Treatment of endometrial hyperplasia

Treatment of endometrial hyperplasia is a complex of measures that are aimed at eliminating pathological processes. Let's consider the basic methods of treatment of endometrial hyperplasia and their effectiveness in relation to certain forms of the disease.

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Hyperplasia of the endometrium is a disease that is a pathological change affecting the glandular and stromal elements of the endometrium. There are several forms of endometrial hyperplasia, which differ in their symptoms, the nature of the course and the methods of treatment.

Treatment can be conservative, prescribing medication, therapeutic baths, drugs, solutions for intravenous administration, tampons, alternative medicine methods. But the treatment can be radical, that is, complete removal of the uterine cavity. The type of treatment depends on the form of the disease. So, the most dangerous form of endometrial hyperplasia is atypical hyperplasia. This type of disease is a precancerous condition, which at any time can turn into a malignant form that requires radical therapies.

Methods of treatment of endometrial hyperplasia

Methods of endometrial hyperplasia completely depend on the type of disease. To date, modern medical methods can cure hyperplasia without radical removal of the uterine cavity. If the hyperplasia did not cause a major change in the uterus, then the medication is used for treatment. If the glands have formed cysts or polyps, then in addition to drug treatment, surgical intervention is used. When choosing therapeutic therapy, the doctor takes into account the patient's health, age and severity of the disease. Let's look at the basic methods of treating endometrial hyperplasia.

Medication Therapy

Several groups of drugs are used to treat endometrial hyperplasia. The doctor selects the necessary dosage and the appropriate drug. This helps to prevent side effects that manifest as weight gain, excessive hair loss or acne on the skin.

• Combined oral contraceptives

The drugs contribute to the restoration of hormonal balance in the female body. The most popular of them are: Zhanin, Yarina, Regulon. As a rule, oral contraceptives are prescribed for young girls, nulliparous women who have glandular-cystic or glandular hyperplasia of the endometrium. The use of medication is explained by the fact that scraping and other surgical methods are not desirable.

Preparations take at least six months. A gynecologist individually makes a contraceptive regimen for taking the drug. This allows you to make the menstrual cycle regular, and the monthly ones are less painful and abundant. While a woman is taking contraceptives, her body starts producing progesterone on her own.

• Synthetic analogues of progesterone

Since endometrial hyperplasia occurs due to a deficiency of progesterone, the use of progesterone drugs can cure the disease. Artificial sex hormone acts in a manner similar to that produced by the body. The use of synthetic progesterone analogues restores the menstrual cycle, and the use of gestagens is effective in treating endometrial hyperplasia in women of all ages.

The only drawback of the drug is that there may be spotting in the period between monthly. Duration of treatment is from three to six months. The most effective drugs: Norkolut and Duphaston.

• Gonadotropin-releasing hormone antagonists (AGNRG)

Modern drugs that reduce the production of estrogen (female sex hormones), which contribute to the growth of the endometrium. Drugs slow down the growth and division of cells, because of which the thickness of the mucous membrane decreases. This kind of process is called atrophy of the endometrium. But medicines allow to avoid infertility and removal of the uterus.

The drugs are easy to use and easy to dispense. Typically, patients are injected one at a time once a month and prescribe a spray for the nose. In the first weeks of the drug, a woman experiences a worsening of the condition, but it goes away, as the estrogen level rises. The woman has a regular cycle, the monthly ones become painless. The duration of treatment with gonadotropin-releasing hormone (AGNRG) antagonists is from one to four months.

Treatment with surgical methods

Surgical methods of treatment involve surgical intervention. This type of treatment can be radical, that is, removal of the uterus or more conservative - scraping, moxibustion, cryodestruction and others. The advantage of this treatment is that it minimizes the chance of recurrence of endometrial hyperplasia in the future.

• Scraping (cleaning) of the uterus

The main diagnostic and therapeutic method for endometrial hyperplasia. The procedure itself is performed under intravenous anesthesia and takes no more than 20-30 minutes. The gynecologist removes the surface functional layer of the endometrium. In other words, 20 minutes of the doctor's work are analogous to the work of the body for 3-7 days of the menstrual cycle. Lack of such treatment - endometrial hyperplasia can recur.

• Cryodestruction

This method is a freezing of the affected parts of the mucous membrane with the use of low temperatures. Cold causes necrosis of the affected layer of the endometrium. The processed portion of the endometrium is rejected and comes out as a bleeding with clots.

• Laser ablation or moxibustion

Moxibustion is similar in principle to the method described above. Only in this case, the gynecologist works with instruments heated to high temperatures. Affected areas of the endometrium are destroyed and independently leave the uterine cavity. After the procedure, the uterine mucosa is restored as after the last menstruation.

• Uterus removal or hysterectomy

This type of treatment is used in atypical and complex forms of endometrial hyperplasia. Hysterectomy is most commonly used to treat hyperplasia in women who are in the menopause period or when there is a high risk of developing cancer. Before removal, the uterus and the ovaries are examined. If the ovaries are without pathological changes, then they are not removed. Complete removal of the uterus, ovaries and fallopian tubes are done with adenomatosis and with the detection of cancer cells.

After such treatment, a woman is prescribed a course of hormonal drugs. This helps improve the overall condition and prevent recurrence of endometrial hyperplasia in the future.

Treatment of glandular hyperplasia of the endometrium

Treatment of glandular hyperplasia of the endometrium begins with a complete diagnosis of the disease and the selection of an individual treatment technique. It is worth knowing that glandular hyperplasia is an overgrowth of the glandular tissue of the endometrium, which leads to its increase in both size and volume. The disease manifests itself in the form of profuse menstruation, infertility, anemia. To determine the pathology, a woman undergoes ultrasound, endometrial biopsy and a series of hormonal studies.

Treatment of glandular hyperplasia of the endometrium involves scraping the uterine cavity to remove the upper layer of the endometrium. In addition to curettage, a woman is treated with hormonal drugs, and if necessary, ablation of the endometrium or resection.

• The first stage of treatment is a diagnostic curettage of the uterine cavity. According to the results of histology, the doctor makes a hormone therapy scheme that aims to eliminate hormonal imbalance and inhibit the proliferation of the endometrium. When glandular hyperplasia of the endometrium, as a rule, prescribe drugs such as: Yarina, Zhanin, Utrozestan, Dyufaston. Duration of use of drugs from three to six months. The therapeutic effectiveness is different and the gestagen-containing intrauterine system Mirena, which has a local therapeutic effect on the layer of the endometrium. For women over 35 years of age, and during the postmenopausal period, aHNRH (gonadotropin releasing hormone agonists) is used for therapeutic purposes. Drugs contribute to the emergence of reversible amenorrhea and artificial climax.
• In addition to hormonal treatment, a woman is required to take vitamin therapy, physiotherapy, correction of anemia. Six months after the treatment, a control ultrasound is performed. And at the end of the course of treatment - a repeated biopsy of the endometrium. To stimulate the ovulatory cycle, use Klimofen and other stimulants.
• If the glandular hyperplasia of the endometrium recurs even after hormone therapy, ablation or resection methods using electrosurgical and laser techniques are used for treatment. This is especially true for women who are interested in procreation.
• For the treatment of glandular hyperplasia of the endometrium, which is complicated by uterine myoma, endometriosis or occurred during the menopause, a hysterectomy or panthistectomy

With regard to the prevention of glandular hyperplasia of the endometrium, it is aimed at preventing uterine cancer and endometrial cancer. For this, a woman should regularly undergo examinations at a gynecologist, pick up contraceptives and undergo vocational training for conception and pregnancy. The main task of a woman is to seek medical help and advice on time, and also to comply with all the doctor's instructions. Since the prognosis of treatment of glandular hyperplasia of the endometrium depends on this.

Treatment of endometrial glandular cystic hyperplasia

Treatment of glandular cystic endometrial hyperplasia is most often performed in women of reproductive age, since they are the ones most affected by this disease. The first stage of treatment is a diagnostic preliminary curettage of the mucous membrane of the uterine cavity, that is, the endometrium. The tissues are sent for histological analysis, according to the results of which, the gynecologist composes the treatment regimen. Treatment is aimed at preserving menstrual functions and correcting ovulation.

For the treatment of glandular-cystic hyperplasia of the endometrium, several standard, effective treatment regimens are used, let's consider them:

• Treatment begins with the first day of menstruation (presumable). A woman should take Ethinyl-Estradiol twice a day for 20 days. Two weeks after menstruation, prescribe a drug called Regnim, which is taken within 10 days. The duration of such treatment takes from four to six months.
• From the first day of menstruation, the woman takes Microfollin, for two weeks, in conjunction with the drug Regnim. Duration of treatment is from four to six months.

This scheme of treatment of glandular-cystic hyperplasia of the endometrium is designed for women in the premenopausal period. Within six months, it is necessary to take estrogen-gestans. This will normalize the hormonal background and prevent the pathological development of the disease.

The glandular-cystic hyperplasia of the endometrium is subject to mandatory treatment, regardless of the degree of manifestation of the pathology and age of the patient. The treatment is chosen individually for each woman. And it depends on the age of the patient, the complexity of the disease, the individual characteristics of the organism. Duration of treatment is from three months to six months. The effectiveness of treatment is checked by repeated biopsy. If, after treatment, the disease has taken a severe form or recurred, this is an indication for an operative intervention, which in particularly difficult cases involves the removal of the uterine cavity.

Treatment of simple endometrial hyperplasia

Treatment of simple endometrial hyperplasia involves the prevention of uterine and endometrial cancer. The tactics of treatment depend on the clinical manifestations of the disease, the histological variant of hyperplasia, the state of the woman's health and other characteristics of her body. Treatment begins with a stop of bleeding, anti-inflammatory therapy and regulation of the menstrual cycle. During the period of treatment, a woman may be hospitalized, both in planned and in urgent order.

Simple endometrial hyperplasia is a polyp that appears on the mucous membrane of the uterus and requires removal. Polyps often recur, so this method of treatment as scraping does not help completely cure hyperplasia. This is because the polyp has a fibrous stem. The most effective method of treatment is hysteroscopy, that is, surgical removal together with the basal layer. After such treatment, a woman is given a control hysteroscopy to confirm the effectiveness of the treatment. In complicated cases of simple endometrial hyperplasia, the patient is prescribed resectoscopy.

In addition to surgical intervention, hormonal treatment is mandatory, to restore normal functioning of the female body and normalize the cycle. For these purposes use oral combined contraceptives (Novinet, Regulon). In some cases, a woman is placed with a hormone-containing spiral, which is an alternative to tablets. But the only drawback of the spiral is a decrease in menstrual flow and even amenorrhea. In any case, the woman is on dispensary supervision from one year to two. This allows the gynecologist to monitor the patient's condition and promptly prescribe or adjust the treatment.

Treatment of simple glandular hyperplasia of the endometrium

Treatment of simple glandular hyperplasia of the endometrium consists of several stages. At the first stage, a woman is provided with medical assistance to stop bleeding and scraping the walls of the uterus for therapeutic and diagnostic purposes. The main task of the first stage of treatment is to stop bleeding by eliminating its source. The endometrial tissue that was obtained as a result of scraping is sent for histological analysis. The analysis confirms the presence of simple glandular hyperplasia of the endometrium. If there are no cancer cells in the analysis, then the treatment is conservative, as a rule, without surgical manipulation.

The next step in the treatment of simple glandular hyperplasia of the endometrium is the recovery of the body and the normal menstrual cycle. To do this, eliminate the causes that prevent ovulation: hormonal failure, anatomical obstacles to the release of the oocyte, the use of estrogen-containing medications without progesterone, and others. For these purposes, use hormonal therapy, which replenishes the deficiency of hormones. If after the hormonal treatment does not occur planned menstruation, it indicates that the hyperplastic processes are not stopped, that is, the disease is progressing.

The final stage of treatment of simple glandular hyperplasia of the endometrium is the elimination of conditions and diseases that contribute to anovulation. This can be due to prolonged psychological overexcitation, metabolic syndrome, rheumatism or polycystic ovary. Elimination of all negative factors is a guarantee that the disease does not recur in the future.

Treatment of endometrial focal hyperplasia

Treatment of endometrial focal hyperplasia is a lengthy process that involves the use of progestogens. A woman is given diagnostic scraping to examine the endometrial tissue for histology. For treatment, prescribe the preparation 17-OPK (solution 17-oksiprogesteronkapronata) and drug Dufaston. Duration of use of medicines takes up to nine months.

An obligatory step in the treatment of focal hyperplasia of the endometrium is hysteroscopy. This allows us to examine in detail the pathological site of the mucosa and choose further treatment tactics. Medical measures should not be limited only to taking hormonal medications. If the patient has metabolic disorders, for example, overweight, then the doctor prescribes a diet. In this case, it is the weight reduction that will determine, and contribute to the effectiveness of the main therapy.

Treatment of atypical endometrial hyperplasia

Treatment of atypical hyperplasia of the endometrium is most often performed in women in the period of pre and postmenopause. Atypical hyperplasia of the endometrium is a pathological precancerous condition, which is an indication for the removal of the uterine cavity. Radical surgery, that is, extirpation of the uterus - is an effective treatment method in this case, which prevents relapses of the disease. But the question of removing the uterus comes after hormonal treatment. As a rule, in addition to the uterus, a woman is removed and the ovaries. The removal of the ovaries depends on their condition and the severity of extragenital pathology.

To date, atypical hyperplasia of the endometrium can occur even in young women who have not yet given birth. In this case, doctors conduct an organ-saving treatment. For these purposes, high-performance synthetic hormonal drugs are used that treat not only hyperplasia with atypia, but also endometrial cancer in the initial stages.

The results of hormonal therapy depend on the pathogenetic variant of the disease and the nature of the atypical process. The process of treatment should be accompanied by dynamic observation. Every two months, a woman is cured, that is, diagnostic scraping. The main criterion for recovery is atrophy of the endometrium. After this, the patient undergoes a course of rehabilitation treatment, which is aimed at restoring the functions of the endometrium, that is, they carry out a course of hormone therapy.

The results of treatment are evaluated every three months. For this, separate diagnostic scraping and dispensary observation is performed. With relapse of the disease, conservative hormonal treatment is replaced by surgical intervention, that is, by the extirpation of the uterus.

Treatment of endometrial adenomatous hyperplasia

Treatment of adenomatous hyperplasia of the endometrium can take place in two ways. The method of treatment depends on the age of the patient, the individual characteristics of her body and the course of the disease. So, for older women who are in the postmenopausal period, perform radical surgical treatment. But for women of reproductive age conservative therapy is possible.

To conduct conservative therapy, aHnRH and a number of other hormone-containing drugs are used. Control of the effectiveness of such treatment is a medical-diagnostic curettage, which is performed every two to three months. In addition, every month a woman must undergo ultrasound to determine the thickness of the endometrium. But even after prolonged conservative treatment, endometrial adenomatous hyperplasia can recur. Because of the inability to control the disease, a woman is removed from the uterus with appendages.

Treatment of endometrial hyperplasia in premenopause

Treatment of endometrial hyperplasia in premenopause is a process that is the elimination of a disease in a transitional period for a woman. Premenopause is a condition that occurs before menopause, as a rule, in women 45-47 years. Sometimes the symptoms of premenopause are observed in women 30-35 years of age, this is possible because of hormonal disorders. This period can last from several months to several years. The woman has a weakened ovarian function, but the ability to conceive a child still persists. The main sign of menopause is the absence of menstruation during the last 12 months.

Premenopause is accompanied by the appearance of many diseases that are caused by hormonal failure. It is against this background that endometrial hyperplasia develops. Treatment of endometrial hyperplasia in premenopause begins with the diagnosis of a woman's condition. Diagnosis allows you to exclude, and if necessary, recognize other pathological processes.

• A woman must undergo ultrasound examination of the pelvic organs for visualization of the uterus and appendages. This will determine the pathology at an early stage of development.
• The analysis on a hormonal profile is obligatory. The analysis is necessary to determine the level of hormones at different periods of the cycle. The data obtained help in the development of hormone replacement therapy.
• Diagnostic curettage makes it possible to determine the form of hyperplasia and to recognize cancer cells. Endometrial tissue obtained as a result of scraping is sent for cytology.

Based on the results of the tests and diagnosis, they make up a treatment plan. As a rule, hormonal therapy is used that helps correct the appearance of menopause and prevents further pathologies of the endometrium and the appearance of tumors of the genital organs. In addition to hormone treatment, vitamin therapy is provided. Such treatment stimulates the functions of the ovaries, with the help of vitamins A, E, calcium. The patient may be prescribed sedatives and antidepressants, which will help cope with problems with sleep and unstable mood. In particularly severe cases of the disease and with recurrent endometrial hyperplasia, the woman is removed by the uterus and the subsequent hormonal treatment.

Treatment of endometrial hyperplasia in menopause

Treatment of endometrial hyperplasia in menopause can be carried out in several ways. The type of treatment depends on the form of the disease, the individual characteristics of the woman's organism, her age and concomitant diseases. Let's look at the main types of treatment for endometrial hyperplasia in menopause.

• Hormonal therapy

The woman is sent for diagnostic endometrial scraping and ultrasound. Based on the results of the tests, the dosage of the administered hormones is selected, which is regularly adjusted after periodic studies of the endometrium. Hormonal therapy contributes to the positive outcome of the disease and is an excellent prevention of the prevention of cancer processes in the uterine cavity.

• Surgery

The patient is scraped out of the mucous membrane surface of the uterine cavity to remove pathological foci and carry out the diagnosis. In some cases, endometrial tissues are cauterized by a laser to destroy the foci of pathology. With regard to hysterectomy, that is, removal of the uterus, this procedure is performed with relapses of endometrial hyperplasia.

• Combined treatment

This treatment method involves combining surgical and hormonal treatment. Hormone therapy reduces the volume of surgical intervention due to a decrease in the overgrown endometrium. But most often, during the menopause, surgical removal of the uterus is carried out followed by hormone therapy

Treatment of endometrial hyperplasia in postmenopausal women

Treatment of endometrial hyperplasia in postmenopausal women begins with diagnostic curettage. The procedure is carried out under the full control of hysteroscopy. If a woman develops a disease for the first time, during the postmenopause, then after the procedure of curettage, the doctor prescribes hormonal therapy. The patient is selected drugs that contain gestagens with prolonged action. The duration of such treatment takes from eight months to a year.

In addition to hormonal treatment, with endometrial hyperplasia in postmenopause, a woman is prescribed analogues of GnRH (Buserelin, Diferelin, Goserelin). The duration of use of these drugs is up to one year. Treatment with hormones is carried out with regular ultrasound examinations to diagnose the process of recovery. If during the postmenopause, endometrial hyperplasia recurs, then surgical treatment is performed. This method involves the removal of the uterine cavity or extirpation of the uterus, ovaries and fallopian tubes.

If after a diagnostic curettage in a woman found atypical hyperplasia of the endometrium, then this indication for surgical treatment. This is necessary to prevent recurrence of the disease and in order to avoid malignancy of the pathology. Most often, complete amputation of the uterus. If the operation can not be carried out because of severe somatic diseases or contraindications, then the woman is given hormone therapy at the maximum permissible dosages.

Scraping with endometrial hyperplasia

Scraping with endometrial hyperplasia carries two functions - diagnostic and therapeutic. Separate diagnostic scraping is performed absolutely for all women with any form of endometrial hyperplasia. The procedure is performed under general anesthesia, under the control of hysteroscopy. If scraping is done without hysteroscopy, then local anesthesia is used.

Scraping with endometrial hyperplasia is performed on the eve of the expected menstruation. During the procedure, the woman is removed all the mucous membrane of the uterus, that is, the layer of the endometrium, carefully working the bottom and the angles in which there may be polyps or adenomatosis. Hysteroscopy is used to control the removal procedure, that is, how clean the mucosa is. Without hysteroscopy, even experienced physicians can leave small areas of the endometrium that lead to recurrence of the underlying disease.

After the procedure of curettage, within 3-10 days a woman may have minor spotting. But this is considered the norm, so it should not cause panic. In addition to bleeding, after the scraping procedure, particles of resected tissue may come out, but this is also a normal postoperative phenomenon. After the first scraping procedure, the second time the scraping is carried out in 4-6 months, with a diagnostic purpose. This allows you to evaluate the results of treatment, and if necessary, to prescribe a number of drugs or to remove the uterus.

Treatment of endometrial hyperplasia without scraping

Treatment of endometrial hyperplasia without scraping is an ineffective therapy, which, as a rule, does not give the expected therapeutic effect. That is, the absence of curettage is a blind treatment. Since without scraping it is impossible to evaluate the effectiveness of the therapy used. A woman must fully rely on her own well-being.

If after the course of hormonal therapy, endometrial hyperplasia recurs, then this indicates ineffectiveness of the main treatment. The gynecologist makes a new treatment plan. If the endometrial hyperplasia remains untreated, the foci of the disease are given to malignancy, the only treatment of which is complete removal of the uterus.

All this suggests that the treatment of endometrial hyperplasia is much more effective if we perform medical-diagnostic curettage. The procedure is carried out under anesthesia, so the woman does not feel pain. Obtained as a result scraping tissue, sent to a cytological analysis. Thanks to this, the doctor makes a treatment regimen that will have an effect for some form of endometrial hyperplasia.

Treatment of endometrial hyperplasia is a long-term therapy that is aimed at treating pathologies in the uterine cavity. To date, there are many effective drugs that are used to treat hyperplasia. Medicines are selected individually for each patient, focusing on her age, the nature and form of the disease, and other features of the body. Modern drugs can cure even atypical and complex forms of the disease. Timely diagnosis and examination by a gynecologist is a guarantee of effective and successful treatment of endometrial hyperplasia.