Why does the endometrium grow?
In a normal cycle, estrogens stimulate the growth of the endometrium in the first phase, and progesterone in the second phase stops this growth and prepares the mucous membrane for rejection. If there is no ovulation, progesterone is not produced, and the endometrium continues to grow under the continuous influence of estrogen.
Over time, the mucous membrane thickens, its structure is disrupted, and hyperplasia develops. From here the whole logic of risk factors becomes clear: anything that creates an excess of estrogen without a counterbalance of progesterone increases the likelihood of disease.
- Obesity - adipose tissue converts androgens into estrogens; one of the leading factors
- PCOS and chronic lack of ovulation
- Perimenopause with irregular cycles
- Taking estrogen without progesterone
- Taking tamoxifen
- Type 2 diabetes mellitus and arterial hypertension
- Ovarian tumors that produce estrogen
- Absence of childbirth and late onset of menopause
- Hereditary syndromes, including Lynch syndrome
Classification: main difference
- Hyperplasia without atypia - cells grow, but their structure remains normal; the risk of progression to cancer is low, the main method of treatment is hormonal therapy
- Atypical hyperplasia (endometrioid intraepithelial neoplasia) - cells are changed; this is a precancerous condition with a significant risk of developing into cancer, and often cancer is detected already during examination of the removed uterus
Symptoms
- Heavy and prolonged menstruation
- Bloody discharge between periods
- Bleeding after a long delay
- Irregular cycle
- Any bleeding or spotting after menopause
- Anemia: weakness, fatigue, shortness of breath
- Infertility due to lack of ovulation
- Sometimes - asymptomatic, detected by ultrasound
Diagnostics
- Transvaginal ultrasound measuring endometrial thickness is a screening method, but does not make a diagnosis
- Pipelle endometrial biopsy - outpatient sampling of material without anesthesia
- Hysteroscopy with targeted biopsy - the most accurate approach
- Diagnostic curettage of the uterine cavity with histology
- Histological examination is the only method for making a diagnosis and determining the presence of atypia
- Complete blood count and ferritin
- Glucose, glycated hemoglobin, lipid profile
- Ultrasound of the ovaries - exclusion of an estrogen-producing tumor
- Body Mass Index Estimation
It is worth emphasizing: “thickening of the endometrium” in the ultrasound conclusion is not yet a diagnosis of hyperplasia. Ultrasound only determines who needs a biopsy. It is incorrect to prescribe treatment based only on ultrasound data.
Treatment
- For hyperplasia without atypia: the intrauterine hormonal system is the first-line method with the greatest effectiveness
- Progesterone preparations in cyclic or continuous mode
- Control biopsy at the time specified by the doctor to confirm the response to treatment
- Losing body weight has a significant impact on the outcome and the risk of relapse
- Compensation for diabetes mellitus
- For atypical hyperplasia: hysterectomy is the standard for women who have completed reproductive plans
- Organ-sparing hormonal treatment for atypical hyperplasia is possible in young women planning pregnancy, but only under strict control with repeated biopsies
- Planning pregnancy, including with the help of IVF, after achieving remission
- Removal of polyps and treatment of concomitant pathologies
- Treatment of anemia
Observation and prevention of relapse
- Control endometrial biopsies according to the schedule established by the doctor
- Ultrasound in dynamics
- Maintenance hormonal therapy for relapse prone patients
- Reducing and maintaining body weight is the most effective preventive measure
- Ensuring regular endometrial shedding in the absence of ovulation
- Monitoring glucose and blood pressure
- Immediate treatment if bleeding resumes
- Screening for Lynch syndrome at an early age and family history
Where to get examined in Tashkent
Ultrasound, the ability to perform endometrial biopsy and hysteroscopy, as well as a high-quality histology laboratory are required.
In Tashkent, examination and treatment of endometrial hyperplasia, including hysteroscopy and surgical treatment for atypical forms, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you experience spotting after menopause - even one-time and scanty discharge - consult a doctor without delay. This is one symptom where early evaluation changes the outcome. Clinic contacts are below on the page.
