Uterine hypoplasia

The term "uterine hypoplasia" is used by doctors in cases when it comes to insufficient development of this organ: the uterine body is reduced in size when compared with normal age and physiological norms. Such a disorder can be congenital or acquired, associated with many pathological reasons. Uterine hypoplasia is not always accompanied by any obvious signs. In many cases, pathology is detected during ultrasound diagnostics - almost by accident. Some forms of hypoplasia pose serious obstacles to pregnancy.

Uterine hypoplasia: what is it in accessible language?

Translated from the Greek language, hypoplasia literally means “insufficient formation”, “insufficient development”. That is, hypoplasia of the uterus is a condition when this organ is developed incorrectly, not fully. A similar diagnosis is made when a woman reaches reproductive age, when it becomes clear that the size of the uterus does not correspond to the minimum adequate size necessary for conceiving and carrying a child. Nevertheless, with many forms of hypoplasia, it is still possible to become pregnant and give birth. The main thing is to find a good doctor, get tested and follow the recommendations of a specialist. [1]

Therefore, the main characteristic of the diagnosis of uterine hypoplasia is its reduced size, which can complicate the onset of pregnancy, or even make conception and gestation impossible.

They say about hypoplasia of the uterus if, upon completion of the process of maturation of the reproductive organs, its size "does not reach" normal values and other structural abnormalities are found. Often, pathology coexists with ovarian infantilism, hypoplasia of the external genital organs or endometrium.

Endometrial hypoplasia is an underdevelopment of the functional uterine layer, which plays an important role in the mechanism of pregnancy development. If this layer at the ovulation stage has a thickness less than 0.8 cm, then the ovum will not be able to gain a foothold in the uterus. Rarely, in such situations, the implantation process still happens, but in a state of endometrial hypoplasia, gestation is difficult, with constant risks of sudden miscarriage or intrauterine fetal freezing as a result of placental insufficiency.

The endometrial layer includes the basal layer, which forms new cells, and the functional layer, consisting of epithelial and glandular structures. The functional layer tends to be rejected with each onset of monthly cyclical bleeding. During the cycle, the endometrium changes, depending on the required functional activity. The possibility of normal conception depends on its thickness and the so-called degree of maturity. [2]

The diagnosis of endometrial hypoplasia is made if, during the first phase of the menstrual cycle, the layer thickness is less than 0.6 cm, and in the second phase - less than 0.8 cm.Under similar circumstances, the fertilized egg is too close to the smallest spiral arteries, which puts it in conditions high oxygen concentration. This negatively affects its viability. As scientific experiments show, embryonic development proceeds more comfortably against the background of reduced oxygen concentration, which occurs when the endometrial layer is 8 to 12 millimeters thick.

Epidemiology

Abnormal development and underdevelopment of internal reproductive organs in women account for about 4% of all known birth defects. They are found in 3.2% of patients of childbearing age.

In general, defects in the development of the urogenital system occupy the fourth place in the list of all congenital human anomalies.

According to statistics, women with a 2 or 3 degree of uterine hypoplasia have every chance of conceiving and giving birth to a healthy baby: this is facilitated by competent treatment prescribed by a doctor. With the first degree of pathology, the chances of conception are sharply reduced, however, provided that the ovaries are working normally and the production of full-fledged eggs, in vitro fertilization can be performed by contacting the surrogacy service.

Uterine hypoplasia is often found in the presence of polycystic ovary disease. The most common complications of hypoplasia are infertility and ectopic pregnancy.

Causes hypoplasia of the uterus

There are many known reasons for the development of uterine hypoplasia. However, the most often indicated are the following:

• impaired intrauterine development of the fetus (pathology is formed even before the girl is born);
• disturbed hormonal balance that occurred in childhood or adolescence, thyroid disease;
• genetic predisposition (similar problems were diagnosed in other female relatives).

The processes of hypoplasia in the uterus can develop as a result of severe stressful situations that took place in early childhood. Often the "culprits" are prolonged infectious and inflammatory diseases, unhealthy diet, excessive physical activity, etc. [3]

The uterus in the female body begins to form at the stage of intrauterine development, which occurs approximately at the fifth week of pregnancy. Before the physiological completion of gestation, this organ should be fully formed, although its size is still small. Until the age of ten, uterine growth is slow, gradual. Moreover, for up to three years, the organ is in the abdominal cavity, and subsequently falls below - into the pelvic cavity. After the age of ten and up to fourteen years, the growth of the uterus is significantly activated: at the stage of puberty, it will acquire its normal volumes:

• uterus about 48 mm long, 33 mm thick, 41 mm wide;
• neck about 26 mm long;
• the total length of the uterus and cervix is about 75 mm.

If there is an abnormal development, or hypoplasia of the uterus, then most often this is due to the following reasons:

• Something prevented the normal development of the organ even at the stage of its formation. Perhaps it was intrauterine intoxication, or a malfunction at the gene or chromosomal level, which led to a halt in the growth of the genital organ.
• The uterus was developing normally, however, a malfunction occurred in the child's body, affecting the work of the endocrine system (hormonal background).

Failure could occur:

• against the background of a severe viral infection (for example, the influenza virus often attacks the main organs of the endocrine system, such as the pituitary gland and hypothalamus);
• after frequent infectious diseases of the respiratory system, including SARS, tonsillitis;
• with constant or severe intoxication, including nicotine, alcoholic and narcotic;
• due to constant stay in a state of stress, or prolonged and deep stresses that negatively affect the hypothalamus;
• with mental or physical overload, which also become severe stress for the body;
• as a result of a lack of vitamins in the body (meaning pronounced hypovitaminosis);
• against the background of tumor processes in the pituitary gland or hypothalamus;
• when the reproductive organs are damaged by a viral infection, in particular measles, mumps, rubella;
• poor nutrition, regular malnutrition, forced and purposeful restriction in the girl's diet;
• early surgical interventions on the ovaries.

Risk factors

The risk group for the birth of children (girls) with uterine hypoplasia includes women who have bad habits (alcohol abuse, smoking), drug addiction, or regularly face occupational hazards, or suffered from viral infections or intoxication in the early stages of pregnancy. The role of a hereditary factor, probable biological cellular inferiority (meaning the structure of the genitals), and the harmful effects of chemical, physical and biological influences is also considered undisputed. [4]

Congenital type of uterine hypoplasia is a sign of sexual infantilism or integral pathology that occurs as a result of damage to the embryo during gestation, or is due to genetic causes. Often, the trigger is a violation of the regulatory system from the hypothalamus, or due to ovarian failure against the background of excessive pituitary activity. Such regulation disorders are noted in childhood and adolescence. They are associated with such factors:

• hypovitaminosis;
• various kinds of intoxication (including alcoholic and narcotic);
• nervous disorders;
• excessive mental and physical (sports) stress that does not correspond to gender and age);
• anorexia;
• frequent infectious processes in the body (angina, viral infection, flu).

These factors directly affect the inhibition of the development of an initially normally forming uterine organ.

Pathogenesis

Intrauterine uterine development occurs from the middle section of paired Müllerian canals merging with each other. The formation of these channels is noted already in the first four weeks of pregnancy, and they merge in the second month of pregnancy. In the fusion zone of the lower canal segment, the vagina is formed, and the upper segments remain unconnected: subsequently, the fallopian tubes are formed from them. Any failure in the process of fusion and formation can lead to various types of defects in the development of the reproductive organ, including partial or complete duplication. With insufficient development of one canal, uterine asymmetry occurs. Uterine hypoplasia appears as a result of a disturbed process of mutual regulation of the endocrine and reproductive systems in the fetus. [5]

In addition, hypoplasia can occur under the influence of external unfavorable factors that directly or indirectly affect the fetus at different stages of pregnancy. Moreover, the severity of the congenital anomaly depends on the duration of exposure and on the gestation period.

The main adverse effects include:

• microbial and viral infections;
• somatic pathologies;
• failure of the endocrine system;
• genetic predisposition;
• taking certain medications that are prohibited for use during pregnancy;
• professional harm;
• drugs of narcotic action;
• alcohol, smoking;
• deep or prolonged stressful situations, psycho-emotional stress;
• prolonged fasting, poor and monotonous food;
• unfavorable ecology.

Symptoms hypoplasia of the uterus

Hypoplasia of the uterus rarely reveals itself with any symptoms, so patients often do not even suspect that they have such a deviation. Clinically, the problem does not manifest itself if the organ is slightly reduced, or such a decrease is due to physiology - that is, the individual characteristics of a woman. So, a small uterus is typical for miniature, short and thin girls, which is the norm for them. [6]

Pathological uterine hypoplasia may be accompanied by the following symptoms: 

• severe pain in the lower abdomen that occurs with the onset of menstrual bleeding;
• regular, severe, prolonged pain in the head, concomitant nausea, a significant deterioration in well-being at the beginning of the monthly cycle;
• underweight, small mammary glands;
• late onset of menstruation (after 15-16 years);
• irregular monthly cycle;
• mild secondary sexual characteristics.

Already at the initial examination, you can pay attention to some deficiency in physical development. Women with uterine hypoplasia are more often thin, short, with slight pubic and axillary hair, a narrow pelvis, small mammary glands. During a gynecological examination, other signs may also be noted:

• underdeveloped labia, bare clitoris;
• small size of the ovaries;
• shortened and narrowed vagina;
• convoluted fallopian tubes;
• incorrect configuration of the cervix;
• insufficient size and incorrect configuration of the uterine organ.

However, all these signs are detected already during the examination, since most often women seek medical help for reasons of inability to become pregnant, frequent miscarriages, lack of orgasm, weak sex drive, chronic recurrent endometritis, endocervicitis, etc.

Uterine hypoplasia can be recognized as early as adolescence, based on such suspicious signs:

• late start of menstruation (no earlier than 15 years, sometimes later);
• irregularity of the monthly cycle, periodic amenorrhea;
• severe pain syndrome, which is noted with each arrival of a new monthly cycle;
• too heavy or too little menstrual bleeding;
• poor physical development of the type of infantility (thinness, short stature, narrowed pelvis, poorly formed chest);
• weak severity of secondary sexual characteristics.

Older women often have:

• infertility;
• spontaneous abortion;
• frequent inflammation of the genitals;
• weak libido;
• weak or absent orgasm.

Of course, uterine hypoplasia is not always the cause of these disorders. However, it is these signs that most often allow one to suspect a problem and seek medical help. [7]

Uterine hypoplasia and multifollicular ovaries

Multifollicular ovaries are a pathological condition in which a large number of follicles (more than 8) mature simultaneously in the ovaries. Normally, the number of follicles in each ovary ranges from 4 to 7.

Most often, the disorder begins in adolescence, but it can develop later. Pathology is often associated with chronic endocrine disorders or infectious and inflammatory diseases, as well as with severe stress. In some patients, uterine hypoplasia is diagnosed simultaneously with multifollicular ovaries .

A similar combination of pathologies is manifested by the absence of regular menstruation, soreness of menstruation. There are also typical external manifestations associated with hormonal disruptions: a woman usually has acne, instability of body weight (more often - excess weight, especially on the abdomen), the appearance of spots on the skin like acanthosis, thinning of hair. In addition, patients with multifollicular ovaries against the background of uterine hypoplasia often complain of mental problems, many of them have apathy, depressive disorders, and a decrease in social activity. [8]

Treatment of such a combined pathology is complex, individual and long-term, with obligatory hormonal therapy.

Uterine hypoplasia and colpitis

Uterine hypoplasia often coexists with various inflammatory pathologies - for example, colpitis, or vaginitis. This disease is an inflammation of the vaginal mucosa, can be infectious and non-infectious in origin. It can occur at any age, even during the neonatal period.

The characteristic signs of colpitis are as follows:

• vaginal discharge of various types (liquid, thick, curdled, frothy, etc.);
• swelling and redness of the vulva;
• discomfort in the form of itching and burning in the genital area;
• unpleasant odor of discharge;
• disorders of the nervous system, mainly associated with a state of discomfort, pain, constant itching (sleep disturbances, irritability, anxiety);
• pain in the pelvic area and external genital organs, pain in the vagina during sexual intercourse;
• sometimes, but not always - an increase in body temperature;
• frequent urination, pain during and after urination.

Colpitis usually responds well to treatment, however, against the background of uterine hypoplasia, the disease acquires a chronic relapsing course. [9]

Is it possible to get pregnant with uterine hypoplasia?

Uterine hypoplasia always creates obstacles to the onset of pregnancy, regardless of the degree of violation. A reduced organ often has incompletely developed ovaries, which is especially unfavorable. However, even with uterine hypoplasia, women become pregnant and reproduce healthy babies. The likelihood of this is determined by the degree of pathology.

• The most serious is the 1st degree of hypoplasia: in patients with such a diagnosis, the uterus is really miniature - about three centimeters. Such an organ is also called "embryonic", or "intrauterine", since its development stops at the stage of intrauterine development. Correction of this degree of pathology is considered impossible, because a woman does not even have a monthly cycle. The onset of pregnancy is most often possible only with the help of surrogacy - provided that the ovaries function normally.
• With hypoplasia of the uterus of the II degree, they speak of an infantile, or "child" uterus: its size is about 3-5 cm, the localization of the ovaries is high, the tubes are long, irregularly configured. As a rule, the organ is related to the neck in a 1: 3 size ratio. A woman's periods come with a delay (after 15 years), they are painful and irregular. Thanks to competent and long-term treatment of such patients, pregnancy can be achieved. It is quite difficult to bear a child, but it is possible: during the entire period of gestation, there are risks of spontaneous miscarriage, so the woman is constantly monitored.
• Grade III uterine hypoplasia is characterized by organ sizes from 5 to 7 cm, with a uterine to cervical ratio of 3: 1. The pathology is treated with the use of hormonal agents, the onset of pregnancy is quite likely. There are also many cases when a patient became pregnant with third degree uterine hypoplasia on her own: experts point out the possibility of restoring normal uterine and ovarian function with the onset of sexual activity.

Stages

Experts talk about three degrees of uterine hypoplasia, which determine the main characteristics of the pathology.

• The most unfavorable in terms of fertility is the embryonic (fetal) uterus, it is also hypoplasia of the uterus of the 1st degree: its outer dimensions are less than 30 mm, there is practically no uterine cavity. This is due to the fact that the formation of such a uterus is completed even at the stage of intrauterine development.
• Hypoplasia of the uterus of the 2nd degree is the so-called "children's" uterus, measuring up to 50 mm. Normally, such an organ size should be present in a nine or ten year old girl. In this case, the uterus has a cavity, albeit a relatively small one. [10]
• Grade 3 uterine hypoplasia is called a "teenage" uterus: it is up to 70 mm in length - normally this is the size of an organ in a 14-15 year old adolescent. If we take into account that the normal uterine length is considered to be 70 mm or more, then the third degree of pathology is considered the most favorable in terms of the realization of a woman's reproductive function.

Moderate uterine hypoplasia

Moderate hypoplasia of the uterus is usually determined by the third degree of the disease and has no pronounced differences from standard dimensional values. A distinctive indicator is the ratio of the body of the uterus to its cervix, which corresponds to 3: 1. The length of the organ usually corresponds to 7 cm. In many cases, this degree of pathology is corrected independently with the onset of sexual activity.

Moderate manifestation of hypoplasia usually does not apply to congenital abnormalities. Such a violation can appear against the background of hormonal disorders that have occurred as a result of excessive physical and mental overload, stressful conditions, prolonged fasting or malnutrition, and improper eating behavior. Other possible causes include viral infection, existing chronic tonsillitis, poisoning and intoxication (narcotic, alcoholic, nicotine). Under the influence of these factors, the uterus slows down its development, regardless of whether the size of the organ corresponded to the norms in the newborn and childhood.

Complications and consequences

Uterine hypoplasia is primarily associated with infertility. If the size of the organ does not exceed 30 mm, then pregnancy becomes almost impossible. And if conception still occurs, then they talk about a significant risk of developing an ectopic pregnancy. The fact is that uterine hypoplasia is often combined with an underdevelopment of the tubal system: the tubes are thinned and have pathological tortuosity.

Since hormonal deficiency is considered one of the most common causes of pathology, the natural defense of the urogenital tract is also disrupted. This entails the development of infectious and inflammatory processes of the internal genital organs: a woman with uterine hypoplasia often has endometritis, endocervicitis, adnexitis, etc.

Severe hypoplasia contributes to the development of tumor processes in the reproductive system, both benign and malignant in origin. To avoid complications, a woman with uterine hypoplasia must undergo dispensary observation by a gynecologist. [11]

Diagnostics hypoplasia of the uterus

Diagnostic procedures begin with interviewing and examining the patient. Uterine hypoplasia can be suspected if there are signs of genital infantilism:

• weak hair growth in the pubic area and armpits;
• insufficient development of the external genital organs;
• narrowed vagina.

The cervix has an irregular conical configuration, and the body of the organ is flattened and underdeveloped. [12]

Analyzes that are required at the outpatient level:

• general clinical examination of blood and urine;
• coagulogram (prothrombin time, fibrinogen, activated partial thromboplastin time, international normalized ratio);
• biochemical blood test (indicators of urea and creatinine, total protein, dextrose, total bilirubin, alanine aminotransferase, aspartate aminotransferase);
• Wasserman reaction in blood serum;
• determination of HIV p24 antigen using ELISA method;
• determination of HbeAg of hepatitis C virus using ELISA method;
• assessment of total antibodies to hepatitis C viruses, using the ELISA method;
• gynecological smear.

Instrumental diagnostics includes the following types of procedures:

• ultrasound examination of the pelvic organs;
• electrocardiography;
• karyotype cytology to exclude or confirm chromosomal developmental abnormalities;
• magnetic resonance imaging of the pelvic organs;
• colposcopy;
• hysteroscopy;
• hysterosalpingography.

Ultrasound, X-ray examination, hysterosalpingography indicate an insufficient size of the organ, an irregular configuration (tortuosity) of the fallopian tubes, and a small size of the ovaries. Be sure to examine the level of sex hormones (follicle-stimulating hormone, progesterone, estradiol, prolactin, luteinizing hormone, testosterone) and thyroid hormones (thyroid-stimulating hormone, T4). Many patients undergo uterine intubation, determination of bone age, an X-ray of the Turkish saddle area, and magnetic resonance imaging of the brain. [13]

Additionally, the consultation of a therapist is required if extragenital pathologies are present, as well as consultations of an endocrinologist, urologist, surgeon, if there are violations from other related organs and systems.

Ultrasound for uterine hypoplasia is considered one of the most informative diagnostic studies. The procedure is performed using a vaginal and transabdominal probe, longitudinal and transverse scanning. [14]

• Before the transabdominal gynecological ultrasound examination, the patient is prepared: an hour before the procedure, she should drink at least 1 liter of water without gas and not urinate until the study is completed.
• Transvaginal ultrasound does not require special preparation, and it is better to empty the bladder before the procedure.

Only a doctor can interpret the results of ultrasound diagnostics.

Echoes of uterine hypoplasia are as follows:

• organ length parameters do not correspond to the age and physiological norm;
• the cervix is large relative to the body of the uterus;
• there is a pronounced bend of the organ anteriorly;
• the fallopian tubes are thin, convoluted, oblong.

The body of the uterus is normally slightly inclined anteriorly, which is defined by terms such as "anteversio" and "anteflexio". The dimensions of the uterus are determined in the form of a transverse, longitudinal and anteroposterior indicator:

• the longitudinal indicator characterizes the length of the organ and normally ranges from 45 to 50 mm (in a woman giving birth, it can increase to 70 mm) + the length of the cervix should be 40-50 mm;
• the transverse indicator characterizes the width of the organ and normally ranges from 35 to 50 mm (in a woman who has given birth, it can increase to 60 mm);
• anteroposterior indicator indicates the thickness of the uterus and is normally from 30 to 45 mm.

The thickness of the endometrium varies throughout the monthly cycle. On the 5-7th day of menstruation, its thickness is determined to be 6-9 mm. [15]

Often, ultrasound alone is sufficient to diagnose uterine hypoplasia. The rest of the research is carried out to clarify the diagnosis and search for the causes of pathology, which is necessary for further correct and effective treatment.

Differential diagnosis

Pathology type	Monthly cycle quality	Ultrasound signs	Gynecological examination
Anomalies of sexual development	Lack of menstrual function during puberty	There are signs of abnormalities: there is no cervix and uterine body, there is a rudimentary horn or intrauterine septum, or a two-horned uterus	Signs of abnormal development of reproductive organs are found
Adenomyosis	The menstrual cycle is irregular, menstrual bleeding is scanty or heavy, there is brown vaginal discharge, menstruation is painful	The anteroposterior size of the uterus is increased, there are zones of high echogenicity of the myometrium, minor round anechoic formations (3-5 mm)	The uterus is moderately painful, has nodes (endometriomas), enlarged
Dysmenorrhea	The monthly cycle is present, but the patients complain of severe pain	No typical echoes	Pathological signs during a gynecological examination are not detected
Pelvic inflammatory disease	Irregular, prolonged uterine bleeding	The wrong size of the uterus and the thickness of the endometrium, a high degree of vascularization, fluid in the small pelvis, thickened fallopian tubes, a non-uniform decrease in the echogenicity of the myometrium zones	Soreness of the uterus and its softness, the presence of tubo-ovarian formations, intoxication symptoms

Treatment hypoplasia of the uterus

Treatment for hypoplasia of the uterus is prescribed taking into account the degree of pathology and pursues the following goals:

• elimination of violation, correction of organ parameters;
• restoration of the monthly cycle, sexual and reproductive function;
• optimization of the quality of life.

The basis of therapy for uterine hypoplasia is the use of hormone replacement or stimulating drugs. Correctly selected treatment allows you to achieve an increase in the size of the organ, sufficient for its normal physiological functions.

Additionally, physiotherapeutic treatment is involved in the form of magnetotherapy, laser therapy, diathermy, inductothermic, UHF procedures, balneotherapy, the use of ozokerite and paraffin. The basic goal of physiotherapy is to improve blood circulation in the uterus.

An excellent effect is obtained from the endonasal galvanization procedure: this method involves stimulating the hypothalamus-pituitary gland, which leads to an increase in the production of hormonal substances, namely, luteinizing hormone and follicle-stimulating hormone. [16]

As support and acceleration of recovery, patients with uterine hypoplasia are shown vitamin therapy, physiotherapy exercises, manual therapy with gynecological massage, and spa treatment.

Vitamin complex preparations containing vitamins A, B, D groups, tocopherol, ascorbic and folic acids are used. Vitamin E has an antioxidant effect, stabilizes the monthly cycle, and optimizes reproductive function. Vitamin C strengthens the vascular network, improves blood flow.

To improve fertility, a woman's diet should be reviewed. The doctor will definitely cancel strict diets and fasting, recommend to adhere to a full diet, consume more fiber, vegetables and fruits, vegetable oils, cereals. Products such as spinach, broccoli and Brussels sprouts, tomatoes, sesame and flaxseed oil, and seafood are especially recommended.

Medicines

Drug therapy is usually complex, including the use of drugs that are different in the mechanism of action.

• Hormonal agents:
  • a continuous course of estrogens during puberty;
  • estrogens for the first phase of the monthly cycle, gestagens for the second phase.

With insufficient general somatic development, thyroid hormones are used (sodium levothyroxine, 100-150 mcg per day), anabolic steroid drugs (methandrostenolone 5 mg 1-2 times a day, depending on the type of disorders). [17]

• Antibiotics are prescribed for frequent infectious processes:
  • sulbactam / ampicillin (intravenously 1.5 g);
  • clavulanate / ampicillin (i.v. 1.2 g);
  • cefazolin (intravenously 2 g);
  • cefuroxime (intravenously 1.5 g);
  • vancomycin (if you are allergic to beta-lactam antibiotics) 7.5 mg / kg every 6 hours or 15 mg / kg every 12 hours for 7-10 days;
  • ciprofloxacin 200 mg intravenously 2 times a day for a week;
  • macrolide antibiotic azithromycin 500 mg once a day intravenously for 3-5 days.

Long-term hormone therapy is often accompanied by undesirable side effects that all patients should be aware of:

• pain, breast enlargement;
• increased appetite, sometimes nausea;
• dry mucous membranes;
• feeling tired, weak;
• thrombosis, thromboembolism.

It is important to understand that side effects do not appear in all patients, and their severity is also different. At the same time, without hormone therapy, it is often impossible to correct the state of the uterus and get rid of hypoplasia, since the growth and development of the organ directly depend on the production of hormones in the body.

Treatment with hormonal drugs

Hormonal drugs for uterine hypoplasia almost always become the main link in treatment. They help balance hormones, which helps to restore the development of the uterus.

Most often, the following hormonal agents become the drugs of choice:

• Femoston is a drug of estradiol and dydrogesterone, which activates the development of the entire reproductive system as a whole, including the fallopian tubes. Treatment is long-term, intermittently: the scheme is drawn up by the attending doctor, taking into account the individual characteristics of the patient and the response of her body to treatment.
• Duphaston with uterine hypoplasia is prescribed very often. This hormonal agent is an artificial analogue of progesterone, which is especially relevant when it comes to endometrial hypoplasia. Duphaston stabilizes the balance of hormones in the body if taken in combination with other complex drugs. The duration of treatment is usually more than six months. The dose and dosage regimen is set by the doctor individually.
• Estrofem is a drug that helps to stabilize the balance of estrogen in the female body, to activate the development of the main reproductive organ, and to improve the function of the fallopian tubes. At the same time, the monthly cycle is getting better. Tablets are taken 1 pc. Every morning. The duration of the treatment course is determined by the doctor individually. As a rule, courses are held for a short time (about 2 months), after which it is necessary to take a break.
• Ovestin contains a natural hormone of a woman - estriol. This hormone interacts with the nuclei of endometrial cells, normalizes the state of the epithelium. As a rule, the drug is used in the form of suppositories: put 1 suppository per day with a slow decrease in dosage, depending on the dynamics of treatment. Vaginal suppositories are inserted into the vagina in the evening, before going to bed.
• Microfollin is an ethinyl estradiol drug that eliminates disorders associated with a deficiency of endogenous estrogens, stimulates the proliferation of the endometrium and vaginal epithelium, contributes to the development of the uterus and secondary sexual characteristics of a woman with hypoplasia.

In no case can hormonal treatment be carried out independently: such drugs are always prescribed by a doctor, and in the future, they control their intake, adjusting the dosage and frequency of use. The reaction of the woman's body to hormonal therapy and the dynamics of treatment are necessarily taken into account. [18]

Physiotherapy treatment

In the form of an addition to the main prescriptions of the doctor for hypoplasia of the uterus, physiotherapy procedures are successfully used. The following are especially common:

• Magnetotherapy using a magnetic field has a decongestant and anti-inflammatory effect, improves blood circulation and stimulates cell structures.
• Ultrasound therapy affects the organ at the cellular level, stimulates the metabolism in tissues, which is combined with pronounced heat production. With an increase in temperature, blood circulation improves, pain disappears, adhesions soften. In addition, ultrasonic vibrations activate the hormonal function of the ovaries, which contributes to the establishment of the monthly cycle.
• Phonophoresis allows you to deliver drugs directly to the pathological focus using ultrasonic waves. This allows the drug to act in a localized manner, which greatly reduces the likelihood of side effects. Most often, antibacterial drugs, anti-inflammatory and vitamin agents are delivered to tissues by phonophoresis.
• Electrophoresis "works" by analogy with phonophoresis, but an electric current is used to conduct drugs.

In addition, with hypoplasia of the uterus, gynecological massage sessions are shown: 10 minutes daily for 1-1.5 months. Gynecological vibration massage optimizes lymph and blood circulation in the small pelvis, which allows you to eliminate congestion and enhance metabolic processes. Thanks to vibration massage, it is possible to strengthen the ligamentous-muscular system of the uterine organ and the pelvic floor. Inductothermy and acupuncture are also helpful. [19]

Herbal treatment

Alternative methods of therapy for uterine hypoplasia can be used, but they will have a real beneficial effect only in conjunction with the main drug treatment. In other words, full-fledged conservative treatment cannot be replaced with home remedies, but it is quite possible to supplement it.

Herbal teas, decoctions and infusions based on herbs that have anti-inflammatory and hormonal activity are successfully used as herbal remedies that correct uterine hypoplasia.

• Borovaya uterus, or orthilia one-sided, contains both phytoestrogens and plant progesterone, therefore the plant is indicated for the treatment of many gynecological diseases. Most often, at home, they use one-sided orthylium tincture. For its preparation, take 100 g of dry crushed plant, pour 1 liter of vodka, place in a dark place. It is kept under the lid for 2 weeks, after which it is filtered and the intake begins: 35 drops with a small amount of water between meals, twice a day. The treatment is usually long, for several months. The product should not be taken in childhood.
• Knotweed, or bird knotweed, has anti-inflammatory, antibacterial, diuretic, antitumor, analgesic effects. Thanks to the phytonutrients included in the plant, knotweed is able to stimulate the female reproductive system, enhance hormone production, and stabilize the monthly cycle. The plant is taken in the form of a decoction. Dried grass in an amount of 20 g is poured with 200 ml of boiling water, insisted for an hour under a lid. Take one sip 3-4 times a day 30 minutes before meals.
• Sage is able to stimulate the production of estrogen by the female body, to establish ovulation. Preparations from the plant are taken in the first phase of the cycle, after the completion of menstrual bleeding (about 4-5 days). You should not take sage for endometriosis, tumors, pronounced hypertension. To prepare the medicine take 1 tbsp. L. Dry plant, brew 200 ml of boiling water, insist until cool, filter and store in the refrigerator. During the day, you need to drink the entire infusion, which is about 50 ml 4 times a day.
• Elecampane successfully stabilizes the menstrual cycle, improves blood circulation in the peritoneal region, thereby contributing to the development of the organ. To prepare the infusion of the plant 2 tbsp. L. Raw materials are poured into 0.5 liters of boiling water and kept under a lid for half an hour. Further, the infusion is filtered and divided into two halves: one part is drunk in the morning half an hour before breakfast, and the second one - an hour before dinner. Take the medicine daily. If nausea, weakness appears, then the dosage is reduced.
• The red brush is a herbal natural remedy that is actively used to treat fibroids, fibroids, mastopathy, cervical erosion, polycystic ovary disease, irregular menstruation and even uterine hypoplasia. For the treatment of hypoplasia, a plant tincture is used: 50 g of dry crushed raw materials are poured into 0.5 liters of vodka, insisted in a corked form in a dark place for one month (sometimes you need to shake it). Next, the tincture is filtered and begin to take 1 tsp. Three times a day 40 minutes before meals. The treatment regimen is as follows: four weeks of admission - two weeks off.

Surgery

With concomitant endometrial hypoplasia against the background of a lack of efficacy from conservative therapy, the doctor may prescribe an operation involving a separate diagnostic curettage. The operation consists in resection of the inner uterine layer (the so-called cleaning) to activate the renewal and subsequent growth of the functional layer of the endometrium. 

The intervention is carried out using general intravenous anesthesia by vaginal access (without incisions).

Monitoring of the performance of surgical procedures is carried out through a hysteroscope, making the operation accurate and safe.

The duration of the surgical intervention is up to half an hour, after which the patient is placed in the ward of the day hospital, where she is under the supervision of medical specialists for several hours. With a satisfactory state of health and the absence of complications, a woman can go home on that day. [20]

Prevention

Preventive measures are necessary, first of all, during preparation for pregnancy and at the stage of conception. Primary prevention of uterine hypoplasia may include the following measures:

• Full nutrition of a woman during the childbearing period, providing the female body with all the necessary vitamins and minerals, taking food supplements recommended by a doctor.
• Avoiding smoking and drinking alcohol, both during the planning phase and during pregnancy. You should also beware of harmful foods and drinks.
• Prevention of exposure to the female body of hazardous substances - in particular, heavy metals, pesticides, certain medicines.
• Timely prevention of infectious diseases, vaccination (for example, rubella vaccine can be administered at least 4 weeks before pregnancy to those patients who have not been previously vaccinated and did not suffer from rubella in childhood).

It is necessary to take care of the health of the entire reproductive system of a girl from the moment of her birth. It is advisable to show the child to a doctor - a pediatric gynecologist already in infancy. This is necessary in order for the specialist to assess the development of the baby's genitals.

Both in early childhood and at subsequent age stages, the child should be protected from stress, ensure normal nutrition, observe hygiene, and prevent infectious and inflammatory diseases.

In a very important age period - adolescence, starting from about 11 years old, the girl must be especially carefully protected from infectious pathologies, and especially from viral ones. It is necessary to eliminate all possible foci of infection in the body - for example, caries, chronic tonsillitis, etc.

Explanatory work with children plays a very important role: it is important to explain to the child why smoking, alcohol consumption, the use of narcotic and toxic substances are harmful. These factors cause great harm to the child's body, since they have gonadotoxicity.

Regular lack of sleep, starvation, early onset of sexual activity, psycho-emotional overload have a negative impact on the development of the female reproductive system as a whole.

Forecast

If uterine hypoplasia is caused by disorders of the endocrine system, then timely treatment may be effective. But the severe form of a congenital defect does not lend itself to correction, and the probability of getting pregnant in a woman is practically reduced to zero. [21]

Treatment with a relatively small degree of hypoplasia is long-term, but the prognosis is often favorable: many women manage to safely endure and give birth to a long-awaited baby.

It is important to understand that patients immediately need to tune in to long-term therapy with strict adherence to all medical prescriptions. The result of this treatment depends on the degree of the anomaly and on the reasons for its occurrence. Uterine hypoplasia is far from always completely cured. However, doctors often manage to achieve the main desired result: women become pregnant and become mothers. The main thing is to find a good specialist who will competently select an approach to treatment.