Glandular hyperplasia of the endometrium

Glandular hyperplasia of the endometrium is the process of proliferation of the endometrial tissue (internal mucous membrane) of the uterus. This pathological process is caused by an increase in the volume of glandular cells due to a change in their structure. Thickening of all endometrial tissues is observed, which is caused by the pathological processes of intensification of proliferation in the glandular layer of the uterus.

Endometrial hyperplasia is called glandular due to the proliferation of glands of the inner layer of the uterus. When the endometrial glands function normally, they look like straight vertical stripes. With hyperplasia, the glands begin to change their appearance - they twist and merge with each other.

During each menstrual cycle, changes occur in the uterine endometrium. The mucous layer of the uterus first grows, then changes, and is finally rejected and removed from the uterine cavity during menstruation. Such transformations occur under the influence of fluctuations in the female body's sex hormones - estrogen and progesterone. Due to a violation of their balance, for example, with an increase in the amount of estrogen, the glandular cells of the endometrium grow and do not decrease in volume. This leads to the appearance of endometrial hyperplasia.

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Causes of glandular hyperplasia of the endometrium

The appearance of glandular hyperplasia of the endometrium can occur at any age. But women in the transitional stages of their development are most susceptible to this process. Such disorders are caused by hormonal changes, for example, during puberty or menopause.

They cause glandular hyperplasia of the endometrium and various pathologies of the female genital organs - polycystic ovaries, ovarian tumors, ovarian dysfunction, uterine fibroids, endometritis and endometriosis. These pathologies are a consequence of hormonal imbalance in the body - increased estrogen production and decreased progesterone.

The causes of glandular hyperplasia of the endometrium are also hidden in abortions, diagnostic curettage, and other gynecological operations. Also, pathological enlargement of the endometrium can be caused by artificial termination of pregnancy, refusal of hormonal contraception, absence of childbirth, and late entry into menopause.

In many cases, such pathological processes in the endometrium are provoked by various diseases, namely, obesity, diabetes, hypertension, mastopathy, liver, kidney and thyroid diseases. These diseases lead to metabolic disorders in the female body and hormonal imbalance. Hyperestrogenism, an increased production of estrogens that occurs in peripheral tissues – skin and adipose tissue, has a strong influence on the increase of the endometrium.

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Symptoms of endometrial glandular hyperplasia

Symptoms of glandular hyperplasia of the endometrium are as follows:

• Menstrual dysfunction in the form of pathological uterine bleeding.
• Deviations in the menstrual cycle also manifest themselves as menorrhagia – periodic, intense and prolonged bleeding that occurs cyclically.
• Menstrual dysfunction also manifests itself in the form of metrorrhagia – bleeding of varying intensity and duration, which occurs unsystematically and acyclically.
• The appearance of bleeding is noticed in the period between menstrual bleeding or immediately after a missed period.
• In adolescence, glandular hyperplasia of the endometrium manifests itself in the form of breakthrough bleeding with the release of clots.
• Constant and prolonged bleeding provokes the appearance of anemia, various types of ailments, weakness and dizziness.
• Glandular hyperplasia of the endometrium causes the occurrence of anovulatory cycle, which leads to infertility.

Simple glandular hyperplasia of the endometrium

Simple glandular hyperplasia of the endometrium is a disorder of the functioning of the mucous tissue of the inner surface of the uterus. It manifests itself in an increase in the number of glandular cells of the endometrium, as well as an increase in their size without pathological changes in the structure. The cells of the glands can have different shapes and be located differently. With this form of hyperplasia, the separation between the functional and basal layers of the endometrium is erased while maintaining the boundaries between the endometrium and myometrium.

Endometrial cells grow to their maximum possible size, and after all available cell resources are exhausted, endometrial tissues are rejected. This is how acyclic uterine bleeding occurs, which occurs between menstrual bleedings and characterizes a violation of the menstrual functions of the body.

Sometimes acyclic bleeding occurs during normal menstruation, but it always differs from normal bleeding during menstruation. Blood discharge can be either strong or weak. In the blood that is released during pathological bleeding, various clots and lumps can be found, which are casts of the endometrium. Casts of the endometrium are layers of immature cells of the inner mucous layer of the uterus. After this, the functioning of the endometrium does not fully normalize. Since immature cells are not rejected in full, and there is no separation of the functional layer of the endometrium from the basal membrane. In some places, areas of accumulation of immature cells remain, which constantly grow during the period of bleeding and after it stops.

With any form of endometrial hyperplasia, the sick woman actually has no menstrual cycle. The existing bleeding is not a release from the process of cell enlargement and tissue growth. Also, the corresponding processes in the uterus do not relate to the reproductive functions of the woman, since the occurrence of pregnancy with endometrial hyperplasia is impossible. This is due to the fact that the eggs do not mature, as a result of which they do not appear from the ovaries.

Simple glandular hyperplasia of the endometrium quite rarely transforms into cancer of the uterine body (approximately one percent out of a hundred).

Simple glandular cystic hyperplasia of the endometrium

Simple glandular cystic hyperplasia of the endometrium is the next stage of pathological changes in the endometrium. In the inner mucous layer of the uterus, endometrial cysts are formed from the cells of the glands of the mucous layer of the uterus. They are small cavities filled with fluid, which contains an excess amount of estrogens.

This process is caused by a malfunction of the glandular cells of the endometrium, which are unable to absorb an increased amount of hormones. As a result of such an anomaly, unabsorbed estrogen is squeezed out by the cells into the intercellular space.

Cysts in endometrial hyperplasia are located inside the functional layer of the uterus. The shape of the resulting cysts can be tree-like or cyst-like. Such small cysts can only be detected under a microscope during a histological examination of scraped tissues. When several cavities merge, pathological formations can be diagnosed using ultrasound.

Focal glandular hyperplasia of the endometrium

Since the endometrium is not uniform in structure, glandular hyperplasia does not appear over its entire surface. First of all, hyperplastic processes are detected in those areas of the endometrium that are characterized by some thickenings with a normal structure and functioning in the usual healthy condition of the inner layer of the uterus. Such processes characterize the formation of focal hyperplasia of the endometrium. In these places, endometrial polyps are formed - proliferations of the integumentary and glandular layers of the endometrium together with the tissues located underneath them.

Focal glandular hyperplasia of the endometrium is characterized by the appearance of cell proliferation processes in the area of the fundus and corners of the uterus. In these places, the endometrial cells are subject to the greatest transformations. The other surface area of this organ cannot undergo strong changes (or undergoes them much less frequently) due to the peculiarities of the structure of the uterus.

Transformations affecting the surfaces of the endometrium outside the corners of the uterus and its fundus are referred to as simple focal glandular hyperplasia of the endometrium. Hyperplasia processes occurring in the mucous membrane of the fundus and corners of the uterus are called the cystic form of focal glandular hyperplasia. Due to this, the appearance of uniform or mixed forms of focal glandular hyperplasia is possible.

Focal glandular hyperplasia is a form of the disease in which altered cells can transform into pathological ones and cause the development of oncological processes.

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Focal simple glandular hyperplasia of the endometrium

Simple focal glandular hyperplasia of the endometrium occurs on the internal areas of the endometrium that do not affect the bottom of the uterus and its angles. Another name for focal hyperplasia is local, since hyperplastic processes in this case do not affect the entire area of the internal surface of the uterus. And on the affected areas, a polyp or several polyps are formed, which are formed from the epithelium of the integumentary and glandular layers, affecting the tissues underneath.

The basis of the formed polyps are immature overgrown endometrial cells that have not been rejected and have not been removed from the uterus by bleeding. At first, they undergo simple hyperplasia, and then polyps are formed in this place. The thickness of the endometrial tissue in this place can increase to five to six centimeters.

Polyps are roundish or slightly elongated bodies that are attached to a stalk. The basis of the polyp is fibrous and glandular cells. A polyp can form in the amount of one or several pieces. Sometimes there are focal forms of glandular hyperplasia, which consist of clusters of a large number of polyps.

Externally, polyps have a smooth surface in structure and pinkish in color. But sometimes ulceration of the polyp occurs due to circulatory defects due to periodic rejection of endometrial tissue. In the structure of the polyp, glands of different sizes are observed, which partially penetrate the middle muscular layer of the uterus. Also in the structure of the polyp there are many components of connective tissue and blood vessels of an expanded sclerotized type.

Focal simple glandular hyperplasia of the endometrium in many cases can provoke the appearance of cancerous formations in the uterus.

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Active glandular hyperplasia of the endometrium

Sometimes glandular hyperplasia of the endometrium is asymptomatic. This course of the disease characterizes the passive (or dormant) form of the disease - hyperplasia processes have a sluggish chronic form. It is associated with a low level of activity of the hormone estrogen of a long-term nature. At the same time, mitoses are quite rare, the nuclei and cytoplasm of the glandular cells have an intense color.

The active form of endometrial hyperplasia has an acute course. In the active form of the disease, glandular hyperplasia of the endometrium is characterized by a set of pronounced symptoms. First of all, the presence of certain symptoms indicates that pathological processes in the endometrium began a long time ago. The appearance of dysfunctional bleeding, delayed menstruation, pain, prolonged bleeding during menstruation - all this indicates an active form of hyperplasia.

Active glandular hyperplasia of the endometrium has distinctive features in the form of the appearance of a significant number of cell divisions (mitoses) in the epithelium of the glands and stromal cells. In the cytoplasm, in this process, a pale color is observed, as well as in the nuclei of the epithelium. The glands are characterized by a large number of light cells, which is a sign of strong estrogenic activity.

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Atypical glandular hyperplasia of the endometrium

Atypical glandular hyperplasia of the endometrium manifests itself in the occurrence of adenomatosis - restructuring of the cell structure and the appearance of a fairly strong proliferation, consisting of a decrease in stromal elements and polymorphism of nuclei. The process of adenomatosis formation is characterized by the appearance of a focus of altered uterine mucosa, in which cells with atypia of structure and functioning in small or strong degrees are observed.

Adenomatosis processes develop either in the functional layer of the endometrium, or in its basal layer, or in both of these layers. In the latter case, tissue degeneration into tumor tissue occurs faster than in the two previous cases.

Atypical glandular hyperplasia of the endometrium is a precancerous condition that often progresses to malignancy. Approximately ten percent of cases of adenomatosis lead to endometrial cancer.

Adenomatosis processes can occur not only in hyperplastic tissue, but also in thinned and atrophic tissue.

Atypical glandular hyperplasia of the endometrium has two forms: cellular (with changes in the cells of the stroma and epithelium) and structural (affecting changes in the shape and location of the glands).

There are several degrees of development of this type of glandular hyperplasia - low, moderate and severe.

Low-grade adenomatosis is manifested by different sizes of glands, which are separated by epithelium of multinuclear and cylindrical type. Cell division also occurs with the help of thin layers of stroma.

In the moderate form of the disease, the shape of the glands changes. And the severe form of adenomatosis is characterized by strong growths of the glands and the formation of their close fusion, with a complete absence of stroma between them. At this stage, strong polymorphism of the multinuclear epithelium of the glands occurs.

Sometimes such pathological processes occur in a polyp (with focal endometrial hyperplasia), then the altered polyp is called adenomatous, and the form of endometrial hyperplasia is focal atypical.

Diffuse atypical endometrial hyperplasia differs from focal hyperplasia in that it appears evenly over the entire surface of the uterine endometrium.

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Glandular hyperplasia of the endometrium without atypia

Glandular hyperplasia of the endometrium without atypia includes the following forms of this disease:

1. Simple glandular hyperplasia of the endometrium.
2. Glandular cystic hyperplasia of the endometrium.
3. Focal (otherwise, local) glandular hyperplasia of the endometrium.
4. Focal cystic glandular hyperplasia of the endometrium.

In these forms of the disease, the cell itself grows to its maximum state without changing its internal structure. In such cells, there are no proliferation processes characterized by a decrease in stromal elements and the appearance of pronounced polymorphism of cell nuclei.

Each of these forms of glandular hyperplasia of the endometrium was discussed in more detail above in the relevant sections.

Proliferative type glandular hyperplasia of the endometrium

Proliferative glandular hyperplasia of the endometrium is another name for the process of pathological increase in the number of cells and their growth, which is also called "glandular hyperplasia of the endometrium." These two names are used when making a diagnosis by gynecologists and pathomorphologists.

Proliferation is the process of endometrial tissue growth, which occurs due to active cell division. During endometrial proliferation, not only the total number of cells increases, but also their volume grows due to pathological hormonal disorders in the body. This process can be characterized by two conditions:

• physiological - that is, be within normal limits;
• pathological - developing into a state of disease.

According to the 1994 WHO classification, glandular hyperplasia of the endometrium is characterized by three forms:

• simple hyperplasia;
• complex hyperplasia;
• the appearance of polyps.

Based on this classification, proliferative type endometrial hyperplasia should be called simple hyperplasia. Simple hyperplasia is not characterized by active cell division. The increase in endometrial tissue occurs through the proliferation of glandular cells. Their structure changes - the glands become larger in size, their ducts become strongly twisted, and the glands are unevenly distributed among the cells of the uterine mucosa. At the same time, the total number of glands does not increase.

There is also a process of displacement of epithelial cells and stroma by enlarged glands – vessels, nerves, connective tissues, and so on, and due to this process, their total volume decreases.

Also, with simple hyperplasia, there are no cells that have changed their structure and can subsequently provoke the appearance of tumors.

Complex glandular hyperplasia of the endometrium

Complex glandular hyperplasia of the endometrium is characterized by a heterogeneous accumulation of enlarged glands in the endometrium.

Complex glandular hyperplasia of the endometrium is of two types:

• complex hyperplasia without nuclear atypia;
• complex hyperplasia with atypia of cell nuclei.

Atypia is a process of changing the structure of glandular cells, in which the structure of the cell nucleus is deformed.

In case of complex hyperplasia without nuclear atypia, the possibility of uterine cancer developing against its background is three percent of all cases of the disease. In case of complex hyperplasia with nuclear atypia, about twenty-nine percent of cases of the disease provoke the development of uterine cancer.

There is also another classification of complex glandular hyperplasia of the endometrium:

1. Focal endometrial hyperplasia (local) is characterized by the appearance of foci of hyperplastic formations in some areas of the endometrium, up to six centimeters in size.
2. Polypous hyperplasia of the endometrium is characterized by the formation of polyps, 1 to 1.5 cm in size, in some areas of the endometrium. They are round in shape and range in color from pink to crimson.
3. Atypical hyperplasia (adenomatous) is characterized by the presence of atypical cells - cells with a modified structure and refers to precancerous forms of diseases. Atypical hyperplasia is formed against the background of simple glandular or glandular-cystic hyperplasia of the endometrium.

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Glandular polypous hyperplasia of the endometrium

Glandular-polypous hyperplasia of the endometrium is a type of complex hyperplasia of the endometrium, which is characterized by the formation of polyps. Another name for this form of hyperplasia is focal glandular hyperplasia of the endometrium. This form of endometrial hyperplasia was described in detail above.

Glandular fibrous hyperplasia of the endometrium

Glandular-fibrous hyperplasia of the endometrium is characterized by the formation of polyps from the glandular and fibrous tissue of the endometrium. They appear as local foci of growth from the basal layer of the endometrium and contain a large amount of connective tissue and a significant number of glands. When the glandular-fibrous form of endometrial hyperplasia occurs, a large number of glands of different shapes and lengths are observed, as well as thickening of the sclerotized walls of blood vessels.

Based on medical statistics, this form of the disease is the most common.

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Simple typical glandular hyperplasia of the endometrium

Simple typical glandular hyperplasia of the endometrium is one of the names of the simple glandular form of endometrial hyperplasia. This form of the disease was described in detail in the section "Simple glandular hyperplasia of the endometrium".

Mixed glandular hyperplasia of the endometrium

Mixed glandular hyperplasia of the endometrium is formed as a result of the appearance of several forms of hyperplasia simultaneously. There is simple glandular hyperplasia of the endometrium and cystic form of glandular hyperplasia of the endometrium, which were described above. When the glandular form of hyperplasia develops in some areas of the uterine epithelium, and glandular-cystic hyperplasia in the corners and bottom of the uterus, this is called mixed form of glandular hyperplasia of the endometrium.

There are also combinations of simple typical glandular hyperplasia of the endometrium with a focal form. That is, in some areas of the inner layer of the uterus, a simple increase in endometrial cells and their proliferation is observed, and in some places, for example, at the bottom of the uterus, glandular or glandular-fibrous polyps are formed.

Glandular hyperplasia of the endometrium and pregnancy

Glandular hyperplasia of the endometrium and pregnancy are incompatible concepts. The eggs simply do not mature, so they do not leave the ovaries. Such disorders are a consequence of hormonal imbalance in the female body.

If, however, the egg matures and leaves the ovaries, the pregnancy will not be able to develop. The fertilization process will occur, but the egg will not be able to implant into the pathologically altered tissues of the uterine endometrium for further development of the embryo and will be rejected by the body.

There are rare cases of pregnancy with the diagnosis of glandular hyperplasia of the endometrium. But such a pregnancy can end in spontaneous termination - miscarriage. In more severe cases, serious deviations in the development of the fetus are observed, which are incompatible with the further normal life of the future person.

If the disease has been developing for a long period before pregnancy, it is possible that tumors of the uterine body may appear that were not diagnosed before pregnancy. Such tumors grow at an accelerated rate in parallel with the fetus, and if they are of a pronounced malignant nature, they pose a significant threat to the life of the child and mother.

Therefore, to achieve a successful pregnancy, it is necessary to undergo a comprehensive examination and a course of treatment for endometrial hyperplasia. Reproductive function is restored in almost all women of childbearing age. But you can only plan conception from one to three years after completing the treatment procedures.

Glandular hyperplasia of the endometrium and IVF

Glandular hyperplasia of the endometrium is characterized by the appearance of infertility in women. Hormonal changes in the female body lead to the fact that the egg does not mature and therefore does not leave the ovaries.

Moreover, in a pathologically altered endometrium, even a fertilized egg will not have the opportunity to attach and develop further. Therefore, it is necessary to first normalize the functioning processes of the endometrium, and then engage in reproductive procedures.

After completing a course of treatment and improving the condition of the endometrium of a sick woman, it is possible to use both natural and IVF methods of conception.

IVF - a method of conception or in vitro fertilization - a method of conception that is carried out outside the female body. Synonyms for IVF - conception are the term "artificial insemination".

The procedure for using artificial conception is as follows. An egg is extracted from the woman's body, placed in a test tube and artificially fertilized. The embryo that appears following fertilization is kept in an incubator, where it is allowed to develop for two to five days. Then the grown embryo is placed in the woman's uterine cavity for subsequent development.

Diagnosis of glandular hyperplasia of the endometrium

Carrying out diagnostic procedures is of great importance when diagnosing glandular hyperplasia of the endometrium. Since the clinical picture of manifestations of this disease is similar to the symptoms of many pathological processes.

Diagnosis of glandular hyperplasia of the endometrium is carried out using the following methods:

• Data collection during the study of the patient's medical history and existing complaints. The gynecologist must clarify issues related to the onset of uterine bleeding, the duration of bleeding, the frequency of its occurrence, the accompanying symptoms of bleeding, etc.
• Analysis of obstetric and gynecological data – previous general and gynecological diseases; various operations; sexually transmitted diseases; previous pregnancies and their results; the patient’s reproductive status, heredity; contraceptive methods used.
• Collection of data and analysis of the characteristics of the patient's menstrual cycle - the age at which menstruation began; the duration and regularity of the cycle; the abundance of bleeding and the painfulness of menstruation, and so on.
• The attending physician performs a gynecological examination of the patient using a bimanual (two-handed) vaginal examination.
• The procedure of gynecological smear microscopy is used.
• The transvaginal ultrasound method is used, which can determine the thickness of the endometrial layer of the uterus, as well as the presence of polypous growths.
• Ultrasound diagnosis determines the category of women who should undergo endometrial aspiration biopsy to confirm the diagnosis.
• The diagnosis can also be confirmed using a separate diagnostic curettage procedure. This method can be used before the onset of menstrual bleeding or immediately after its appearance using hysteroscopy control - examination of the uterine walls with a hysteroscope. The hysteroscopy procedure helps to perform a full curettage (scraping) and remove the pathologically altered endometrium in full.
• Endometrial scrapings undergo a histological examination procedure, during which the type of hyperplasia is determined and a morphological diagnosis is established.
• The validity and informativeness of the diagnostic hysteroscopy procedure is 94.5 percent. The transvaginal ultrasound procedure has a lower percentage of informativeness - 68.6%.

The use of a laparoscopy procedure - the introduction of an optical device into the abdominal cavity through several small incisions in the anterior abdominal wall. In this case, the pelvic organs and abdominal cavity are examined, and, if necessary, treatment procedures are carried out.

• If the diagnosis of "glandular hyperplasia of the endometrium" is established, the patient undergoes a diagnostic procedure to study the level of hormones progesterone and estrogen in the blood in the first and second phases of the menstrual cycle, as well as the amount of hormones of the adrenal glands and thyroid gland.
• Sometimes hysterography and radioisotope scanning are used to assist in diagnosis.
• A procedure is carried out to determine the level of tumor markers in the blood - substances that indicate the presence of tumors in the body, such as CA 125, CA 15-3.

Differential diagnostics of glandular hyperplasia of the endometrium is carried out simultaneously with symptoms of ectopic pregnancy, trophoblastic disease, polyps, cervical erosion, uterine cancer, uterine fibroids.

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Treatment of glandular hyperplasia of the endometrium

Treatment of glandular hyperplasia of the endometrium is carried out using various methods.

Surgical treatment methods – removal of pathologically deformed areas of the mucous membrane of the body of the uterus using:

• curettage procedures of the uterine cavity (diagnostic separate curettage when diagnosing a disease is already the first stage of treatment of the disease);
• surgical intervention using the hysteroscopy method.

Surgical treatment methods are used in the following cases:

• patients are at an age when the body's reproductive functions can still be carried out;
• during premenopause;
• in serious emergencies involving heavy bleeding;
• based on the results of an ultrasound examination that diagnosed the presence of polyps in the body of the uterus.

The results of scraping the affected endometrial tissues are sent to the laboratory for diagnostic procedures using histological analysis. Based on the data obtained, as well as using information about the patient's age and existing concomitant diseases, the attending physician prescribes conservative therapy methods.

Conservative treatment methods:

• hormonal therapy
  • taking hormonal combined oral contraceptives (COC) for medical purposes, namely Regulon, Yarina, Janine, Logest, Marvelon. The drugs must be taken for six months, based on the contraceptive regimen.
  • taking pure gestagens - progesterone preparations (Duphaston, Utrozhestan), drugs that help reduce the production of sex hormones by the ovaries. These drugs can be taken by women of any age for three to six months from days 16 to 25 of the menstrual cycle.
  • installation of the gestagen-containing intrauterine device "Mirena" - is installed for a period of five years and has a local effect on the endometrium of the uterine body. But the side effects of this method include the appearance of bleeding for three to six months from the moment of installation of the IUD.
  • taking gonadotropin-releasing hormone agonists – Buserelin and Zoladex. These are the most effective hormonal therapy drugs, which are usually prescribed to women after 35 years of age and during menopause. These drugs are taken for three to six months, which leads to a stable positive result in the treatment of the disease. Side effects of these drugs are considered to be the early onset of menopause symptoms, namely hot flashes and increased sweating.
• general strengthening therapy
  • taking vitamin and mineral complexes, especially vitamins C and B;
  • preparations containing iron to prevent anemia – Sorbifer, Maltofer and others.
  • sedative therapy – taking motherwort and valerian tinctures.
  • physiotherapeutic procedures – electrophoresis, acupuncture, etc.

The use of a therapeutic diet for patients with overweight and obesity to increase the effectiveness of therapy and improve the general condition of the patient.

Prescribing regular therapeutic exercise with light levels of stress as general strengthening procedures.

Treatment of glandular hyperplasia of the endometrium with Duphaston

Treatment of glandular hyperplasia of the endometrium gives good results when using the drug Duphaston.

Duphaston belongs to a group of drugs containing gestagens - drugs of the hormone progesterone, which help reduce the level of estrogens in the patient's body. The drug can be prescribed to women of all age groups and for any type of endometrial hyperplasia. The drug is used to treat women both in the reproductive period and in the menopause period.

The initial stage of therapy lasts for three months, then the patient’s condition is analyzed and a decision is made to continue the course of treatment or stop using the drug.

Treatment of glandular hyperplasia of the endometrium with Duphaston is carried out as follows. The drug is used from the 16th to the 25th day of the menstrual cycle. Duphaston is used orally at 5 mg per day.

Treatment of focal glandular hyperplasia of the endometrium

Treatment of focal glandular hyperplasia of the endometrium is carried out using a combined treatment method: surgical and medicinal methods simultaneously.

• First of all, the method of scraping out the affected areas of the endometrium using hysteroscopy (observation of the procedure using a hysteroscope) is used.

During surgery, tissue samples are sent for testing to detect atypical cells that are precancerous in nature.

If a large amount of atypically altered tissue is detected, the uterus is subject to removal, thereby preventing the appearance and spread of tumor processes in the patient’s body.

• Drug treatment of focal glandular hyperplasia of the endometrium is carried out after surgical treatment and is carried out by prescribing hormonal agents and gestagen drugs.

Usually, with this form of the disease, a longer course of treatment or other types of drugs are prescribed than with simple glandular and glandular-cystic forms of hyperplasia. For example, from the gestagen drugs, the drug 17-OPK (17-hydroxyprogesterone capronate solution) is used. And the drug Duphaston is prescribed for a nine-month treatment period in the amount of 5 mg per day.

Prevention of glandular hyperplasia of the endometrium

Prevention of glandular hyperplasia of the endometrium includes the following procedures:

1. Regular visits to a gynecologist (once every six months).
2. Proper management of the pregnancy period, which includes taking special courses to prepare for pregnancy and childbirth.
3. Correct selection of suitable contraceptives.
4. Timely detection and treatment of various inflammatory and infectious diseases of the pelvic organs.
5. Getting rid of various bad habits – smoking, drinking alcohol.
6. A healthy lifestyle aimed at maintaining health:
   • regular, feasible physical activity training;
   • transition to a healthy, nutritious diet, which includes avoiding fatty, smoked, salted, spicy, canned foods; dishes prepared by frying; reducing the amount of sugar and flour products; including a large amount of fresh vegetables, herbs, fruits and berries in the daily diet; using whole grain cereals and bread made from coarse flour, etc.
7. Constant maintenance of personal hygiene.
8. When using hormonal drugs, it is necessary to strictly follow the regimen for taking them.
9. Eliminate abortion as a method of terminating pregnancy. Instead, take care of sufficient methods of contraception.
10. Periodically undergo general diagnostics of the body - once a year. If deviations are detected, start treatment of diseases of the thyroid gland, liver, adrenal glands in time. Monitor the level of glucose in the blood if you have diabetes, constantly monitor the level of pressure if you have hypertension.

After carrying out procedures related to the treatment of glandular hyperplasia of the endometrium, it is necessary to pay attention to preventing relapses of the disease. In this regard, the following are used:

• Periodic consultations with a gynecologist.
• Undergoing an examination by a gynecologist-endocrinologist.
• Consultation with specialists regarding the correct selection of contraceptives.
• The recommendations for a healthy lifestyle presented above are also relevant.

Prognosis of glandular hyperplasia of the endometrium

The prognosis for the development of glandular hyperplasia of the endometrium depends on timely diagnosis and treatment of the disease. Contacting specialists at the early stages of the disease and performing all prescribed procedures leads to a complete cure for the disease and restoration of the functions of the female body.

One of the negative consequences of glandular hyperplasia of the endometrium is the occurrence of infertility in women. This occurs due to the fact that the disease occurs against the background of hormonal imbalance in the body, the disappearance of ovulation and pathological changes in the mucous membrane of the uterus. But with timely treatment of the disease in the early stages, it is glandular hyperplasia of the endometrium (of all forms of hyperplasia of the uterine body) that gives favorable prognosis for the restoration of the reproductive functions of the female body.

Glandular hyperplasia of the endometrium has frequent cases of relapse. Therefore, patients need to undergo regular examination by specialists and adhere to all recommendations of the attending physician in order to prevent relapses of the disease. If an exacerbation of glandular hyperplasia of the endometrium occurs, then specialists treat the disease with other drugs, or by increasing the doses of those used previously.

The appearance of simple glandular and glandular-cystic forms of endometrial hyperplasia does not tend to develop into a malignant form, so sick women should not be afraid of the occurrence of tumor processes in the endometrium.

Focal and atypical forms of glandular hyperplasia of the endometrium are considered precancerous conditions, since they tend to transform into malignant tumors. Therefore, in these cases, it is necessary to follow all recommendations of specialists regarding treatment and periodically undergo diagnostic procedures in order to identify the state of endometrial hyperplasia.

Glandular hyperplasia of the endometrium is a complex disease, which, however, can be successfully treated in the early stages of its development. Therefore, when the first alarming symptoms appear, it is necessary to contact specialists who will help to make the correct diagnosis and prescribe adequate therapy for the disease.