Endometrial focal hyperplasia

Focal hyperplasia of the endometrium is a limited thickening of the uterine layer, which lining its internal surface.

In the case, when the number of endometrial cells is increased, one should speak of a simple focal form, which is often referred to as background pathology. If the pathology is complex, then the appearance of certain structures that are not inherent in the physiological structure of the endometrium is characteristic of it.

With the growth of the cellular composition, it is common to distinguish between glandular hyperplasia, when there is an increase in the number of glandular cells, glandular-cystic cells with an additional formation of cystic formations, and also atypical, which is a precursor of cancer pathology.

The most common pathology is the fibrous type and fibrocystic cystic with the appearance of polyposic structures. The risk of malignant degeneration in this case is at a low level.

There is a possibility of complications in the absence of necessary treatment. Thus, with an atypical form, there is a high risk of malignization of the pathological process. Quite often it is possible to diagnose relapses of the disease. In addition, this pathology is the cause of infertility and a chronic form of anemia.

[1], [2]

Causes of focal endometrial hyperplasia

An increase in the number of endometrial cells can occur at different ages, but there has been a trend towards increased incidence in the transition period of life, for example, at pubertal age during the development of the menstrual cycle or in menopause. The main reason for the beginning of the multiplication of cells is hormonal fluctuations in the body in these periods.

Especially worth paying attention to the level of estrogens, because it is their increased amount leads to imbalance of hormones, while progesterone remains in short supply.

The causes of focal hyperplasia of the endometrium also suggest the presence of concomitant pathology outside the reproductive system. For example, the pathology of the endocrine system with the development of diabetes, heart and blood vessels against a background of increased blood pressure, a metabolic disorder manifested by obesity, an imbalance of thyroid hormones, adrenal and breast diseases.

It is not difficult to guess that all of the above diseases directly or indirectly affect the hormonal background of the body, which, as already mentioned, is the main cause of hyperplasia.

With regard to the genitals, here the causes of focal hyperplasia of the endometrium are the presence of inflammatory processes of chronic form, adenomyosis, uterine fibroids and polycystic ovary syndrome. Again, it is not difficult to guess that these pathologies affect the hormonal state of a woman.

In addition, hereditary predisposition, or focal enlargement of the endometrium, or to the aforementioned concomitant diseases, increases the risk of developing pathology. In both cases, there is a hormonal imbalance.

And, finally, we can not help remembering frequent abortions, diagnostic curettage and late pregnancies. And in these cases, the risk of fluctuations in the level of hormones is very high.

[3]

Signs of focal endometrial hyperplasia

Despite a kind of pathology, there is one symptom that is characteristic for each of its forms - it is the blood allocation outside the menstrual cycle. A distinctive feature of this feature is a small amount of allocated blood, sometimes spotting discharges.

This is typical for menopause, but for the pubertal period there are more abundant bleeding with the presence of clots. As a result, a decrease in the level of erythrocytes and hemoglobin in the girl's blood is observed - this is how chronic anemia develops in the absence of a sufficient therapeutic complex.

Signs of focal hyperplasia of the endometrium are infertility, since a woman can not become pregnant due to the absence of ovulation in her menstrual cycle. This is due to an excessive amount of estrogens in the blood. In some cases, pathology can have absolutely no clinical manifestations, so the inability to become pregnant is a reason for visiting a doctor and further examination.

With hyperplasia, menstruation is characterized by strong secretions, not counting that a small amount of blood is also released outside the cycle. In the aggregate, a girl can feel weak, dizzy, and the skin becomes pale.

In the anovulatory cycle, the most common is glandular-cystic hyperplasia, which develops due to the processes of dystrophy and death of the cells of the uterine layer.

Focal glandular hyperplasia of the endometrium

Depending on the structural changes in the inner uterine layer, it is customary to distinguish certain species. Thus, focal glandular hyperplasia of the endometrium is a local multiplication of cells of the glandular tissue, when a thickening of the endometrium is noted on this site.

The background disease for the development of pathology can be endocrine, vascular pathology, as a result of which hormonal disorders occur. Increasing the level of estrogen and reducing progesterone stimulate the growth of glandular tissue.

In addition, the diseases of the reproductive system (myoma, genital endometriosis, inflammatory processes) also participate in endometrial hyperplasia.

Focal glandular hyperplasia of the endometrium is most often found when a gynecologist's woman visits a pregnancy. However, it is possible to change the cycle of menstruation as a result of the formation of endometrial polyps, fibroids or endometriosis.

Possible delays in the onset of menstruation with subsequent heavy bleeding, resulting in a woman loses blood red blood cells, which leads to the development of anemia. Manifestations of it are dizziness, pallor, weakness and deterioration of appetite.

Therapeutic tactics means the use of medicines with a substitute purpose. In addition to oral hormonal agents, injections, plasters and intrauterine devices are often used.

In the absence of a therapeutic effect, surgical intervention should be performed when removal of the affected endometrium is performed. In severe cases, it is possible to eradicate (remove) the uterus. After surgical treatment, additional hormonal drugs can be prescribed in a low dose.

[4]

Simple endometrial focal hyperplasia

Based on the presence of a large number of cells or additional structures in the endometrium, a simple focal endometrial hyperplasia and a complex one are isolated. It is the simple form that is most favorable in view of the presence of only a large cellular composition and the absence of atypia.

It refers to the background pathology, since it is characterized by an insignificant risk of malignancy. In turn, simple hyperplasia can be glandular or cystic. The diagnosis is made after the detection of cystic lesions or proliferation of glandular tissue.

In view of the fact that this pathology has a hormonal genesis, the treatment of pathology should also be aimed at regulating the hormonal ratio and normalizing the qualitative and quantitative cellular composition of the endometrium.

To do this, you can use hormonal drugs tableted form. It must be remembered that the dosage, the frequency of reception and the duration of the therapeutic course should be determined exclusively by the doctor. In the case of improper selection of a dose of a hormonal drug, it is possible not only the absence of a positive effect on hyperplasia, but the progress of concomitant pathology and the occurrence of adverse reactions.

In addition to the tablet preparations, injectable hormones, shepherds or a spiral, which can be inserted intrauterine, can be used. Sometimes a combined treatment is required. It consists in the appointment of hormonal drugs after surgical removal of the hyperplasia of the endometrium.

Focal basal endometrial hyperplasia

This form of pathology is noted rarely. It is characterized by an increase in the thickness of the endometrium, in particular the basal layer, as the glandular tissue grows. Pathological multiplication of cells occurs in a compact layer in parallel with stromal hyperplasia, as a result of which polymorphic nuclei of large stromal cells arise.

Focal basal endometrial hyperplasia is recorded mainly after 35 years, differing in the limited growth of cells. The basal layer, which undergoes hyperplasia, has blood vessels arranged in the form of a coil. Their walls are changed by sclerotic processes, as a result of which an increase in their thickness is noted.

The explanation of prolonged menstruation with severe bleeding and pain is the delayed rejection of the basal layer, which undergoes hyperplasia.

When conducting the examination and confirming the diagnosis, it is recommended to perform diagnostic curettage on the 6-7 day from the beginning of menstruation.

This species is not considered a precancerous process, since the risk of degeneration into a malignant form is minimal.

[5]

Focal atypical endometrial hyperplasia

In comparison with other forms of pathology, focal atypical endometrial hyperplasia is considered the most dangerous, since it has the greatest risk of malignant transformation. Endometrial cells lose their physiological structure and acquire a new characteristic.

In some cases, the cells are so different that they stand out clearly against the background of healthy ones. The degeneration of the cellular composition may be of a malignant nature, which requires a special therapeutic approach.

Focal atypical endometrial hyperplasia usually turns into a malignant form in women after 45 years, because the defenses of the body weaken and the treatment does not have a positive effect than expected. At the same time, at a young age, the incidence of malignancy of the atypical type of pathology is practically not noted.

In addition, at an older age hormone therapy used to stabilize hormone levels is not always effective, suggesting the use of a surgical method of treatment.

In view of the fact that the endometrium consists of 2 layers, pathological changes in the cells can be noted in both the functional and basal layers. The former is capable of rejecting during menstruation and gradually recovering under the influence of estrogens, so it is more susceptible to hyperplastic processes.

As for the basal layer, the appearance of atypia in its cells indicates a cancer process. Most often, atypical cells arise as a result of imbalance of hormones, as well as other related diseases, which become the starting point for the beginning of transformation.

[6], [7]

Focal iron-cystic endometrial hyperplasia

Hormonal disorders can serve as a background process or the main cause of the appearance of glandular-cystic hyperplasia. Insufficient amount of progesterone and, conversely, excess estrogen stimulate the thickening of the uterine layer due to the growth of the glandular tissue with the formation of cystic formations.

Hormonal fluctuations are possible at different ages, but most of the reported cases occur in the pubertal period and menopause.

Focal iron-cystic hyperplasia of the endometrium at a young age can be a consequence of frequent abortions, late pregnancy and prolonged intake of oral contraceptives.

In addition, disorders in the endocrine system, for example, dysfunction of the thyroid, pancreas, adrenal and metabolic processes also provoke the development of pathology in the endometrium.

Do not forget that surgical intervention in the uterine cavity has a direct traumatic effect on its layers, which in the presence of background diseases is threatened by the appearance of uncontrolled multiplication of cells.

Clinical symptoms are manifested in the form of changes in the menstrual cycle with the appearance of bloody discharge between menstruation. In addition, there are strong and long-lasting discharges, as a result of which a woman feels weak, worsened appetite, and the skin pale.

Another manifestation is infertility, resulting from the absence of ovulation.

[8], [9], [10], [11], [12]

Focal endometrial hyperplasia and pregnancy

Relying on statistical data, focal endometrial hyperplasia and pregnancy can not exist at the same time. Exceptions can be noted only in the focal form of pathology.

This pathology is one of the causative factors of infertility, which causes a woman to turn to a gynecologist. The menstrual cycle does not have ovulation, so the chances of getting pregnant are extremely low. However, in some cases nevertheless fertilization of the ovum and attachment to the wall of the uterus is possible.

As a consequence, the risk of developing spontaneous abortion in the early term is increased. With hyperplasia, the process of bearing a fetus can have a number of pathological processes, including for the future baby.

As for the pregnant woman, in this period the risk of malignancy increases, because hormonal reorganization is again observed, which has a direct effect on hyperplasia.

However, in some cases, on the contrary, there is regression of hyperplasia under the influence of progesterone, which was not enough, and in pregnancy its amount increases.

If a woman does not plan a pregnancy yet, but she has hyperplasia of the endometrium, the treatment is to take hormonal contraception. In the case when a woman wants to have children, but because of illness, pregnancy does not occur, treatment is carried out both in this pathology and infertility.

[13], [14], [15]

Diagnosis of endometrial focal hyperplasia

When visiting a gynecologist, the first thing to do is to disassemble the patient's complaints and conduct an objective examination. Thus, you can learn about the cycle of menstruation, the amount of blood allocated, pain and the presence of intermenstrual secretions.

In addition, the appearance of the pale skin can be seen, and with palpation of the mammary glands - fibroadenoma or other formations that will indicate hormonal disorders.

Diagnosis of endometrial focal hyperplasia consists in a gynecological examination, in which the walls of the vagina, the uterus, their consistence, color and the presence of additional formations are inspected.

With the help of ultrasound it is possible to determine the thickening of the endometrium and polyps in the form of oval formations. This method refers to screening, since only the thickness of the endometrium is recorded without visualization of the cellular composition.

Hysteroscopy is carried out with the help of a special device that allows you to examine the uterine cavity. After separate diagnostic curettage, scraping is subjected to a histological analysis to determine the form of the pathology.

Scraping must be done, pre-planned for the period before menstruation. This method simultaneously perform two functions: first, it leads the diagnosis and confirms the diagnosis, and secondly, is simultaneously considered a medical manipulation.

Ultrasound with a vaginal sensor has about 70% of information, while hysteroscopy is almost 95%. Another diagnostic method is aspiration biopsy, when a small portion of the endometrium is taken and a histological examination is performed.

And, finally, to determine the causative factor of the appearance of hyperplasia, it is necessary to determine the level of hormones in the blood, which in most cases confirms the hormonal nature of the pathology.

[16], [17], [18], [19]

Treatment of endometrial focal hyperplasia

Regardless of the age of the patient, treatment of endometrial focal hyperplasia should be carried out in full to avoid the development of complications and deterioration of health status.

In the process of hysteroscopy, not only the diagnosis of the disease is carried out, but also the treatment. The operative method is used in the reproductive age, the period before menopause and in emergency cases, when there is a large bleeding or the presence of polyposic lesions.

Scraping is carried out under the control of a hysteroscope. During the operation, removal of the endometrial hyperplasia is performed. Polypous lesions are removed by forceps or special scissors, this is called polypectomy.

After the surgical intervention, the remote material is sent for histological examination, according to the results of which hormonal therapy is subsequently prescribed. Its goal is to restore the balance of hormones and prevent the appearance of hyperplasia in other areas of the endometrium.

Exceptions are fibrotic polyps, which do not require the use of hormonal drugs. The remaining forms need these facilities. Widely used oral contraceptives, for example, Yanina or Janine.

With massive bleeding in adolescents, large doses of hormones are used to avoid scraping. Also with a therapeutic purpose, gestagens, such as Utrozhestan or Dufaston, are used. The duration of the therapeutic course is from 3 to 6 months.

In addition to the tablet form, there is a gestagen-containing spiral "Mirena", which is installed inside the uterus. Its difference is the local effect on hyperplasia, which more successfully and to a lesser extent affects the overall hormonal background than oral medications.

It is also necessary to note a group of gonadotropin releasing hormone agonists, for example, Buserelin or Zoladex, which are used after the age of 35 and menopause for up to six months. In addition to pathogenetic therapy should take vitamin complexes and especially the drugs of the gland for the treatment of anemia. In some cases, physiotherapy and acupuncture are prescribed.

Prevention of focal endometrial hyperplasia

To avoid the development of a pathological process, some recommendations should be followed. They will help reduce the likelihood of atypia and cell proliferation.

Prevention of focal hyperplasia of the endometrium is a regular examination of the gynecologist, at least 2 times a year. This will not only prevent the progression of pathology in the event of its presence, but also start treatment in time, which increases the chances of recovery.

In addition, abortion should be avoided, since frequent traumatization of the endothelium may cause activation of the pathological process. It is necessary to use protective equipment during sexual intercourse to prevent or reduce the likelihood of unwanted pregnancy and abortion, respectively.

It is necessary to control the activity of chronic inflammation of the genital organs and to try to carry out the necessary treatment in order to avoid provoking its progression and the appearance of complications.

Since concomitant pathology also has an impact on the development of pathology by means of hormonal background, it is therefore necessary to carry out their full treatment and further prevent relapse.

Moderate physical activity and a minimum amount of stressful situations also contribute to normalizing the hormonal ratio and preventing the appearance of hyperplasia.

Forecast

Depending on the form of manifestation of the pathological process, it is necessary to differentiate the prognosis for life. The most dangerous is considered atypical hyperplasia, as they are characterized by the appearance of altered cells, which possibly means transformation into a malignant species. In view of this, early diagnosis of atypical form and treatment can reduce the risk of malignancy.

The prognosis of focal hyperplasia of the endometrium in the presence of the glandular-cystic component is relatively unfavorable. The threat to life does not represent such a form, but it worsens the standard of living. This is due to the lack of ovulation in the menstrual cycle, which in turn significantly reduces the chances of becoming pregnant.

In most cases, it is infertility that is the reason for a woman's treatment of a gynecologist. If the cystic formations are not removed in time, there is a possibility of their degeneration into malignant tumors.

The prognosis also depends on the concomitant pathology, because hypertensive disease reduces the chances of recovery, since the treatment will not provide the desired result in full. This is especially true of diseases that affect the hormonal background, for example, dysfunction of the thyroid gland, adrenal glands and ovaries.

Focal hyperplasia of the endometrium is not an occasion for disorders, because modern medical methods allow you to monitor the pathological process and gradually contribute to its regression. To avoid the appearance of this pathology, you should follow these recommendations, and in case of detection of the disease with gynecological examination - as soon as possible to begin treatment.

[20], [21], [22]