Glandular endometrial hyperplasia

The glandular hyperplasia of the endometrium is the process of proliferation of the endometrial tissue (inner 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. There is a thickening of all endometrial tissues, which are caused by the emerging pathological processes of intensification of proliferation in the glandular layer of the uterus.

Hyperplasia of the endometrium is called glandular due to the proliferation of glands of the inner layer of the uterus. With the normal functioning of the glands of the endometrium, they have the appearance of straight vertical bands. With hyperplasia, glands begin to change their appearance - they coil and merge with each other.

Changes occur throughout the menstrual cycle in the endometrium of the uterus. The mucous layer of the uterus first grows, then changes and, after all, is rejected and withdrawn from the uterus during menstruation. Such transformations occur under the influence of fluctuations in the sex hormones of the female body - estrogen and progesterone. Due to a violation of their balance, for example, with an increase in the amount of estrogens, the glandular cells of the endometrium grow and do not decrease in their volume. That leads to the appearance of endometrial hyperplasia.

[1],

Causes of glandular hyperplasia of the endometrium

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

Causes glandular hyperplasia of the endometrium and various pathologies of female genital organs - polycystic ovaries, ovarian tumors, ovarian dysfunctions, uterine myomas, endometritis and endometriosis. These pathologies are a consequence of a violation of the balance of hormones in the body - an increase in the production of estrogen and a decrease in the amount of progesterone.

The causes of glandular hyperplasia of the endometrium lie in the abortions, diagnostic curettage, as well as in other gynecological operations. Also, a pathological increase in the endometrium may be caused by the artificial termination of pregnancy, the rejection of hormonal contraception, the absence of labor and the late entry into menopause.

In many cases, similar pathological processes in the endometrium are provoked by various diseases, namely obesity, diabetes mellitus, hypertension, mastopathy, liver, kidney and thyroid diseases. These diseases lead to disruption of metabolism in the female body and imbalance of hormones. A strong effect on the increase in the endometrium has hyperestrogenism - an increased production of estrogens, which occurs in peripheral tissues - skin and adipose tissue.

[2], [3], [4]

Symptoms of glandular hyperplasia of the endometrium

Symptoms of glandular hyperplasia of the endometrium are manifested as follows:

• Violation of menstrual functions in the form of the appearance of uterine bleeding pathological nature.
• Deviations in the menstrual cycle are also manifested as menorrhagia - periodic intense and prolonged bleeding, which appear cyclically.
• Menstrual dysfunction also manifests itself in the form of metrorrhagia - bleeding with varying degrees of intensity and duration, which occur haphazardly and acyclicly.
• The appearance of bleeding is seen between menstrual bleeding or immediately after a delay in menstrual bleeding.
• In adolescence, glandular hyperplasia of the endometrium manifests itself in the form of breakthrough bleeding with secretions of clots.
• Constant and prolonged bleeding provokes the appearance of anemia, various kinds of ailments, weakness and dizziness.
• The glandular hyperplasia of the endometrium causes the appearance of an 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 the growth of the number of glandular cells of the endometrium, as well as in the increase in their size without pathological changes in the structure. The cells of the gland can have different shapes and can be arranged in different ways. With this form of hyperplasia, the separation between the functional and basal layers of the endometrium disappears, while the boundaries between the endometrium and the myometrium remain.

Endometrial cells grow to their maximum possible size, and after exhaustion of all available cell resources, endometrial tissue is rejected. So there are acyclic uterine bleedings, which pass between menstrual bleeding and characterize the violation of menstrual functions of the body.

Occasionally, acyclic bleeding occurs during the prescribed menstruation, but always differs from normal bleeding during menstruation. Allocations of blood can be strong or weak. In the blood that is released during pathological bleeding, it is possible to detect various clots and lumps that are molded by the endometrium. Endometrial shots are layers of immature cells of the inner mucous layer of the uterus. After this, there is no complete normalization of the functioning of the endometrium. Since immature cells are rejected not in full volume, and there is no peeling of the functional layer of the endometrium from the basal membrane. In some places there are areas of accumulation of immature cells, which all the time grow during the bleeding period and after it stops.

With any form of endometrial hyperplasia, a woman does not actually have a menstrual cycle. The existing bleeding is not a release from the process of increasing cells and tissue growth. Also, the corresponding processes in the uterus are not related to the reproductive functions of a woman, since the occurrence of pregnancy with endometrial hyperplasia is impossible. This is due to the fact that the eggs do not mature, so they do not appear from the ovaries.

A simple glandular endometrial hyperplasia rarely transforms into a uterine body cancer (approximately one percent of one hundred).

Simple glandular cystic endometrial hyperplasia

A 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 a liquid, in which there is an excessive amount of estrogens.

This process is caused by a dysfunction of the glandular cells of the endometrium, which are not able to absorb an increased amount of hormones. As a result of this anomaly, unassigned estrogen is squeezed out by cells into the intercellular space.

The location of cysts with endometrial hyperplasia occurs within the functional layer of the uterus. The shape of the formed cysts can be dendritic or racemiform. It is possible to detect such small cysts only under a microscope with a histological examination of scraped tissues. When the fusion of several cavities occurs, pathological formations can be diagnosed by ultrasound.

Focal glandular hyperplasia of the endometrium

Since the endometrium is not distinguished by a homogeneous structure, glandular hyperplasia does not appear over its entire surface. First of all, hyperplastic processes are found in those areas of the endometrium, which are characterized by some thickening in the normal structure and functioning in the normal healthy condition of the inner layer of the uterus. Such processes characterize the formation of focal hyperplasia of the endometrium. In these places, the epithelial polyps are formed - proliferation of integumentary and glandular layers of the endometrium together with the tissues under them.

Focal glandular hyperplasia of the endometrium is characterized by the appearance of processes of cell proliferation in the region of the bottom and corners of the uterus. In these places the endometrial cells are subject to the greatest transformations. The other surface area of this organ can not undergo significant changes (or is much less frequent) due to the structure of the uterus.

Transformations affecting the surface of the endometrium outside the corners of the uterus and its bottom are referred to as simple focal glandular hyperplasia of the endometrium. The processes of hyperplasia occurring in the mucosa of the bottom and corners of the uterus are called the cystic form of focal glandular hyperplasia. Due to this, there are possible the appearance of the same or mixed forms of focal glandular hyperplasia.

The focal form of glandular hyperplasia is such a form of the disease, as a result of which the changed cells can be transformed into pathological ones and cause the appearance of oncological processes.

[5], [6]

Focal prostate glandular hyperplasia of the endometrium

Simple focal glandular hyperplasia of the endometrium occurs on the inner areas of the endometrium, which do not affect the uterine fundus and its angles. Another name for focal hyperplasia is local, since hyperplastic processes in this case do not affect the entire area of the inner 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 with affecting the underlying tissues.

At the heart of the formed polyps are immature overgrown endometrial cells, which are not rejected and not removed from the uterus with the help of bleeding. In the beginning they undergo a simple hyperplasia, and then on this place polyps are formed. The thickness of the endometrial tissue in this place can be increased to five to six centimeters.

Polyps are round or slightly elongated bodies that are attached to the leg. The basis of the polyp is fibrous and glandular cells. Polyp can be formed in the amount of one or several pieces. Sometimes focal forms of glandular hyperplasia occur, which consist of clusters of a large number of polyps.

Outside the polyps have a surface that is smooth in structure and pinkish in color. But sometimes there is ulceration of the polyp 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 into 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 enlarged sclerotized species.

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

[7], [8]

Active glandular hyperplasia of the endometrium

It happens that the glandular hyperplasia of the endometrium is asymptomatic. Such a course of the disease characterizes the passive (or resting) form of the disease - the processes of hyperplasia have a sluggish chronic form. It is associated with a small level of activity of the hormone estrogen of a long-lasting nature. At the same time, mitoses are quite rare, the nuclei and cytoplasm of gland cells are intensely colored.

The active form of endometrial hyperplasia has an acute course. With an active form of the disease, glandular hyperplasia of the endometrium is characterized by a set of brightly expressed symptoms. First of all, the presence of a certain symptomatology indicates that the pathological processes in the endometrium have begun for a long time. The emergence of dysfunctional bleeding, delay in menstruation, pain, prolonged bleeding with menstruation - all this indicates an active form of hyperplasia.

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

[9], [10], [11]

Atypical glandular hyperplasia of the endometrium

Atypical glandular hyperplasia of the endometrium is manifested in the appearance of adenomatosis - the restructuring of the cell structure and the appearance of a sufficiently strong proliferation, consisting in the reduction of stromal elements and polymorphism of the nuclei. The process of formation of adenomatosis characterizes the appearance of the focus of the altered mucous membrane of the uterus, in which cells with atypia of structure and functioning in small or strong degrees are observed.

The processes of adenomatosis develop either in the functional layer of the endometrium, or in its basal layer, or in both of these layers. In the latter variant, the degeneration of tissues into tumor tissues occurs more rapidly than in the two previous cases.

Atypical glandular hyperplasia of the endometrium is a precancerous condition, which often turns into malignant formations. Approximately ten percent of adenomatosis causes endometrial cancer.

The processes of adenomatosis can occur not only in hyperplastic tissue, but also in thinned and atrophic.

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, medium and heavy.

A low degree of adenomatosis is manifested by different gland sizes, which are separated by an epithelium of a multinucleate and a cylindrical species. Cell division also occurs with the help of thin streaks of the stroma.

With a moderate form of the disease, the shape of the gland changes. A severe form of adenomatosis is characterized by strong proliferation of glands and the formation of a close merger, with a complete lack of a streak between them. At this stage, there is a strong polymorphism of the multinucleated epithelium of glands.

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

Diffuse atypical hyperplasia of the endometrium differs from the focal one in that it appears uniformly on the entire surface of the endometrium of the uterus.

[12]

Glandular endometrial hyperplasia without atypia

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

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

With 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 the cell nuclei.

More about each of these forms of glandular hyperplasia of the endometrium was mentioned above in the relevant sections.

Glandular hyperplasia of proliferative type of endometrium

The glandular hyperplasia of the proliferative type of endometrium is another name for the process of pathological increase in the number of cells and their growth, which is termed "glandular hyperplasia of the endometrium". These two names are used in the diagnosis of gynecologists and pathologist specialists.

Proliferation is the process of proliferation of endometrial tissue, which occurs due to active cell division. When proliferating the endometrium, not only does the total number of cells increase, but their volume also grows due to pathological hormonal disorders in the body. This process can be characterized by two states:

• physiological - that is, to be within the norm;
• pathological - passing into the state of the disease.

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

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

If we proceed from this classification, hyperplasia of the proliferative type of endometrium should be called simple hyperplasia. For simple hyperplasia, active cell division is not characteristic. Endometrial tissue enlargement occurs by the proliferation of gland cells. Their structure changes - the glands become larger in size, their ducts strongly wriggle, there is an uneven arrangement of glands among the cells of the mucous membrane of the uterus. This does not increase the total number of glands.

There is also a process of displacement of the epithelial cells and stroma-vessels, nerves, connecting elements, etc. By the increased glands, and by virtue of this process, their total volume decreases.

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

Complex glandular hyperplasia of the endometrium

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

Complex glandular hyperplasia of the endometrium is of two types:

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

Atipia - the process of changing the structure of the glandular cells, under which the deformation of the structure of the nucleus of the cell occurs.

With complex hyperplasia without atypia of nuclei, the possibility of the appearance of uterine cancer against it is three percent of all cases of the disease. With complex hyperplasia with atypical nuclei, about twenty nine percent of cases of the disease provoke the appearance of uterine cancer.

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

1. Focal hyperplasia of the endometrium (local) - characterized by the appearance of foci of hyperplastic formations in some areas of the endometrium, up to six centimeters.
2. Polypous hyperplasia of the endometrium - characterized by the formation of polyps, ranging in size from 1 to 1.5 cm in some areas of the endometrium. They have a rounded shape and a spectrum of color - from pink to purple.
3. Atypical hyperplasia (adenomatous) is characterized by the presence of atypical cells - cells with a changed structure and refers to precancerous forms of diseases. There is atypical hyperplasia on the background of simple glandular or glandular-cystic hyperplasia of the endometrium.

[13], [14], [15]

Glandular-polypous endometrial hyperplasia

Glandular-polypous endometrial hyperplasia is a kind of complex endometrial hyperplasia that is characterized by the formation of polyps. Another name for this form of hyperplasia is focal glandular hyperplasia of the endometrium. Details of this form of endometrial hyperplasia were described above.

Fibrous-fibrous endometrial hyperplasia

The glandular fibrous hyperplasia of the endometrium is characterized by the formation of polyps from the glandular and fibrous endometrial tissue. 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 amount of glands. When a glandular fibrous form of endometrial hyperplasia occurs, a large number of glands of different shapes and lengths are observed, as well as a thickening of the sclerotized walls of blood vessels.

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

[16], [17]

Simple, typical glandular hyperplasia of the endometrium

A simple, typical glandular hyperplasia of the endometrium is one of the names of a simple glandular form of endometrial hyperplasia. Details of this form of the disease were described in the section "Simple glandular hyperplasia of the endometrium."

Mixed glandular glandular endometrial hyperplasia

Mixed glandular fibrillation of the endometrium is formed as a result of the appearance of several forms of hyperplasia at the same time. There is a simple glandular hyperplasia of the endometrium and a cystic form of glandular hyperplasia of the endometrium, which was described above. When on the epithelium of the uterus in some areas the glandular form of hyperplasia develops, and in the corners and the uterus's bottom - glandular-cystic, this is called the mixed form of glandular hyperplasia of the endometrium.

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

Glandular endometrial hyperplasia and pregnancy

Glandular endometrial hyperplasia and pregnancy are incompatible concepts. Eggs simply do not mature, so do not leave the ovaries. Such violations are a consequence of hormonal imbalance in the female body.

If, nevertheless, the maturation of the egg has occurred, and she left the ovaries, pregnancy can not develop. The fertilization process will occur, but the egg can not be implanted in pathologically altered endometrial tissue of the uterus for further development of the embryo and will be rejected by the body.

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

If the disease developed before the onset of the disease for a long period, there may be tumors of the uterus body that were not diagnosed before pregnancy. Such tumors grow at an accelerated pace in parallel with the fetus, and in severe malignant nature, the life of the child and mother is endangered.

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

Glandular endometrial hyperplasia 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 ripen and therefore does not leave the ovaries.

In addition, in pathologically altered endometrium, even a fertilized egg will not have the opportunity to gain a foothold and develop later. Therefore, in the beginning it is necessary to normalize the processes of functioning of the endometrium, and then to engage in reproductive procedures.

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

ECO - the method of conception or in vitro fertilization - the way of conception, which is carried out outside the female body. Synonyms for IVF - conception is the term "artificial insemination".

The procedure for applying artificial conception is as follows. From the woman's body an egg is extracted, which is placed in a test tube and artificially fertilized. The embryo that appears after fertilization is contained in the incubator, where it is given the opportunity to develop for two to five days. Then the grown embryo is placed in the womb of the woman's uterus for later development.

Diagnosis of glandular hyperplasia of the endometrium

Conducting diagnostic procedures is of great importance in the diagnosis of "glandular hyperplasia of the endometrium." Since the clinical picture of the 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 in the study of the patient's anamnesis and available complaints. The doctor-gynecologist should find out the questions connected with the beginning of occurrence of uterine bleeding, the duration of bleeding, the frequency of their appearance, the available accompanying symptoms in bleeding, and so on.
• Analysis of obstetric-gynecological data - general and gynecological diseases transferred; various operations; diseases that are sexually transmitted; past pregnancies and results from the permit; state of child's genitive functions, heredity; applied methods of contraception.
• Collection of data and analysis of the features of passing the menstrual cycle of the patient - the age of the onset of menstruation; duration and regularity of the cycle; the abundance of bleeding and painful menstruation and so on.
• The attending physician performs a gynecological examination of the patient with the help of a bimanual (two-hand) vaginal examination.
• The procedure for gynecological smear microscopy is used.
• The method of transvaginal ultrasound is used, which can determine the thickness of the endometrial layer of the uterus, as well as the presence of polyposic growths.
• Diagnosis with ultrasound examines the category of women who must undergo aspiration biopsy of the endometrium to confirm the diagnosis.
• The diagnosis can also be confirmed using a separate diagnostic curettage procedure. This method can be resorted to before the beginning of menstrual bleeding or immediately after their appearance with the help of hysteroscopy - examination of the walls of the uterus with a hysteroscope apparatus. The procedure of hysteroscopy helps to conduct a full curettage (scraping) and remove the pathologically altered endometrium in full.
• Endometric scrapings undergo a procedure of histological examination, during which a variety of hyperplasia is determined and a morphological diagnosis is established.
• The validity and informativeness of diagnostic hysteroscopy is 94.5 percent. The procedure of transvaginal ultrasound has a lower percentage of information - 68.6%.

Using the procedure of laparoscopy - the introduction of an optical device into the abdominal cavity through several small incisions in the anterior abdominal wall. In this case, the organs of the small pelvis and the abdominal cavity are examined, and if necessary, therapeutic procedures are performed.

• With the established diagnosis of "glandular hyperplasia of the endometrium," the patient undergoes a diagnostic procedure to study the level of hormones of progesterone and estrogens in the blood in the first and second phases of the menstrual cycle, as well as the number of hormones of the adrenals and thyroid gland.
• Sometimes, as a help in the diagnosis, hysterography and radioisotope scanning are used.
• The procedure for determining the level of oncomarkers in the blood - substances that show the presence of tumors in the body, such as CA 125, CA 15-3.

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

[18], [19], [20]

Treatment of glandular hyperplasia of the endometrium

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

Operative methods of treatment - removal of pathologically deformed parts of the mucous membrane of the body of the uterus with the help of:

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

Operative methods of treatment are used in the following cases:

• patients are in the age period when the reproductive functions of the body can still be carried out;
• in the period of premenopause;
• in serious emergency cases, in which there are abundant bleeding;
• with ultrasound results, which diagnosed the presence of polyps in the uterus.

The scraping results of 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 age of the patient and available co-morbidities, the attending physician prescribes methods of conservative therapy.

Conservative methods of treatment:

• hormonal therapy
  • reception of hormonal combined oral contraceptives (COCs) for medicinal purposes, namely drugs Regulon, Yarina, Zhanin, Logest, Marvelon. Taking medications is necessary to carry out within half a year, proceeding from their scheme of reception of contraceptives.
  • the intake of pure progestogen progesters (Dufaston, Utrozhestan), drugs that help reduce the production of sex hormones by the ovaries. These drugs can be taken to women of any age for three to six months from 16 to 25 days of the menstrual cycle.
  • the installation of the gestagen-containing intrauterine device "Mirena" is set for a period of five years and has a local effect on the endometrium of the uterus body. But the side effects of this method include the appearance of bleeding for three to six months from the installation of the spiral.
  • reception of gonadotropin agonists - hormone releasing - preparations of Buserelin and Zoladex. These are the most effective means of hormone therapy, which are usually prescribed to women after 35 years and during menopause. These drugs are taken from three to six months, which leads to a stable positive result in the treatment of the disease. Side effects of these drugs are considered the earliest occurrence of symptoms of menopause, namely hot flushes and excessive sweating.
• general restorative therapy
  • the intake of vitamin-mineral complexes, especially of vitamins C and Group B;
  • preparations containing iron to prevent anemia - Sorbifer, Maltofer and others.
  • sedative therapy - taking tinctures of motherwort and valerian.
  • Physiotherapeutic procedures - electrophoresis, acupuncture and so on.

The use of a therapeutic diet for overweight and obese patients to improve the effectiveness of therapy and improve the overall condition of the patient.

The appointment of regular measures of exercise therapy with mild degrees of exercise as general strengthening procedures.

Treatment of glandular hyperplasia of the endometrium with DuPaston

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

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

The initial phase of therapy takes place within three months, then the patient's condition is analyzed and a decision is taken to continue the course of treatment or to cancel the use of the drug.

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

Treatment of focal glandular hyperplasia of the endometrium

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

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

Samples of tissues during the operation are given for examination for the detection of atypical cells, which have a precancerous character.

If a large amount of atypically altered tissue is found, the uterus is to be removed, thereby preventing the appearance and spread of tumor processes in the patient's body.

• Medicamentous treatment of focal glandular hyperplasia of the endometrium is carried out after surgical treatment and is carried out by the administration of hormonal and progestogen preparations.

Usually, with this form of the disease, a longer course of treatment or other types of medications is prescribed than with a simple glandular and glandular-cystic form of hyperplasia. For example, 17-OPK medicament (a solution of 17-hydroxyprogesterone caprate) is used from progestogen preparations. And the drug Dufaston is appointed for a nine-month period of treatment in an amount of 5 mg per day.

Prophylaxis of glandular hyperplasia of the endometrium

Prophylaxis of glandular hyperplasia of the endometrium involves the following procedures:

1. Regular visit to a gynecologist (once every six months).
2. Competent carrying out of the period of pregnancy which includes passage of special courses on preparation for pregnancy and sorts.
3. The 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 full-fledged lifestyle aimed at maintaining health:
   • constant feasible training of physical activity;
   • transition to a healthy full-fledged diet, which includes avoiding fatty, smoked, salty, spicy, canned foods; dishes that were cooked with frying; reduction of sugar and flour products; inclusion in the daily diet of a large number of fresh vegetables, herbs, fruits and berries; the use of whole grain cereals and wholemeal bread in food and so on.
7. Continuous maintenance of personal hygiene.
8. When using hormonal drugs must strictly follow the scheme of their reception.
9. Eliminate abortion as a method of abortion. Instead, take care of sufficient methods of contraception.
10. Periodically pass the general diagnosis of the body - once a year. If abnormalities are detected in time, treat diseases of the thyroid gland, liver, adrenal glands. To monitor the level of glucose in the blood in the presence of diabetes, constantly monitor the level of pressure in the presence of hypertension.

After the procedures associated with the treatment of glandular hyperplasia of the endometrium, attention should be paid to the prevention of recurrence of the disease. In connection with this, the following are used:

• Periodic consultations with a gynecologist.
• Passage of examination from a gynecologist-endocrinologist.
• Consultation with specialists about the correct selection of contraceptives.
• The recommendations on healthy lifestyles presented above are also relevant.

Prognosis of glandular hyperplasia of the endometrium

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

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

Glandular endometrial hyperplasia has frequent cases of relapses. Therefore, patients need to undergo a regular examination of specialists and adhere to all the recommendations of the attending physician in order to prevent the occurrence of relapses of the disease. If, however, an exacerbation of glandular hyperplasia of the endometrium occurs, then specialists conduct therapy of the disease with the help of other drugs, or by increasing the doses used earlier.

The appearance of a simple glandular and glandular-cystic form of endometrial hyperplasia does not tend to turn into a malignant form, so it is not necessary for women to fear the onset of endometrial tumor processes.

Focal and atypical forms of glandular hyperplasia of the endometrium are considered precancerous states, as the slopes transform into malignant tumors. Therefore, in these cases, it is necessary to comply with all the recommendations of specialists regarding treatment and periodically undergo diagnostic procedures to identify the state of endometrial hyperplasia.

Glandular hyperplasia of the endometrium is a complex disease, which, nevertheless, lends itself to successful treatment in the early stages of its development. Therefore, when the first disturbing symptoms appear, it is necessary to contact specialists who will help to diagnose correctly and prescribe adequate therapy for the disease.