The mucous membrane of the uterus, subject to cyclical changes throughout the menstrual cycle, is called endometrium. At the beginning of the menstrual cycle, this membrane, under the influence of hormones, begins to grow and change its structure, preparing to receive the embryo. If fertilization has not occurred, the endometrium gradually departs from the base and leaves the uterus with blood secretions - menstruation begins, and with it a new cycle of endometrial development begins. In case of excessive proliferation of the endometrium, there is a disease of endometrial hyperplasia.
This disease most often manifests itself with uterine bleeding, having a dysfunctional nature, which occur after delayed ovulation, as well as against the general background of the regular cycle. However, cases of asymptomatic hyperplasia are not uncommon, when the diagnosis is first made during a comprehensive examination for infertility. The absence of pregnancy is explained by the fact that glandular endometrial hyperplasia is a pathological dishormonal condition, in the presence of which ovulation may be completely absent. In addition, embryo implantation is not possible due to changes in the uterine mucosa.
There are several types of hyperplasia differing in a different histological picture:
- atypical hyperplasia;
- glandular cystic hyperplasia;
- glandular endometrial hyperplasia;
- endometrial polyps.
Glandular cystic hyperplasia and simple glandular endometrial hyperplasia are very similar in manifestations, but the first form is more pronounced. Endometrial polyps are localized, limited hyperplasia, and in the presence of structural rearrangement of the uterine mucosa and more pronounced proliferation of specific glands, atypical endometrial hypoplasia is diagnosed as a precancerous mucosa. Also, doctors are very wary of glandular hyperplasia, which again occurs after curettage, and hyperplastic processes that are resistant to hormone therapy.
Glandular endometrial hyperplasia: causes
The reasons for the development of this disease are quite diverse. First of all, these include hormonal disorders, pathologies of lipid and carbohydrate balances, gynecological diseases, disorders of reproductive and menstrual functions, as well as surgical interventions in the uterus and appendages. In addition, often enough, glandular endometrial hyperplasia occurs in women with diseases such as hyperestrogenia, uterine fibroids, mastopathy, endometriosis, polycystic ovaries, impaired fat metabolism, hypertension, elevated blood sugar, liver disease with impaired hormone utilization.
Timely detection of endometrial hyperplasia is of great importance for the treatment and prevention of infertility, as well as for the prevention of endometrial cancer. To identify this disease, a variety of methods are used, the most common, but not always reliable (the accuracy of the method is not more than 60%), the ultrasound method is used. Also, for the diagnosis of hyperplasia in the second half of the cycle, an aspiration or biopsy of the uterine mucosa is performed. The most informative diagnostic method includes hysteroscopy, which consists in introducing a special optical system into the uterine cavity, with which an aimed biopsy is performed. In addition, this diagnostic method allows you to visually assess the condition of the walls of the uterus.
Glandular endometrial hyperplasia: treatment
First of all, the treatment consists in removing that part of the mucous membrane that has undergone pathological changes. For this, curettage, controlled by hysteroscopy, is carried out, after which a histological examination is performed . After the focus of inflammation is removed, hormone therapy is performed. Depending on the characteristics of the clinical picture of the disease, estrogen-progestogen drugs, GnRH agonists or pure progestogens are used in the form of oral contraceptives. Treatment is strictly individual, carried out within at least three months. Then an additional examination of the endometrium is necessary.