Endometrial hyperplasia: why curettage
Hyperplasia - excessive growth of the endometrium under the influence of estrogens without a counterbalance of progesterone (anovulation, PCOS, obesity, menopause) - is manifested by heavy and prolonged bleeding and, with atypia, can develop into cancer. Ultrasound shows thickening, but the type of hyperplasia is determined only by the histology of the entire endometrium, so curettage (preferably under the control of hysteroscopy) remains the diagnostic standard. Based on the results, hormonal therapy (gestagens, IUD with levonorgestrel) is prescribed with a control biopsy after 3–6 months; in case of atypical hyperplasia, the issue of removing the uterus or preserving treatment for those wishing to give birth is decided.
Indications
- endometrial hyperplasia, polyps, abnormal uterine bleeding, bleeding during menopause - diagnosis and stop of bleeding;
- non-developing (frozen) pregnancy, incomplete miscarriage, remnants of the fertilized egg;
- suspicion of endometrial pathology in preparation for operations and IVF;
- fibroids with bleeding - assessment of the endometrium before treatment.
Security and control
Curettage is performed under short-term intravenous anesthesia and takes 15–30 minutes; the modern standard is control by hysteroscopy before and after, in order to remove all contents and not injure the cavity, and during pregnancy, vacuum aspiration, which is less traumatic for the endometrium. The resulting tissue must be examined histologically (in case of a missed miscarriage, with the possibility of genetic analysis). Complications (perforation, infection, synechiae) are rare if the technique and prevention are followed; recovery of the cycle - after 4-6 weeks.
