The endometrium is the mucous layer that lines the uterus from the inside. Its functions include ensuring implantation and embryo development. In addition, the menstrual cycle depends on the changes occurring in it.
One of the important processes in a woman’s body is endometrial proliferation. Violations in this mechanism cause the development of pathology in the reproductive system. Proliferative endometrium marks the first phase of the cycle, that is, the stage that occurs after the end of menstruation. During this stage, endometrial cells begin to actively divide and grow.
The concept of proliferation
Proliferation is an active process of cell division of tissue or organ. As a result of menstruation, the mucous membranes of the uterus become very thin due to the fact that there was a rejection of the cells that make up the functional layer. This is what determines the proliferation process, since cell division updates the thinned functional layer.
Nevertheless, the proliferative endometrium does not always indicate the normal functioning of the woman's reproductive system. Sometimes it can occur in the case of pathology, when the cells divide too actively, thickening the uterine mucosa.
Causes of occurrence
As mentioned above, the natural cause of proliferative endometrium is the end of the menstrual cycle. The rejected cells of the uterine mucosa are removed from the body along with blood, thereby thinning the mucous layer. Before the next cycle begins, the endometrium needs to restore this functional area of the mucosa using the division process.
Pathological proliferation occurs as a result of excessive stimulation of cells with estrogen. Therefore, when the mucous layer is restored, the division of the endometrium does not stop and there is a thickening of the walls of the uterus, which can lead to the development of bleeding.
Process phases
There are three phases of proliferation (in its normal course):
- Early phase. It occurs during the first week of the menstrual cycle and at this time epithelial cells, as well as stromal cells, can be found on the mucous layer.
- Middle phase. This stage begins on day 8 of the cycle and ends at 10. During this period, the glands enlarge, the stroma swells and loosens, and the cells of the epithelial tissue are pulled.
- Late phase. The proliferation process stops on day 14 from the beginning of the cycle. At this stage, the mucous membrane and all glands are completely restored.
Diseases
The process of intensive division of endometrial cells can fail, as a result of which cells appear in excess of the required number. These newly formed “building” materials can combine and lead to the development of tumors such as proliferative endometrial hyperplasia.
It is a consequence of hormonal disruption in the monthly cycle. Hyperplasia is a proliferation of endometrial glands and stroma, can be of two types: glandular and atypical.
Types of Hyperplasia
The development of such an anomaly occurs mainly in women at menopause. The main reason most often becomes a large number of estrogens, which act on endometrial cells, activating their excessive division. With the development of this disease, some fragments of the proliferative endometrium acquire a very dense structure. In particularly affected areas, the seal can reach 1.5 cm in thickness. In addition, it is possible the formation on the endometrium of a proliferative type of polyps located in the cavity of the organ.
This type of hyperplasia is considered a precancerous condition and is found most often in women during menopause or in old age. In young girls, this pathology is very rarely diagnosed.
Atypical hyperplasia is considered pronounced proliferation of the endometrium, which has adenomatous sources located in the branching glands. Examining scrapings from the uterus, you can find a large number of tubular epithelial cells. These cells can have both large and small nuclei, in addition, in some they can be stretched. In this case, the tubular epithelium can be both in groups and scattered. The analysis also shows the presence of lipids on the walls of the uterus, their presence is an important factor in the diagnosis.
The transition from atypical glandular hyperplasia to cancer occurs in 3 out of 100 women. This type of hyperplasia is similar to endometrial proliferation in the normal monthly cycle, however, during the development of the disease there are no decidual tissue cells on the uterine mucosa. Sometimes the process of atypical hyperplasia can turn back, however, this is possible only under the influence of hormones.
Symptomatology
With the development of proliferative endometrial hyperplasia, the following symptoms are observed:
- The menstrual functions of the uterus, manifested by bleeding, are impaired.
- There is a deviation in the menstrual cycle, in the form of intense cyclic and prolonged bleeding.
- Metrorrhagia develops - unsystematic and non-cyclical bleeding of different intensity and duration.
- Bleeding occurs between menstruation or after their delays.
- Breakthrough bleeding with clot discharge is observed.
- The constant occurrence of bleeding provokes the development of anemia, malaise, weakness and frequent dizziness.
- An anovulatory cycle occurs, which can cause infertility.
Diagnostics
Due to the similarity of the clinical picture of glandular hyperplasia with other pathologies, diagnostic measures are of great importance.
Diagnosis of endometrial proliferative hyperplasia is carried out by the following methods:
- A study of the patient’s history and complaints related to the time of the onset of bleeding, their duration and frequency. Accompanying symptoms are also being studied.
- Analysis of obstetric and gynecological information, which includes heredity, pregnancy, contraceptive methods used, past diseases (not only gynecological), operations, diseases transmitted through sexual contact, etc.
- Analysis of information about the beginning of the menstrual cycle (patient's age), its regularity, duration, soreness and profusion.
- Conducting a bimanual vaginal examination by a gynecologist.
- Gynecological smear collection and its microscopy.
- The appointment of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of polyps of proliferative endometrium.
- Ultrasound determination of the need for an endometrial biopsy for diagnosis.
- Separate curettage using a hysteroscope that performs scraping or complete removal of pathological endometrium.
- Histological examination of scrapings to determine the type of hyperplasia.
Treatment methods
Therapy of glandular hyperplasia is carried out by various methods. It can be both operational and conservative.
Surgical treatment of pathology of the proliferative type of the endometrium provides for the complete removal of areas that have undergone deformation:
- Curettage of diseased cells from the uterine cavity is performed.
- Surgical intervention by hysteroscopy.
Surgical intervention is provided in cases:
- the age of the patient allows the reproductive function of the body;
- the woman is on the verge of menopause;
- in cases of heavy bleeding;
- after detection on the endometrial proliferative type of glandular polyps.
The materials obtained as a result of curettage are sent for histological analysis. According to its results and in the absence of other diseases, the doctor may prescribe conservative therapy.
Conservative treatment
Such therapy provides certain methods of influencing pathology. Hormone therapy:
- Oral hormonal combined contraceptives are prescribed, which should be taken 6 months.
- A woman takes pure progestogens (progesterone preparations), which help reduce the body's secretion of sex hormones. These drugs should be taken 3-6 months.
- A gestagen-containing intrauterine device is installed that acts on endometrial cells in the uterus. The duration of such a spiral is up to 5 years.
- The appointment of hormones intended for women over 35 years of age, also positively affecting treatment.
Therapy aimed at strengthening the body:
- Reception of complexes of vitamins and minerals.
- Reception of iron preparations.
- Prescribing sedatives.
- Conducting physiotherapeutic procedures (electrophoresis, acupuncture, etc.).
In addition, to improve the general condition of patients with overweight develop a therapeutic diet, as well as measures aimed at physical strengthening of the body.
Preventive actions
Measures to prevent the development of proliferative endometrial hyperplasia may be as follows:
- regular examination by a gynecologist (twice a year);
- passing preparatory courses during pregnancy;
- selection of suitable contraceptives;
- immediate medical attention if any abnormalities in the functioning of the pelvic organs occur.
- quitting smoking, alcohol and other bad habits;
- regular feasible physical activity;
- healthy eating
- careful monitoring of personal hygiene;
- taking hormonal drugs only after consulting a specialist;
- avoid abortion procedures using the necessary contraceptives;
- annually undergo a full examination of the body and if a deviation is found from the norm, immediately consult a doctor.
In order to avoid relapse of endometrial proliferative hyperplasia, it is necessary:
- regularly consult with a gynecologist;
- undergo examinations by a gynecologist-endocrinologist;
- consult with a specialist when choosing methods of contraception;
- lead a healthy lifestyle.
Forecasts
The prognosis of the development and treatment of endometrial proliferative gland hyperplasia directly depends on the timely detection and treatment of pathology. Turning to a doctor in the early stages of the disease, a woman has a high chance of being completely cured.
Nevertheless, one of the most serious complications of hyperplasia can be infertility. The reason for this is the failure of the hormonal background, leading to the disappearance of ovulation. Timely diagnosis of the disease and the implementation of effective therapy will help to avoid this.
Very often there are cases of relapse of this disease. Therefore, a woman needs to regularly visit a gynecologist for an examination and follow all his recommendations.