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Causes of endometrial hyperplasia
Last reviewed: 23.04.2024
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For proper treatment of uterine diseases associated with abnormal proliferation of stromal and glandular components of the mucous membrane of its cavity, it is necessary to establish the causes of endometrial hyperplasia and its nature.
Depending on the peculiarities of structural changes in hyperplastic processes in the tissues of the inner shell of the uterus, gynecologists distinguish between glandular, cystic (glandular-cystic) and polypoid hyperplasia. What causes the development of this common pathology?
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Causes of glandular hyperplasia of the endometrium
Hyperplasia is defined as glandular when the epithelial cells of the tubular glands that are present in the thickness of the uterine mucosa grow abnormally. The main causes of glandular hyperplasia of the endometrium (however, like other structural forms of this pathology) lie in the violations of the production of female sex hormones estrogen and progesterone or in the absence of their physiological balance.
Synthesis of sex hormones in the body of women occurs cyclically, and the same cycle - under the action of these steroids - three-phase morphological transformations of the endometrium occur monthly: proliferation (the phase of folliculin action), secretion (the phase of action of lutein) and desquamation (rejection). They affect the rejective functional layer of the endometrium (consisting of a superficial and spongious sublayer with glands and stroma), which thickens almost five times during the middle stage of the cycle. The thickest endometrium occurs before the beginning of menstruation, and the thinnest - just after its termination.
The effect of estrogen, stimulating the proliferation of cells of all structures of the endometrium, is neutralized by progesterone, which in the second half of the cycle suppresses the growth of the mucous membrane of the uterine cavity - so that during the next preparation for embryo introduction into the uterine epithelium it turns into the so-called decidual tissue necessary for the further development of the embryo.
And the main cause of endometrial hyperplasia is an excess of estrogen and a lack of progesterone that counteracts it. After all, these hormones control the monthly process of preparing the uterus for pregnancy.
Causes of glandular cystic endometrial hyperplasia
The causes of glandular cystic hyperplasia of the endometrium differ little from the etiology of glandular hyperplasia: the entire difference in structure. And this difference arises due to the appearance in the lower layers of the mucous membrane of the uterine cavity of the cysts - small capped capsules with various contents, most often liquid. Cysts can also form directly in the endometrial glands. This disrupts the normal blood supply of tissues, squeezing the vessels, which, against the background of estrogen-progesterone imbalance, aggravates its abnormal growth.
In addition, the development of all forms of hyperplastic processes in the mucous membrane of the uterus can be associated with chronic diseases (diabetes, polycystic ovaries, hereditary non-lipopic colorectal cancer); inflammatory diseases (endometriosis, endocervicosis, oophoritis, salpingitis, adnexitis); neoplasms in the uterus (adenomyosis, fibroids, fibiomyoma, leiomyoma, estrogen-secreting ovarian tumors), as well as defeat of the herpes virus and papillomavirus.
A considerable "contribution" to the development of this pathology makes obesity, since "adipose" estrogen is stored in adipose tissue. For this reason, women with excess body weight are much more likely to be diagnosed with endometrial hyperplasia.
As the gynecological practice shows, women who have irregularities in the menstrual cycle are at greater risk of developing endometrial hyperplasia. Also, the pathological proliferation of cells in the mucous membrane of the uterine cavity and the tendency to form cysts can be genetically conditioned and inherited.
Causes of polypoid hyperplasia of the endometrium
Causes of polypoid hyperplasia of the endometrium, which gynecologists call focal, are associated with all the above factors and, in particular, with a deficiency of progesterone.
With this form of the disease, the hyperplastic process taking place in the tissues of the endometrium is accompanied by the formation of abnormal formations in the form of polyps - protruding above the surface of the mucosa of single or several nodes on a "leg" of varying height and thickness. As gynecologists note, most often this occurs in women of premenopausal age and for the same reason as the actual endometrial hyperplasia. Polyps can consist of cells of connective or glandular tissue, endometrial glands, particles of fibrous fibers.
In younger women, the development of polypoid hyperplasia of the endometrium is facilitated by mechanical abortion, other methods of interrupting unwanted pregnancies, spontaneous interruption (miscarriage), curettage (scraping) of the uterine cavity, and prolonged protection with the help of an intrauterine device.
So, after childbirth or abortion, polyps in the uterus can be formed from placenta particles (placental polyps). Histological examination of samples taken during a biopsy may reveal atypical cells, which indicates an increased risk of malignant polyposis.
As you can see, the causes of endometrial hyperplasia are serious, and in time the unidentified process - in the absence of treatment - can lead to no less serious consequences. Therefore, for any violation of the menstrual cycle, with "incomprehensible" vaginal spotting (or bleeding) you need to go to the gynecologist.