Endometrial hyperplasia in menopause

Menopause is a natural change in the functioning of the female reproductive system associated with the age-related hormonal changes in the body. A woman loses the ability to ovulate, conceive and bear pregnancy. During this period, care for health is especially important, because changes in the hormonal background lead to a decrease in the elasticity of the vessels and the occurrence of diseases with dangerous complications (strokes, heart attacks). Particular attention should be given to diagnosed pathologies that are related to the genitourinary area, since menopause is associated with a high risk of malignant neoplasm or hyperplastic age-related changes.

Endometrium (mucous layer) is an internal hormone-dependent mucous interlayer lining the body of the uterus. It facilitates the implantation of a fertilized egg into the uterus and the onset of pregnancy progression. From the vessels of the endometrium, the blood supply system of the placenta is formed. The mucous layer is subject to cyclic transformations during the period of the woman's ability to reproduce. The endometrium responds to hormonal changes in the body and, in the case of no pregnancy, is rejected, leading to the appearance of menstrual bleeding. The detachment occurs before the basal level of the endometrium. With the cessation of menstrual bloody discharge, the growth of the inner mucous layer of the uterus resumes from the basal cells. The cyclicity of the onset of menstruation continues throughout the period of the woman's ovulatory capacity or before the onset of pregnancy. After birth, the regularity of menstrual bleeding is restored and lasts until the onset of menopause.

Hyperplasia of the endometrium is a proliferation, thickening and thickening of the mucous tissue of the uterus body, preventing the normal functioning of the reproductive system. Pathologies affect women of any age. Especially dangerous is hyperplasia during the menopause, because the risk of malignant tumors in the uterus is significantly increased. The pathology of the endometrium is less dangerous for women in the reproductive phase. But ignore the diagnosed proliferation of the mucous uterus is not at any age.

A variety of endometrial overgrowth is adenomyosis. In the case of this pathology, the endometrium is able to germinate into the muscular and outer layers of the uterus. Gynecologists do not consider hyperplasia of the endometrium and adenomyosis synonyms or an absolutely identical pathology. These are different in nature of the process diagnoses, although they have many similar and common features.

[1], [2]

Causes of the endometrial hyperplasia in menopause

The main cause of the appearance of endometrial hyperplasia (GGE) is a failure in the hormonal equilibrium between estrogen and progesterone. A large number of estrogens with clearly reduced progesterone provokes GGE. This pathology can occur in women of any age group. In the reproductive age, the growth of the endometrium often leads to infertility.

Among the factors that provoke endometrial hyperplasia in menopause, gynecologists note heredity, transferred inflammatory processes of the reproductive system, abortion, the use of oral and intrauterine contraceptives, endocrine pathologies that cause changes in the hormonal background of the entire female body and the menstrual cycle, in particular.

[3]

Risk factors

The risk group for the diagnosis of endometrial hyperplasia includes women who have a history of:

• diabetes,
• obesity,
• hypertension complicated by hypertensive crises,
• tumor processes in the uterus,
• polyposis neoplasms in the reproductive system,
• disorders in the functioning of the liver and thyroid gland,
• inflammatory gynecological diseases,
• operative interventions on the reproductive organs.

[4], [5], [6], [7]

Pathogenesis

In the period of menopause, the height of the endometrium in the uterine cavity should not exceed 5 mm. Changes in the hormonal balance can cause pathological chaotic cell division, which leads to complex morphological transformations of the structural elements of the tissue. Proliferative processes increase the thickness of the endometrium and lead to an increase in the volume of the uterine body. The hormone-dependent tissue of the endometrium is sensitive to the level of estrogen in the body. Violation of the normal functioning of tissue units under the influence of hormones can cause benign complications, as well as serve as the basis for the emergence and development of malignant neoplasms. Estrogens can provoke uncontrolled division of endometrial cells. Estrogens have an internal origin - pathological processes in the ovaries, as well as external - inadequately selected hormonal agents or a therapy regimen. Normally, if there are no hormonal disorders, progesterone in the second phase of the cycle has an estrogen-damping effect and protects the endometrium from pathological proliferation. Hyperplasia of the tissue of the inner layer of the uterine body is facilitated by the conditions of prolonged exposure to estrogen hormones. If there is no protective effect of progesterone (for all conditions, when there are many estrogens and little progesterone). For the development of endometrial hyperplasia, the duration and dose of estrogen is important.

Such violations occur when:

• ovarian dysfunction, especially before the onset of menopause;
• polycystic ovary syndrome (PCOS);
• hormonally active ovarian tumors;
• obesity.

The probability of GGE disease is high among obese women after 50 years of age who have high blood pressure or who suffer from diabetes.

Estrogens that promote the formation of endometrial hyperplasia are generated directly by the ovaries or excess fatty tissue in obesity. Lipid tissue has the ability to produce estrogens.

A particular cause of endometrial hyperplasia is the generation of large amounts of estrogen hormones in the ovary, when there is a hormone-active tumor. Such a process can provoke the emergence of the most dangerous atypical type of disease, which over time, without timely adequate treatment, turns into malignant neoplasms of the uterus.

[8],

Symptoms of the endometrial hyperplasia in menopause

In the period of menopause, endometrial hyperplasia can pass asymptomatically.

The main symptoms of endometrial hyperplasia in menopause are - proliferation of the endometrium more than 5 mm in height and an increase in the body of the uterus. During menopause, any uterine bleeding or spotting from the vagina, regardless of their volume (abundant or meager), duration and frequency should be perceived as an alarm and a possible symptom of a malignant process.

Common comorbid symptoms include rapid fatigue, weakness, lethargy, frequent headaches, hypertension, disability. When the process is maligned, a sharp decrease in weight is possible.

[9],

Forms

Diagnosed endometrial hyperplasia is classified by the nature and type of morphology of the growth:

The glandular form is a common benign pathology of the endometrium, a characteristic feature of which is the excessive progression of the growth of glandulocytes (glandular cells). As a result of pathological division of structural elements of the endometrial tissue thickens. Tubular glands of straight lines turn into sinuous, but their secret is freely allocated. The glandular form of proliferation of the endometrial layer is considered the least dangerous - malignancy occurs only in 2-4% of cases.

The glandular- cystic form is a more serious pathology in which not only an increase in the growth of glandulocytes is observed, but also the appearance of cystic formations in the inner layer of the uterine body. Cysts appear as a consequence of the impossibility of free evacuation of the secret of glandular cells. The revealed glandular-cystic form of endometrial hyperplasia in 7% of cases is prone to degeneration into malignant neoplasms.

The atypical form (adenomatosis) is diffuse or focal. The most dangerous hyperplastic condition of the endometrium. Malignancy of this form of endometrial hyperplasia in childbearing age is 10% of cases, and in the period of premenopause, menopause and postmenopause reaches 50%. Treatment of pathology is immediate and mostly surgical.

One type of endometrial hyperplasia, classified according to localization and limitation of the pathological process, is focal extensions of the inner layer of the uterus - polyps. They are distinguished by morphology - glandular, fibrous and glandular fibrous. Treatment is surgical. The forecast is favorable. The percentage of malignancy is low. But the presence of endometrial polyps provokes favorable conditions for the development of oncoprocess.

Any form of hyperplastic endometrial pathology in menopause requires close attention, since each of the described proliferative conditions of the endometrium can lead to the provocation of a serious oncological disease.

[10], [11], [12], [13]

Complications and consequences

The appearance of endometrial hyperplasia in menopause has a large number of negative sides. First and foremost, immunity decreases with age, which means that it is more difficult for the body to provide effective protection against all sorts of diseases. Previously transferred operations and illnesses affect the patient's health. Hyperplasia of the endometrium proceeds for a long time without any symptoms, and the consequences of adenomatosis during the menopause may be its transformation into a malignant tumor. Regular examination at the gynecologist and ultrasound diagnostics allow timely detection of pathology, which significantly reduces the risk of development of oncological complications.

Complications arising from endometrial hyperplasia in the menopausal period:

• recurrent course (despite competent therapy, the disease has the property of recurrence);
• problems with the genitourinary system (neoplasms can squeeze adjacent organs, resulting in acute urinary retention and disruption of its normal outflow);
• risk of malignization of the process of hyperplastic state of endometrial tissue;
• anemic conditions (uterine bleeding can be quite abundant, resulting in a significant decrease in hemoglobin in the bloodstream).

[14], [15]

Diagnostics of the endometrial hyperplasia in menopause

To prevent the progression of endometrial hyperplasia in menopause, it is necessary to undergo a preventive checkup twice a year with a gynecologist.

At the scheduled visit to the doctor, a detailed history (patient complaints, anamnesis of life, gynecological anamnesis), assessment of the general health condition, examination of the patient on the gynecological chair, ultrasound of the pelvic organs, smears for the presence of atypical cells. Bacteriological or bacterioscopic studies, a general blood test, hormonal background research may be prescribed. If necessary, hysteroscopy is performed.

[16], [17], [18]

Analyzes

For the precise diagnosis and the appointment of adequate therapy, the following studies are carried out:

• General blood analysis.
• General urine analysis.
• Diagnosis of smear for the presence of urogenital infections transmitted sexually.
• Smear test for the presence of atypical cells.
• Diagnostic biopsy.
• Hysteroscopy and separate diagnostic curettage. These procedures are quite complex and traumatic. Simultaneously play the role of research and treatment.
• Examination of the hormonal background of the body by blood. Usually, the levels of FSH, LH, estradiol, testosterone, progesterone, prolactin, adrenal hormones and thyroid gland are determined. It is used to examine the level of hormones and if there is a suspicion of metabolic syndrome or polycystic ovary syndrome.

[19], [20], [21], [22], [23]

Instrumental diagnostics

With instrumental diagnosis of endometrial hyperplasia in menopause, hysteroscopy, curettage, and aspiration biopsy can be prescribed.

Hysteroscopy with diagnostic curettage is a complex procedure carried out with the help of special optical equipment - a hysteroscope. It is used with diagnostic and therapeutic (surgical) purposes. It allows visual inspection of the inner walls of the uterine cavity to reveal common and focal pathological processes. Scraping is carried out to clarify the diagnosis. The obtained material is examined in the laboratory with obligatory histological diagnosis. Hysteroscopy refers to simple surgical interventions and is performed under general anesthesia.

Curettage and histological diagnosis of the tissues obtained is the main method for determining the morphological type of endometrial hyperplasia. Curettage is an instrumental extension of the cervix, and further diagnostic curettage makes it possible to distinguish between hyperplasia and malignant neoplasms in the uterine cavity. A scraping procedure is performed under one of the types of anesthesia - local, epidural or general. The decision concerning anesthesia during the curettage and curettage is made by the doctor, taking into account all contraindications and possible complications.

Aspiration biopsy of the endometrium (pipe-diagnosis) is performed with the help of the aspirator "Pipel". The method is based on pulling the endometrial tissue site by the apparatus. This type of research is widely used in the diagnosis of endometrial hyperplasia and maloinformative in the presence of focal pathological processes. The tissue obtained by aspiration is examined under laboratory conditions. The method has a number of significant advantages: it is performed on an outpatient basis, minimally invasive and practically painless (all depends on the individual pain threshold).

These diagnostic methods during menopause are used to confirm or refute the diagnosis associated with pathological processes in the endometrium.

US-diagnostics helps to determine the height and echostructure of the endometrium, the presence and exact location of cystic formations.

Transvaginal echography helps to diagnose thickening of the uterine walls, heterogeneous tissue structures.

Mammography - X-ray examination of mammary glands to exclude proliferative processes. It is prescribed by a gynecologist in combination with other diagnostic procedures.

In ambiguous situations, magnetic resonance imaging can be assigned .

Very rarely a study using radioactive phosphorus is used.

Differential diagnosis

For differential diagnosis, the doctor should be convinced of the absence of common systemic diseases, the symptomatic complex that is accompanied by uterine bleeding: hematologic diseases, liver, thyroid, and adrenal pathologies. It is necessary to exclude organic lesions of the ovaries - hormone-active neoplasms (tecoma, hormone-producing granulosa cell tumors of the ovaries, fibroma, Brenner's tumor). In the elderly, it is necessary to differentiate endometrial hyperplasia from malignant lesions of the uterus, hormone-producing ovarian tumor, uterine myoma.

Treatment of the endometrial hyperplasia in menopause

Therapeutic tactics in HPE depends on the diagnosed pathology of the endometrium, the age of the patient, the etiology and pathogenesis of the disease, the concomitant gynecological and extragenital pathology.

Treatment for endometrial hyperplasia can be carried out in several ways.

Medications used for conservative treatment of endometrial hyperplasia in menopause are hormone-containing drugs.

Progesterone (female sex hormone, which is produced in the second half of the menstrual cycle) has a restraining effect on the growth of the endometrium. Due to this, preparations containing a substance like progesterone (progestins or gestagens) are the main method of drug therapy for hyperplasia of the uterine body. The spectrum of modern hormonal drugs for the treatment of proliferative conditions of the endometrium contains the necessary doses of hormones and prevents the malignancy of pathological processes in the uterus.

Progestins (medroxyprogesterone acetate, levonorgestrel, megestrol acetate) have a positive effect and lead to the complete disappearance of hyperplasia in the vast majority of women within 3-6 months of treatment.

There is no single regimen for treating gestagens at the moment. Based on the diagnostic conclusion about the type of proliferative growth of the endometrioid tissue, the doctor (gynecologist-endocrinologist) appoints a hormonal drug, determines the dosage and duration of the course of therapy, taking into account the individual characteristics of the patient (the age of the woman, her weight, concomitant diseases, side effects of the drug, the cost of treatment, ).

Hormonal drugs are prescribed exclusively by the doctor strictly according to the indications. The specialist takes into account possible risks and contraindications associated with taking hormonal drugs. Consideration is given to the presence of chronic systemic diseases (rheumatism, thrombophlebitis, hypertension, diabetes mellitus, biliary tract and liver diseases), bad habits (smoking) and the systematic intake of alcohol. The presence of these pathologies significantly increases the possibility of developing side effects. Prior to therapy and during treatment, the state of the immune and vascular systems, endocrine glands, and liver should be monitored. Scheduled blood tests (coagulogram, general blood test) and urine are prescribed.

Surgery

When ineffective conservative therapy for the treatment of endometrial hyperplasia and a high risk of malignancy of the process, radical surgical methods are used.

Removal of endometrial sites (functional and basal layers) using a resectoscope. This method is considered by doctors to be controversial, since after its application there is no persistent remission and relapses of the disease are not uncommon. It is contraindicated in the presence of atypical cells and the danger of malignization of the process.

Surgical removal of the uterus (with or without ovaries).

Indications for surgical treatment:

• inefficiency of conservative treatment of hyperplastic proliferation of endometrial tissue;
• repeated cases of hyperplasia;
• contraindications to hormone treatment,
• atypical hyperplasia.

In those cases when the histological examination of the morphology of tissue samples obtained during curettage shows a high risk of developing a malignant process in the uterus (the presence of atypia), it is recommended that the uterus be surgically extirpated. Only such an operation can protect a woman from the development of malignant neoplasms of the uterus in the future.

Alternative treatment

Nowadays, there are no really effective alternative methods or recipes for the treatment of hyperplasia. In this regard, the use of alternative methods of treatment of endometrial tissue pathologies is permissible only in combination or after the main treatment. The use of alternative medicine must be agreed with the attending physician.

The vast majority of the currently known alternative methods of treating endometrial hyperplasia include performing vaginal douching or inserting tampons moistened with medicinal infusions into the vagina. It should be noted that alternative methods can aggravate a woman's condition, lead to a loss of time to start effective treatment and provoke the development of dangerous complications.

Although traditional medicine also denies the positive effect of treating hyperplasia with alternative methods, but there are isolated cases of complete recovery.

[24], [25], [26], [27]

Herbal Treatment

Specialists-herbalists in the treatment of endometrial hyperplasia in menopause suggest using both individual plants and herbal preparations. Many plants contain so-called phytohormones, which are able to normalize and stabilize the hormonal background in women during menopause. Here are a few recipes:

Decoction of an ortilia lopsided (boron uterus). To prepare this product 1 tbsp. Spoon the plant with pour boiling water in the amount of 0.5 liters and hold in a water bath for a quarter of an hour. Then cool and cool the broth. Take before meals for 3 times. Similarly, a decoction of the herb of the saber is prepared, which must be eaten after eating.

Tincture of the leaves of the ortilia one-sided. To prepare, you need a dried plant, which must be placed in a hermetically sealed container of dark glass. Pour 0.5 liters of alcohol (40%), vodka or cognac. After this, leave the remedy for 2 weeks in a dark place, shaking daily. Drink the medicine three times a day for 1 tsp, with water. The course of therapy is three months.

Treatment of the hyperplastic state of the endometrium should be complex, so several medicines should be taken simultaneously. Alternative medicine claims that this treatment complex will help to cope with this dangerous disease.

The course and therapy scheme is designed for sixteen weeks:

• The first four weeks must be taken freshly squeezed beetroot and carrot juice (50-100 ml per day), before eating twice a day, take a tablespoon of linseed oil, drinking it with cool water. Twice a month, alternative medics recommend syringing with celandine infusion (30 g of raw materials per 3 liters of boiling water).
• You should prepare medicinal tincture (applied from the fifth week of treatment), consisting of: aloe juice (400 g), flower honey (400 g) and red wine - cahors (0.7 l). All the ingredients are thoroughly mixed and leave the mixture infused for two weeks.
• At the fifth week of treatment, the tincture of cahors and aloe juice is added to all previous procedures. Continue treatment until the end of treatment.

Homeopathy

Treatment of hyperplastic conditions of the endometrium with homeopathic preparations has a number of advantages: there are no side effects, complications, allergic reactions and contraindications. Homeopathic treatment of endometrial pathology had positive results.

The main emphasis in selecting a homeopathic drug in the treatment of hyperplasia should be directed to restoring the hormonal background, stabilizing the nervous system and improving the functioning of the liver. According to homeopathic doctors, the failure in the work of these organs and systems is the most common cause of the appearance of endometrial hyperplasia in menopause.

The most popular homeopathic preparations in the treatment of hyperplastic states of the endometrium are:

• Kalium carbonicum;
• Acidum nitrikum;
• Genicocheel.

Many homeopathic preparations are available in the form of granules or solutions. The standard scheme of treatment - 10 drops, dissolved in 30 ml of water, 3 times a day inside. The duration of therapy is 2-3 weeks. If the product is released in granules, then 6-10 granules sublingually twice a day.

The spectrum of homeopathic preparations is huge, it is impossible to make the right choice on your own. Great importance is given to the dosages of the drugs in each individual case. Therefore, the correct solution is the selection of a homoeopathic preparation from a homeopathic doctor.

Prevention

Knowing what endometrial hyperplasia is dangerous in menopause, you can make a plan for preventive measures, since the pathological process can be asymptomatic. The only way to identify endometrial hyperplasia is a systematic systematic examination by a gynecologist (twice a year). Annually it is necessary to conduct ultrasound examination of the pelvic organs. During the visit to the gynecologist, you should ask without hesitation any questions of interest. Sometimes, during a conversation, the presence of abnormalities is detected.

It is recommended to monitor the weight, maintain a healthy and active lifestyle, choose the right diet and do not hesitate to visit the doctor if there are inflammatory pathologies of the genitals. Adequately selected by the specialist hormonal therapy will help stabilize the general condition in a difficult period of menopause.

[28], [29],

Forecast

The prognosis for diagnosed endometrial hyperplasia in menopause depends on the condition and structural morphology of the endometrioid tissue.

The danger of malignization of the hyperplastic state of the endometrium depends on the histological picture of the inner shell of the uterus and is: for a simple GE, 1-3%; with a complex (adenomatous) GE - 3-10%; with a simple atypical ET, 10-20%; with a complex atypical ET, 22-57%.

Unfortunately, no one is immune from cancer. Modern equipment and progressive diagnostic methods help to determine the pathology of the endometrium at the earliest stages of development. Timely access to a doctor and the appointment of competent adequate comprehensive treatment contribute to the rapid recovery of patients with an initial stage of proliferation of the endometrium.

[30], [31], [32], [33], [34]