Ovarian hyperplasia

Ovarian hyperplasia is a gynecological disease characterized by the growth of the stroma and endometrium, which leads to an increase in the ovary. Let's consider the causes of this pathology, diagnostic methods, types of treatment and prevention.

Ovarian hyperplasia is a proliferation of the glandular stroma simultaneously with luteinization, proliferation or androgen hyperproduction. The disease may appear as a result of congenital pathology or a previous disease that caused a hormonal imbalance. Without proper treatment, the pathology leads to tissue thecomatosis, which indicates a precancerous process. It indicates an increase in the number of cells, which is accompanied by a violation of hormone secretion and the appearance of a corresponding clinical picture.

Hyperplasia can appear in one of the glands or in different ones. Very often the disease occurs against the background of other tumor processes of the ovaries or uterus. It can appear at any age, causing pronounced endocrine disorders and hyperplastic processes of the endometrium. Most often the disease appears in the pre- and postmenopausal period.

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Causes of ovarian hyperplasia

The causes of ovarian hyperplasia are not fully understood, but they are divided into congenital and acquired.

• Congenital ovarian hyperplasia may appear as a result of hereditary gynecological diseases. These include tumors of the genitals or mammary glands. Failure during puberty and any hormonal disorders.
• Acquired ovarian hyperplasia occurs due to such provoking factors as: inflammatory and non-inflammatory diseases of the genital organs, gynecological surgical interventions, the presence of hormone-dependent diseases of the genital organs (endometriosis, myoma, mastopathy).

Ovarian hyperplasia may arise as a complication due to diseases of the endocrine organs, liver and even cardiovascular system. Of particular importance for the course of the disease are such signs as: obesity, high blood sugar, hyperglycemia or arterial hypertension. The cause of the disease is increased formation of the sex hormone estrogen, which is responsible for the normal development and functioning of the female genital organs.

In addition to the above reasons, there are a number of possible provoking factors that can lead to the development of the disease, let's consider them in more detail:

• Retrograde menstruation – blood particles are ejected during menstruation and enter the abdominal cavity, where they are fixed and function as real uterine tissue. As a result, the blood does not flow out, which leads to the appearance of foci of inflammation, localized blood loss and ovarian hyperplasia.
• Metaplastic cause - during menstruation, tissue particles are not fixed inside, but lead to a change in the structure of the endometrium. This can happen due to changes in the immune system and pathology of the fallopian tubes.

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Symptoms of ovarian hyperplasia

Symptoms of ovarian hyperplasia depend on the cause that led to the disease. The clinical picture of glandular damage is characterized by early or late menarche (first menstruation), menstrual cycle disorders, especially during the climacteric period, and infertility. The presence of cystic follicles can also be a sign of ovarian hyperplasia.

Main symptoms: irregular menstruation, the appearance of bloody discharge that is not associated with menstruation. Hormonal disorders and hormonal imbalance, excessive hair growth on the body, excess weight, can also indicate pathology in the functioning of the glands.

Endometrial hyperplasia of the ovary

Endometrial hyperplasia of the ovaries is a disease of hormonal origin. With endometrial hyperplasia, the tissue that is rejected during menstruation due to disturbances in the peristalsis of the fallopian tubes gets into the peritoneum and glands. This process also occurs in healthy women, but due to hormonal disorders and a number of other factors, ovarian hyperplasia develops. Endometrioid foci and cysts form on the surface of the glands, which leads to an increase in the ovaries.

There are several types of ovarian endometrial hyperplasia, each of which has different symptoms, treatment methods and prognosis.

• Glandular cystic hyperplasia of the ovarian endometrium is very common. The disease is characterized by the presence of numerous glands on the walls of the glands that resemble the endometrium. Such ovarian formations are most often bilateral, accompanied by endometrioid foci and adhesions in the small pelvis. Ultrasound is used to diagnose this lesion.
• Endometrial hyperplasia of the ovaries is not a tumor, but refers to tumor processes. In the cystic form of pathology, endometrioid cysts reach large sizes, which leads to a significant increase in glands. This type of disease is almost asymptomatic with minimal manifestations. Hyperplasia is detected during an examination by a gynecologist. For a more detailed diagnosis, ultrasound and histological examination are used to study the endometrial tissue.

Hyperplasia of the right ovary

Right ovarian hyperplasia is more common than bilateral lesions. At first glance, the left and right ovaries do not differ, but doctors say that this is not the case. This pathology is associated with increased blood supply to the right ovary, since an artery from the aorta goes to it, and from the kidneys to the left ovary. As a rule, right ovarian hyperplasia occurs in women after 40 years of age, that is, during menopause.

There are many reasons that can provoke the appearance of hyperplasia. These are mainly hormonal changes in the body and changes in the blood supply to the pelvis. It can occur against the background of a long-term inflammatory process in the ovary with other hormone-dependent diseases.

The symptoms manifest as pain in the area of the right ovary, which has a wave-like character. For diagnosis, the woman undergoes an ultrasound examination and histological analysis, based on the results of which a treatment plan is made. For treatment, drug therapy can be used, in particularly difficult cases - surgical intervention.

Hyperplasia of the left ovary

Left ovarian hyperplasia is rare and indicates dysfunction of the pelvic organs and glands in particular. Hyperplasia can occur in patients of any age. The main cause of the disease is hormonal changes in the body. Increased production of hormones or, conversely, their deficiency can provoke abnormal growth of endometrial and stromal cells. As a result, the gland begins to function poorly, increases in size, and causes painful sensations.

The main symptoms that should be a cause for concern and subsequent visit to a gynecologist are frequent pain in the lower abdomen, regardless of the cycle, discomfort or painful sensations during intercourse, irregular menstruation, the appearance of bloody discharge, general malaise. Ultrasound examination is used for diagnosis, based on the results of which an effective treatment plan is drawn up.

Ovarian stromal hyperplasia

Ovarian stromal hyperplasia is a disease in which the glandular stroma grows, and occurs along with processes of androgen hyperproduction. As a rule, the stromal form is observed in women during premenopause and postmenopause. The lesion can have an estrogenic or androgenic manifestation, cause obesity, hypertension, glucose metabolism disorders, etc.

Stromal hyperplasia does not always result in enlargement of the glands. If the enlargement is small, it has fuzzy pale yellow nodules in the stroma. When conducting a microscopic examination, oxidative enzymes are found in the stromal cells, which are responsible for the production of steroid hormones.

• To confirm ovarian stromal hyperplasia, doctors conduct differential diagnostics with fibroma, cancerous processes or endometrial stromal sarcoma.
• Ultrasound examination and laparoscopic biopsy are mandatory. Hormonal studies can identify disorders that led to high testosterone levels.
• When conducting a histological examination, the stromal form is characterized by the presence of large luteinized cells with a high lipid content with a small number of atretic follicles.

Treatment of the stromal form and other hyperplastic processes (tecomatosis, hyperthecosis) at first is carried out with the help of drug therapy. The woman is awaiting a course of anti-inflammatory and microwave therapy, endonasal electrophoresis with vitamins B1 and B6. If these methods do not give a positive result, then the patient undergoes laparotomy or laparoscopy. Resection allows to normalize the menstrual function and general condition. But after surgery, it is very difficult to restore reproductive functions. If the stromal form occurs in elderly patients, then the glands are removed, since there is a high risk of malignant neoplasms.

Diagnosis of ovarian hyperplasia

Ovarian hyperplasia is diagnosed if there are clinical symptoms. It is the painful sensations and discomfort that are the reason to go to a gynecologist for an examination, who will prescribe further diagnostics. Ovarian hyperplasia may not manifest itself for a long time. And this is not surprising, since not all women worry about bloody discharge after and between periods. They contact a gynecologist if this pathology has caused the absence of menstruation or the periods are heavy and cannot stop. With ovarian hyperplasia during premenopause and menopause, the symptoms are more pronounced. The woman experiences prolonged spontaneous bleeding and pain, which lead to anemia.

The doctor collects the medical history and conducts a gynecological examination, during which ovarian hyperplasia may be suspected. For an accurate diagnosis, a more detailed examination is used:

• Ultrasound diagnostics allows us to confirm the presence of this pathology and identify other pathological processes in the pelvic area.
• Histological examination and cytology reveal morphological changes in the glands, hyperplastic epithelium and stroma.
• Hormonal examination – tests for progesterone and estrogen levels.

During the diagnostic process, it is very important not only to confirm the disease, but also to determine its morphological features.

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Treatment of ovarian hyperplasia

Treatment of ovarian hyperplasia depends on the morphology of the disease and how extensive the damage to the glands is (both ovaries, left or right). Treatment begins with the use of conservative methods. The patient is prescribed anti-inflammatory treatment, dehydration therapy and other procedures. The basis of drug treatment is hormone therapy using combined oral contraceptives. The goal of such treatment is to normalize the hormonal background by reducing the level of estrogens and reducing the foci of pathology.

• Combined oral contraceptives are most often prescribed to young girls who have not given birth and women who have an irregular menstrual cycle. Such treatment allows you to restore normal ovarian function and prevent surgical intervention. The scheme and duration of taking the pills is determined by the doctor.
• Synthetic analogues of progesterone are prescribed to women of any age with any form of pathology. The therapy is long-term, about 6 months. During the course of taking the drugs, bloody discharge and pain in the area of the affected gland are possible.
• Ovarian hyperplasia is treated with Duphaston and Norcolut. The duration of treatment and the regimen of drug administration are prescribed by the doctor. The gynecologist may recommend inserting the Marena intrauterine device. The device is a hormonal therapy and a contraceptive.
• Another method of conservative treatment of ovarian hyperplasia is gonadotropin-releasing hormone agonists. The drug shows effective treatment results and has a convenient regimen. The active substances block the production of sex hormones, which leads to inhibition of tissue and cell proliferation. As a result, the hormonal background and normal functioning of the glands are restored.

Combined treatment may be used for treatment. This method involves a combination of surgical treatment and restorative hormonal therapy. Hormonal therapy may also be administered before surgery to reduce its volume and affect foci that are beyond the reach of surgical removal.

If drug treatment is ineffective, the patient undergoes surgical therapy. Wedge resection is used for treatment. Laparoscopic electrocoagulation can be performed, that is, cauterization of the ovary at 4-8 points using an electrode. If none of the above methods help in treatment, the woman undergoes removal of the glands, that is, oophorectomy. As a rule, such treatment is carried out for patients in the postmenopausal period. Removal helps prevent the occurrence of malignant neoplasms. After such treatment, the patient is prescribed hormone replacement therapy, which will alleviate the general condition after surgery.

Prevention of ovarian hyperplasia

Prevention of ovarian hyperplasia is a set of measures aimed at preventing the disease. Since the main cause of the pathology is hormonal disorders, it is necessary to observe and maintain hormonal balance. To do this, it is recommended to reduce stress effects on the body. Another method of prevention is the fight against obesity. Excess weight leads to hormonal disorders, menstrual cycle failure, ovarian hyperplasia and other gynecological diseases and endocrine disorders.

Particular attention should be paid to the menstrual cycle. If there are any irregularities, it is better to consult a gynecologist and treat them. Do not forget about preventive examinations and ultrasound examination of the pelvic organs. This will allow you to timely identify pathologies in the functioning of the ovaries and the reproductive system as a whole.

To prevent hyperplasia in young patients, doctors recommend prophylactic use of hormonal drugs, which significantly reduce the risk of the disease. At the first symptoms of hyperplasia, which can manifest as bloody discharge between periods, pain in the lower abdomen, discomfort in the glands, heavy uterine bleeding or absence of menstruation, you should consult a doctor.

Prognosis of ovarian hyperplasia

The prognosis for ovarian hyperplasia depends on the form of the disease, its severity, the patient's age, her health, and the presence of chronic diseases, including gynecological ones. If the pathology was detected at an early stage, drug treatment will help stop the process, and prevention methods will prevent its occurrence in the future. In this case, we can talk about a favorable prognosis. If ovarian hyperplasia was detected at a late stage and developed into a cystic or cancerous process, the prognosis is unfavorable. The woman undergoes surgical removal of the gland and subsequent hormonal therapy for recovery.

Ovarian hyperplasia is a pathological process that without proper treatment can lead to serious consequences. Taking care of your health, regular examinations by a gynecologist, preventing infectious and inflammatory diseases is an ideal method for preventing this pathology and other gynecological diseases.