? Advances in molecular diagnostics may lead to more personalized treatment approaches, allowing doctors to tailor therapies based on specific genetic or molecular profiles of the hyperplastic tissue. This could potentially improve treatment outcomes and reduce the risk of progression to cancer.

Emerging Treatment Options

While current treatments are effective for many women, researchers are exploring new options that may offer additional benefits:

• Targeted hormonal therapies with fewer side effects
• Minimally invasive surgical techniques
• Combination therapies that address both the hyperplasia and underlying hormonal imbalances

What role might immunotherapy play in the treatment of endometrial hyperplasia? While immunotherapy has shown promise in treating various cancers, its potential role in managing precancerous conditions like endometrial hyperplasia is an area of ongoing research. Early studies suggest that modulating the immune response might help in controlling abnormal cell growth in the endometrium.

The Importance of Patient Education and Awareness

Increasing awareness about endometrial hyperplasia among women and healthcare providers is crucial for early detection and timely intervention. Key aspects of patient education include:

• Understanding the signs and symptoms of abnormal uterine bleeding
• Recognizing risk factors and taking preventive measures
• Importance of regular gynecological check-ups, especially for high-risk individuals
• Awareness of treatment options and their potential outcomes

How can healthcare providers improve patient education about endometrial hyperplasia? Implementing comprehensive educational programs, providing clear and accessible information materials, and fostering open communication during consultations can significantly enhance patient understanding and engagement in their care.

The Role of Primary Care in Early Detection

Primary care physicians play a crucial role in the early detection of endometrial hyperplasia. By being aware of the risk factors and symptoms, they can:

• Conduct appropriate screenings during routine check-ups
• Provide counseling on lifestyle modifications to reduce risk
• Refer patients to specialists when necessary for further evaluation

What screening methods can primary care physicians use to detect endometrial hyperplasia? While there’s no routine screening test for endometrial hyperplasia, primary care physicians can perform thorough history-taking, focusing on menstrual patterns and risk factors. They can also conduct physical examinations and order initial tests like transvaginal ultrasound when appropriate.

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 > Fact Sheets > Yale Medicine

Overview

Endometrial hyperplasia is a precancerous condition in which there is an irregular thickening of the uterine lining. This may cause uncomfortable symptoms for women, including heavy menstrual periods, postmenopausal bleeding, and anemia due to the excess bleeding.  

Endometrial hyperplasia is most common among women in their 50s and 60s who have experienced menopause. It may also occur in women who are in perimenopause, a transitional state during which women still have their menstrual periods but on an irregular basis.  

Left untreated, endometrial hyperplasia may develop into endometrial cancer. Treatments are available to effectively manage the condition, which, in turn, helps to lower the risk that endometrial hyperplasia will advance to cancer.

“All women with changes in menstrual bleeding should be evaluated to see if they are at risk for endometrial hyperplasia. If they are, they can potentially be treated to reduce the chances of it progressing to endometrial cancer,” says Shefali Pathy, MD, MPH, a Yale Medicine obstetrician-gynecologist. 

What is endometrial hyperplasia?

During a woman’s childbearing years, her uterus develops a lining every month. If conception occurs, the uterine lining serves as a cushion for the fetus as it grows within the uterus. If conception does not occur, the uterine lining is shed through menstruation. Each month the cycle begins anew.

The root cause of endometrial hyperplasia is an imbalance between estrogen and progesterone; the condition may mean that the lining is not fully shed each month. When there is an unusual thickening of the uterine lining, it can result in what is known as endometrial hyperplasia. The condition is associated with heavy menstrual periods, short menstrual cycles (oligomenorrhea), and postmenopausal bleeding.

In women with endometrial hyperplasia, cells that amass in the uterine lining are abnormal and may, over time, become cancerous. For this reason, women with heavy periods and other symptoms of endometrial hyperplasia should not wait to seek diagnosis and treatment.

What causes endometrial hyperplasia?

Endometrial hyperplasia develops when a woman has an imbalance of estrogen and progesterone. There are a number of reasons this can occur:

• Having irregular menstrual periods, being obese, or having polycystic ovary syndrome (PCOS) may interfere with ovulation, which reduces progestin exposure.
• During perimenopause, when a woman is not ovulating regularly, her exposure to progesterone is reduced.
• After menopause, a woman no longer ovulates, so she is no longer exposed to progesterone.
• The breast cancer medication tamoxifen mimics the effects of estrogen, without progestin (a synthetic chemical that mimics the effects of progesterone on the body). Some people take prescription estrogen without also taking progestin.

What are the symptoms of endometrial hyperplasia?

Women who have endometrial hyperplasia may experience:

• Heavier-than-normal menstrual periods
• Lengthier-than-normal menstrual periods
• Bleeding between menstrual periods
• Menstrual cycles that are shorter than 21 days
• Menstrual-type bleeding after menopause
• Anemia, in some instances, due to heavy menstrual bleeding

What are the risk factors for endometrial hyperplasia?

Women are more likely to develop endometrial hyperplasia after age 35, particularly if they:

• Started getting their menstrual periods at a young age
• Never became pregnant
• Were diagnosed with infertility
• Went through menopause at an older age
• Are obese
• Take tamoxifen, a breast cancer medication
• Take prescription estrogen without progesterone

Additionally, having these medical conditions may increase risk of endometrial hyperplasia:

• Diabetes
• Polycystic ovary syndrome (PCOS)
• Thyroid disease
• Gallbladder disease
• Lynch syndrome
• Cowden syndrome
• Being diagnosed with a tumor that excretes estrogen
• A personal or family history of uterine cancer, ovarian cancer, or colorectal cancer

How is endometrial hyperplasia diagnosed?

Doctors are able to determine whether or not a woman has endometrial hyperplasia by learning about her medical history and symptoms, performing a physical exam, and offering diagnostic tests.
 

During a medical history, doctors will ask about a woman’s history of irregular menstrual bleeding, as well as details about her menstrual history: When her menstrual periods began, when they ended (if applicable), how long her menstrual cycle is/was and whether she has ever been pregnant. The doctor should also ask about medication usage, specifically tamoxifen or estrogen.
 

A pelvic exam may be normal, because endometrial hyperplasia doesn’t cause physical changes to the reproductive system.  

When a doctor suspects endometrial hyperplasia, they may recommend some additional tests.  A transvaginal ultrasound is an imaging tool that shows the inside of the uterus and allows doctors to see if the uterine lining is thicker than it should be.
 

If the uterine lining is too thick, a biopsy of it will be offered to diagnose the condition. This can be done in the office in most cases. In some cases, however, a procedure, known as dilation and curettage (called a D&C) and hysteroscopy, can be performed with some sedation. In this procedure, a doctor inserts a hysteroscope—a tube equipped with a camera and a light—into the vagina, through the cervix, and into the uterus. This enables  the doctor to see inside the uterus. During the D&C portion of the procedure, the cervix is opened, or dilated, to allow the doctor to access the uterus. The doctor then uses a device called a curette to remove of the lining of the uterus. The results may show that the uterine lining cells are:

• normal
• abnormal yet non-cancerous
• abnormal and precancerous
• abnormal and cancerous

Abnormal findings that are non-cancerous and pre-cancerous indicate endometrial hyperplasia.

How is endometrial hyperplasia treated?

For women with endometrial hyperplasia who have abnormal, non-cancerous cells, progestin therapy may be recommended. This synthetic hormone helps to balance out the effects of estrogen in the system, which should eliminate or minimize symptoms of endometrial hyperplasia.

Women who have not yet reached menopause may be prescribed:

• Birth control pills containing progestin
• Birth control pills containing estrogen plus progestin
• Progestin injections
• Vaginal cream containing progestin
• An intrauterine device (IUD) that gradually releases a progestin (levonorgestrel)

Women who have reached menopause should not take birth control pills containing estrogen plus progestin. They may be prescribed:

• Progestin-only birth control pills
• Progestin injections
• Vaginal cream containing progestin
• An IUD that gradually releases progestin

For women with endometrial hyperplasia who have abnormal, pre-cancerous cells, hysterectomy may be recommended. This procedure removes the uterus, eliminating the possibility that endometrial cancer could develop. It’s important to note that having a hysterectomy means a woman is no longer able to get pregnant.

What is the outlook for people with endometrial hyperplasia?

Treatment helps endometrial hyperplasia to resolve in most patients, so that women no longer experience heavy or abnormal menstrual bleeding. If endometrial hyperplasia is not diagnosed and treated, it may develop into endometrial cancer. For this reason, it’s important for women with symptoms of endometrial hyperplasia to seek treatment.

What makes Yale unique in its treatment of endometrial hyperplasia?

“Yale doctors are experts in evaluating abnormal bleeding and can effectively treat women with hyperplasia,” says Dr. Pathy. “Our team of gynecologists work with the patient to identify their goals and then develop treatment plans accordingly.” 

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.