Precancerous conditions of the body of the uterus. Adenomatous hyperplasia of the endometrium: symptoms, treatment Focal adenomatosis of the endometrium

From the appearance of this disease, neither young women nor ladies who have stepped over the threshold of menopause are insured.

Its insidiousness lies in the fact that adenomatous hyperplasia of the endometrium makes it necessary to show increased oncological alertness, the probability of transforming the cells of the inner layer of the uterus into atypical formations is so great.

What is adenomatous endometrial hyperplasia?

Atypical hyperplasia, or adenomatosis, is a pathological growth of the endometrium, atypical for the physiology of the uterus. It is accompanied by restructuring of glandular cells and stroma.

In other words, the endometrium lining the uterine cavity begins to grow and swell, degenerating into precancerous cells. Most often diagnosed in women 45-55 years old, with a frequent and prolonged course, it makes us consider the pathology as a chronic disease.

The frequency of malignancy (transition to cancer), according to various sources, ranges from 8 to 29% of all diagnosed cases of adenomatosis.

It is necessary to distinguish endometrial adenomatosis from adenomyosis. If, with adenomatosis, the inner lining of the uterus grows with a change in the structure of the cells, then in the second case, the endometrium grows into the muscular layer of the uterus, and the disease does not occur after the onset of menopause.

At the same time, endometrial cells retain their structure, in contrast to the structure of epidermal cells in atypical hyperplasia.

Causes of adenomatosis

The basis of this disease is a hormonal imbalance caused by an excess of estrogen and a lack of progesterone, which inhibits the excessive proliferation of the inner lining of the uterus. The endometrium is a hormone-dependent tissue, the functioning of which is directly related to the influence of these hormones.

Factors predisposing to the development of the disease:

Age fluctuations in hormone levels;
late menopause;
Ovarian dysfunction (polycystic, estrogen-producing tumors);
Anomalies and inflammatory diseases of the pelvic organs;
Repeated instrumental intervention in the uterine cavity (abortion, diagnostic curettage);
Long-term use of drugs containing estrogen (hormone replacement therapy);
Endocrine disorders (obesity, diabetes, thyroid disease);
Hypertonic disease.

In addition, a woman may have a hereditary predisposition to the disease.

Symptoms of adenomatous hyperplasia

The main symptom of adenomatosis in women of reproductive age is uterine bleeding. They can take the following forms:

Alternation of delayed menstruation lasting 1-3 months with prolonged uterine bleeding (60-70% of women);
Cyclic bleeding occurring simultaneously with menstruation, increasing the amount of discharge and their duration (20-25% of patients);
Bleeding against the background of the absence of menstruation (5-10% of women).

In exceptional cases, adenomatosis in women of reproductive age does not show any symptoms and is diagnosed by ultrasound.

Simultaneously with uterine bleeding, a woman can be diagnosed with:

Obesity (60-70% of patients);
Virilization (manifestation of male physique, body hair, voice timbre);
Secondary infertility;
Inflammatory diseases of the pelvic organs of a chronic course;
Mastopathy;
endometriosis;
Myoma;
Miscarriage.

To clarify the diagnosis, a histological examination of the endometrium is performed. According to its results, the following changes in the morphology of the inner layer of the uterus are determined:

A large number of glands too close to each other;
The absence of epithelial cells between them;
Irregular shape of the glands, their tortuosity, branching;
The appearance of structures formed according to the type of "iron in iron";
The ducts of the glands are strongly tortuous, papillae and protrusions may appear in their lumen.

To make a diagnosis of "adenomatosis" it is enough to fix the accumulation of too densely located glands. These signs can appear both in separate areas and on the entire inner surface of the uterus.

Atypical cells do not mature to the end, they are constantly rejuvenated, which increases the risk of their uncontrolled reproduction and transformation into a malignant neoplasm.

Types and classification of adenomatous hyperplasia

Depending on the localization and extent of distribution of modified cells, the following forms of atypical hyperplasia are distinguished:

Focal adenomatosis.

The process captures a limited area, which over time takes the form of a polyp protruding into the uterine cavity.

Diffuse adenomatosis.

The process occupies the entire surface of the endometrium.

Classification of the disease depending on the type of cells included in the pathological process:

Glandular hyperplasia.

The number of endometrial glands increases.

Glandular cystic hyperplasia.

Cystic structures form between the glands.

Depending on structural changes, the following forms of the disease are diagnosed:

Simple.

Endometrial cells are enlarged, their number is excessive, but the structure remains unchanged.

Complex (adenomatous).

The structures formed as a result of changes in the endometrium are not normally found in a healthy uterus.

Adenomatous endometrial polyp as a special case of hyperplasia

With a focal form of atypical hyperplasia, an adenomatous endometrial polyp is formed, most often located in the bottom of the uterus or near the mouth of the fallopian tubes. It has the appearance of a loose formation on a small leg - from 5 to 30 mm. The leg of the polyp consists of blood vessels twisted into a ball and smooth muscle fibers.

The body of this formation is made up of glands of a bizarre shape and structure. They cease to depend on hormones, tending to uncontrolled growth and proliferation. This feature of the morphology of the polyp makes us consider it a precancerous pathology.

Treatment of adenomatous hyperplasia and endometrial polyp

Before determining the tactics of treatment, the doctor prescribes diagnostic measures. First, a gynecological examination and anamnesis are taken to determine the characteristics of the menstrual cycle.

During the transvaginal ultrasound, the state of the endometrium, possible pathologies of the ovaries are determined. Signs of adenomatous hyperplasia may be excessive thickness of the endometrium:

Over 7 mm in reproductive age;
Over 5 mm in postmenopause up to 5 years;
Over 4 mm in postmenopause for longer than 5 years.

Additional diagnostic manipulations - aspiration biopsy, separate diagnostic curettage. The most informative study is hysteroscopy followed by a histological examination of endometrial scrapings.

Depending on the results of the diagnosis, the doctor determines the tactics of treatment. To normalize the state of the endometrium for 6 months, gestagenotherapy is used - the use of steroid hormones. If after the control hysteroscopy the condition of the endometrium does not normalize, a second course of treatment is prescribed.

In case of contraindications to hormonal therapy or in menopause, a minimally invasive operation is performed to remove the entire uterine mucosa.

This intervention is carried out under the control of a hysteroscope using high frequency currents. With a long course of adenomatosis, relapses of pathology, ineffectiveness of conservative therapy, a hysterectomy of the uterus is performed along with the ovaries.

Most often, it is necessary to operate on the uterus with appendages when an adenomatous polyp is combined with pathological processes in the endometrium (atrophy, adenomatosis). This radical method is used to prevent the transformation of foci of adenomatous hyperplasia into adenocarcinoma with metastases.

Content

Adenomatosis is an atypical form of dishormonal hyperplasia. Researchers consider this form of the disease a precancerous condition. Considering that precancerous hyperplasia degenerates into a cancerous tumor in about 10-20 percent of patients and undergoes regression in the same number of patients, it is necessary to carefully and carefully monitor the patient's condition and test results.

What is endometrial hyperplasia

Endometrial hyperplasia is an excessive and uncontrolled proliferation of cells and tissue structures of the outer mucous layer of the uterus. Share:

simple (glandular and glandular-cystic);
focal / complex (endometrial adenomatosis).

Glandular hyperplasia characterized by the formation of a large number of glands, cysts, polyps, which contain cells with intact structure. This is a relatively safe form of the disease that still needs treatment.

Brain dysfunction(hypothalamus) and a weakened state of the body's immune defenses (metabolic syndrome) can cause cancer in glandular hyperplasia at any age.

Complex hyperplasia consists in the formation in the tissues of the endometrium of special structures - "glands in the gland", which are not characteristic of the normal structure of the uterus (polyps, glandular-cystic or glandular-fibrous formations with a special structure). This is focal adenomatosis.

Uterine adenomatosis is not cancer and this is not an indication for removal of the uterus.

Uterine adenomatosis and cancer

Any changes in the uterus (proliferation of cells and tissues, changes in cell structures, the appearance of neoplasms, etc.) should cause some alertness, because there is a risk of developing cancer. However, they are rarely truly malignant.

Focal adenomatosis is considered a precancerous condition, but the main evidence of its danger is the histological examination of tissue scrapings from the uterine cavity. The term "without atypia" as a result of the study indicates the good quality of the process and the minimal risk of developing uterine cancer in the near future. And the identification of atypical cells according to the results of histology indicates a precancerous condition.

Regardless of research results hyperplastic processes in the uterus must be treated.

Treatment Methods

In order to prevent the further spread of the disease and its degeneration into a cancerous tumor, it is necessary to carry out treatment.

Adenomatosis most often causes infertility, but even if conception has occurred, against its background there are high risks of developing a threat of abortion or miscarriage.

At an early stage of the disease, treatment without surgical intervention is possible. Long-term use of hormonal drugs (combined oral contraceptives, estrogen-progestin drugs, progestogens, gonadotropin-releasing hormone antagonists, androgens) allows you to avoid surgery.

In more advanced cases, adenomatosis is treated with surgical methods, the essence of which is the mechanical removal of diseased tissue areas. Types of surgery for adenomatosis.

Scraping. Surgical cleaning of the uterine cavity with a curette is perhaps one of the most common methods of treating this pathology. Such an operation is performed under general anesthesia and allows not only to completely remove all the affected tissues, but also to obtain a large amount of material for a detailed histological examination.
Hysteroscopy. Minimally invasive surgical intervention, in which tissue removal occurs under the control of a video camera, which allows the safest and most accurate removal of adenomatous nodes. This method is considered to be less traumatic as minimal expansion of the cervical canal is required. However, the risks of developing relapses of the disease, according to statistics, are somewhat greater than with classic curettage.
Amputation of the uterus (hysterectomy) is the complete or partial removal of an organ. Such an operation is carried out strictly according to indications, mainly in postmenopausal women with a frequently relapsing disease, with the ineffectiveness of other methods of treatment and high risks of developing cancer.

After the operation and obtaining the results of histology, therapy is carried out aimed at normalizing the hormonal background and improving local immunity, to stimulate the growth of healthy tissue of the uterine mucosa.

Reasons for development

Several reasons have been identified that can cause hyperplastic changes in the endometrium of the adenomatous type. But none of them can be considered a 100% guarantee of the development of the disease in the future.

Hormonal disorders. An imbalance in the production of estrogens and progestogens leads to uncontrolled growth of endometrial tissues.
Diseases of the ovaries. The absence of ovulation almost always leads to the growth of the endometrium.
Incorrect or uncontrolled intake of hormonal drugs.
Violations in the work of the endocrine system.
Diseases of the liver and biliary tract.
hereditary factor.

Symptoms and Diagnosis

The main symptoms of the development of hyperplastic processes in the uterus.

Bleeding. Abundant menstruation, acyclic bleeding, "daub".
Pain. Pain in the lower abdomen before critical days and during bleeding, back pain.
metabolic syndrome. Obesity, elevated insulin levels, male-pattern hair growth, voice changes, and other masculine traits.
Fertility problems. Infertility and miscarriage is one of the main symptoms of hyperplasia.
Mastopathy.
Inflammatory diseases of the pelvic organs.
Painful intercourse, an admixture of blood in the discharge after intercourse.

Ultrasound examination by transvaginal method can confirm or refute the diagnosis with a high degree of probability. However, the key in the diagnosis of adenomatosis is the determination of the presence of atypical cells in the tissues, which can only be confirmed as a result of a detailed analysis - a histological examination of a scraping from the uterine cavity. Additionally, if concomitant ovarian diseases or the development of metabolic syndrome are suspected, a detailed blood test for sex hormones is prescribed.

Ultrasound for diagnosis should be carried out on the 5-7th day from the onset of bleeding.

Treatment of hyperplastic changes in the uterus of any nature, in any case, must be started as early as possible. If the gynecologist has already diagnosed "adenomatosis", it is better to immediately ask for a referral to an oncologist. Many women are afraid to contact such doctors, but as practice shows, precancerous forms of the disease are best treated by specialized specialists.

It is very important for women who are faced with this diagnosis to understand the essence and sequence of this procedure, as well as to be aware of the possible consequences. With endometrial hyperplasia, scraping, according to reviews, is used very often.

What is this pathology?

Endometrial hyperplasia is a benign neoplasm in the endometrium (inner layer of the uterus), leading to its thickening and increase in size. The reason for this process is an increase in the number of stromal and glandular elements in the endometrium.

There are different types of endometrium:

Glandular (increased glandular tissue).
Glandular cystic.
Adenomatosis. This is a precancerous pathology. In about 10 percent of cases, it develops into a malignant tumor.
Fibrous and glandular fibrous polyps of the endometrium. This is the most common type of hyperplasia. They rarely become cancerous, but can cause endometrial cancer.

Below we will consider what reviews they write about the scraping procedure.

Endometrial hyperplasia is a pathology common in all age groups in women. Most often, however, this pathology occurs during puberty or menopause, when cardinal hormonal changes occur in the body.

Prerequisites

The prerequisites for endometrial hyperplasia are:

Failure in the hormonal balance (deficiency of progesterone against the background of an excess of estrogens).
Diabetes mellitus, hypertension, obesity, diseases of the thyroid gland, adrenal glands, etc.
Uterine fibroids and adenomyosis.
genetic predisposition.
abortion.

With endometrial hyperplasia in menopause, curettage, according to reviews, is the only method of therapy.

signs

The main symptom of all types of this pathology is irregular and non-cyclic discharge of bloody color. They usually appear between periods or after a delay. Allocations are not plentiful, smearing. An excess of estrogen in a woman's body can lead to infertility, while endometrial hyperplasia does not manifest itself. Therefore, the absence of pregnancy with regular sexual activity during the year is a serious reason to consult a specialist. Hyperplasia is often confused with fibroids (in the presence of this diagnosis) or with an early miscarriage.

Endometrial hyperplasia is diagnosed (curettage and reviews will be discussed below) after a gynecological examination, ultrasound of the pelvic organs and hysteroscopy (examination of the uterus using a special device). Scraping obtained during hysteroscopy is examined to determine the type of hyperplasia. An aspiration biopsy can also be performed, when a histological examination is performed with a piece of endometrium. Checking the level of estrogen and progesterone is also one of the types of diagnosis of endometrial hyperplasia.

Therapy for endometrial hyperplasia is necessary for everyone, regardless of age and degree of damage. Hysteroscopy and curettage are the most effective methods of treatment and diagnosis. Below we will talk in detail specifically about scraping. Hyperplasia of the endometrium according to reviews in postmenopause may occur.

Indications and contraindications

Curettage (curettage of the endometrium) is a common procedure in gynecology. It is an invasive intervention in the structure of the genital organs of a woman. During this manipulation, the doctor removes the functional layer of the mucous membrane with a special tool without affecting other tissues. By the next menstruation, the endometrium is restored on its own.

But in rare cases, it happens that endometrial hyperplasia without scraping (reviews on this subject are available) is cured.

Cleaning of the uterine cavity is performed for the purpose of diagnosing or treating various gynecological diseases. Therefore, the procedures are divided into therapeutic and diagnostic. The latter option is used in the presence of the following symptoms:

Irregular monthly cycle.
Abundant and prolonged menstrual bleeding.
Menorrhagia (bleeding between periods).
Algomenorrhea (pain during menstruation).
Infertility.
Suspicion of a malignancy.

Quite often there are also benign growths of the mucous membrane (focal or diffuse). Therefore, scraping with endometrial hyperplasia, according to reviews, is very common. It is important for women who are waiting for confirmation of the diagnosis.

For medicinal purposes, scraping is used not only for hyperplasia, but also for other pathologies, namely:

Submucosal (submucosal) fibroids.

Polyps of the body and cervix.

Frozen or ectopic pregnancy.

Childbirth with pathology.

You can cure the conditions listed above with the help of scraping. Among other things, this procedure is carried out as one of the methods for terminating an unwanted pregnancy. And although other methods are now more used, such as vacuum aspiration or medical abortion, this procedure is still relevant.

It is important to remember that the endometrial scraping procedure for hyperplasia in menopause, according to reviews, also has contraindications. For example, in case of acute infectious and inflammatory diseases of the vagina and cervix, the procedure should be abandoned, as it can provoke damage to the uterus. An exception is the case of retained placenta during childbirth.

Preparation and conduct of the procedure

As with any invasive intervention, endometrial hyperplasia must be carefully prepared. The first thing to remember is that the procedure is performed on certain days of the menstrual cycle, which reduces bleeding. The second is that a multifaceted examination of a woman is necessary, including:

General analysis of blood and urine.
Microscopy of the vagina (smear).
Bakposev secretions.
A blood test for biochemistry, as well as for hormones.

Such an examination is necessary to identify pathologies accompanying hyperplasia, as they can prevent curettage or lead to postoperative complications. Before the procedure, a woman must comply with the following conditions:

Refuse to take any medications.
Refrain from sexual activity.
Stop using intimate hygiene products, including vaginal suppositories and tablets. The consequences of scraping endometrial hyperplasia and reviews are of interest to many.

You should stop taking medication two weeks before the procedure, the rest of the conditions are met a few days before the manipulation. 12 hours before the operation, you should refuse to eat and drink, that is, you should come to the procedure on an empty stomach.

The most important thing that excites the patient before the procedure is, in fact, how it is carried out. Curettage is performed in stationary conditions in the gynecological operating room. Since this manipulation is very painful, the patient is necessarily introduced into anesthesia using intravenous anesthesia. If the procedure is performed after childbirth or miscarriage, then anesthesia is not required, since the cervix will be sufficiently dilated.

At the initial stage, using a special metal dilator, the cervical canal is opened. Next, there is a direct scraping of the mucous membrane with a curette (surgical spoon). Sometimes a vacuum aspirator is used for this purpose. But before introducing it, it is necessary to check the location and length of the uterine cavity, since a bend is possible.

Ideally, the operation is performed under the control of a hysteroscope, however, the “blind” option is also possible. The hysteroscope displays an image on the monitor, which clearly shows which areas require curettage. A biopsy may also be taken at the same time for further investigation. Endometrial hyperplasia may require a two-stage procedure - first the uterine cavity is scraped, and then the cervical canal. Curettage with endometrial hyperplasia in postmenopause and reviews will be discussed below.

Consequences of scraping

When scraping, the surface layer of the endometrium is removed, and that is why it takes a certain amount of time to regenerate it. As a rule, this is a fast process, comparable in duration to a normal menstruation. However, this procedure still damages the mucous membrane, so paroxysmal pain in the lower abdomen and spotting are possible. Initially, the discharge is clot-like, then bloody, bloody, and after a week and a half they stop, and everything returns to normal. If the pain is intense and disturbs the woman in the postoperative period, it is possible to take anti-inflammatory drugs such as Ibuprofen. Other treatment options after curettage for endometrial hyperplasia with menopause, according to reviews, are not required.

Possible Complications

After the operation, a delay of up to 4 weeks or more is possible. In case of a delay of more than three months, it makes sense to consult a gynecologist. It is also worth doing if the discharge does not end, and the pain intensifies, or if the temperature rises. Such symptoms indicate the presence of complications, for example:

Endometritis (inflammatory process).
Uterine bleeding.
Hematometra (accumulation of blood in the uterus).

Endometrial hyperplasia, curettage: doctors' reviews

During the operation, damage to the uterus, rupture with a cuvette, dilator or probe is possible. This can happen due to incompetent manipulation or due to the lack of a hysteroscope. Over time, these lesions will heal, adhesions may appear in their place, which may well cause the embryo not to attach to the wall of the uterus and, accordingly, infertility.

Treatment of endometrial hyperplasia after curettage, according to reviews, should be comprehensive.

After a successful procedure, a woman is advised to be attentive to her health, to allow the body to fully recover.

Rules after surgery

Gynecologists advise following the following rules for the next two weeks after the operation:

Sexual abstinence.
Do not take a bath or go to the sauna, exclude any thermal stress on the body.
Do not use syringes or tampons.
Avoid strenuous exercise.
Do not take blood thinners such as Heparin or Aspirin.
Control three months after the procedure with blood donation for hormones.

Important question

No less exciting for a woman who has survived curettage is the question of the further possibility of conceiving a child. Unfortunately, no one can give a concrete answer to it. No specialist can guarantee a future pregnancy. It depends on the individual characteristics of the organism, on the success of the procedure, on the reason for which the manipulation was carried out. If endometrial hyperplasia did not affect the ovaries, then there should be no barriers to childbearing after the procedure, pregnancy can occur as early as the next ovulation after the operation.

With endometrial hyperplasia, is curettage necessary? Reviews confirm that there is an alternative. More on this later.

With numerous recurrences of hyperplasia, drastic measures can be taken. If the patient does not intend to give birth anymore, we can talk about the complete removal of the endometrial mucosa. In particularly difficult cases, the uterus, ovaries and appendages can be completely removed. Therapy in this case will be long and complicated, because such measures greatly affect the hormonal balance in a woman's body.

In order to avoid future health problems, only experienced doctors should be trusted with curettage; in this case, a woman is required to strictly follow all recommendations in the pre- and postoperative period.

Curettage with endometrial hyperplasia with menopause

Reviews confirm that when the hormone estrogen accumulates excessively in a woman's body while reducing progesterone, this can lead to such a dangerous disease as endometrial hyperplasia during menopause. The risk group includes the fair sex, who had long, heavy periods before menopause, with fibroids, inflammation of the endometrium, or formations in the breast. Treatment consists of the following steps:

diagnostic curettage;
analysis of material from the uterus;
then the gynecologist selects the hormones necessary to stop hyperplasia;
curettage of found anomalies in the uterus, a laser is used in some places of cell growth;
hormonal and surgical forms of exposure are combined;
if there is a relapse of the disease, the organ is removed, after which a course of hormones is again carried out.

Alternative

In addition to curettage of the uterine cavity, other types of therapy are also used. The most important of them is a conservative correction with the help of medication. These are, first of all, hormonal drugs, the effect of which is aimed at restoring the estrogen-progesterone balance in the body. The main drugs used in this case are:

The listed drugs can be prescribed as an independent type of treatment or as maintenance and rehabilitation therapy after curettage. In the latter option, it is possible to achieve the greatest effect from the treatment. In addition to these drugs, immunomodulators, antioxidants and other drugs can be prescribed to maintain the body in a normal state. But still, the treatment of endometrial hyperplasia with curettage, according to reviews, is more effective.

It represents a necessary measure in the diagnosis and treatment of many gynecological diseases, including pathological conditions of the endometrium. The procedure is relatively simple, but it requires high-quality performance, high qualification of the specialist who conducts it, careful preparation and attentive attitude to your body during the rehabilitation period. All this will help to avoid problems in the future and will contribute to the positive dynamics in the treatment.

Reviews

The opinion of patients about this procedure is rather ambiguous. Many note that with endometrial hyperplasia, a relapse occurs some time after the curettage. In such a situation, it is necessary to understand the importance of subsequent therapy after surgery, because curettage of the uterus with endometrial hyperplasia, according to reviews, does not cure, but only removes the symptoms.

What is endometrial adenomatosis

Adenomatosis is an atypical form of dishormonal hyperplasia. Researchers consider this form of the disease a precancerous condition. Considering that precancerous hyperplasia degenerates into a cancerous tumor in about a percent of patients and undergoes regression in the same number of patients, it is necessary to carefully and carefully monitor the patient's condition and test results.

What is endometrial hyperplasia

Endometrial hyperplasia is an excessive and uncontrolled proliferation of cells and tissue structures of the outer mucous layer of the uterus. Share:

simple (glandular and glandular-cystic);
focal / complex (endometrial adenomatosis).

Glandular hyperplasia is characterized by the formation of a large number of glands, cysts, polyps, which contain cells with an intact structure. This is a relatively safe form of the disease that still needs treatment.

Uterine adenomatosis and cancer

Treatment Methods

In order to prevent the further spread of the disease and its degeneration into a cancerous tumor, it is necessary to carry out treatment.

In more advanced cases, adenomatosis is treated with surgical methods, the essence of which is the mechanical removal of diseased tissue areas. Types of surgery for adenomatosis.

Scraping. Surgical cleaning of the uterine cavity with a curette is perhaps one of the most common methods of treating this pathology. Such an operation is performed under general anesthesia and allows not only to completely remove all the affected tissues, but also to obtain a large amount of material for a detailed histological examination.
Hysteroscopy. Minimally invasive surgical intervention, in which tissue removal occurs under the control of a video camera, which allows the safest and most accurate removal of adenomatous nodes. This method is considered to be less traumatic as minimal expansion of the cervical canal is required. However, the risks of developing relapses of the disease, according to statistics, are somewhat greater than with classic curettage.
Amputation of the uterus (hysterectomy) is the complete or partial removal of an organ. Such an operation is carried out strictly according to indications, mainly in postmenopausal women with a frequently relapsing disease, with the ineffectiveness of other methods of treatment and high risks of developing cancer.

Reasons for development

Hormonal disorders. An imbalance in the production of estrogens and progestogens leads to uncontrolled growth of endometrial tissues.
Diseases of the ovaries. The absence of ovulation almost always leads to the growth of the endometrium.
Incorrect or uncontrolled intake of hormonal drugs.
Violations in the work of the endocrine system.
Diseases of the liver and biliary tract.
hereditary factor.

Symptoms and Diagnosis

The main symptoms of the development of hyperplastic processes in the uterus.

Bleeding. Abundant menstruation, acyclic bleeding, "daub".
Pain. Pain in the lower abdomen before critical days and during bleeding, back pain.
metabolic syndrome. Obesity, elevated insulin levels, male-pattern hair growth, voice changes, and other masculine traits.
Fertility problems. Infertility and miscarriage is one of the main symptoms of hyperplasia.
Mastopathy.
Inflammatory diseases of the pelvic organs.
Painful intercourse, an admixture of blood in the discharge after intercourse.

When endometrial hyperplasia occurs, its signs, treatment and the likelihood of malignancy

For practical gynecology, the processes of endometrial hyperplasia, which make up from 15 to 40% and occupy the second place after infectious pathology in the structure of all gynecological diseases, are a multifaceted and complex problem.

This is due to their tendency to a recurrent long-term course, the absence of specific symptoms, the difficulty of timely differential diagnosis and difficulties in choosing an adequate treatment. What is dangerous hyperplasia and what are its causes?

Endometrial hyperplasia - what is it?

Endometrial hyperplasia is a morphological and functional pathological condition of the uterine mucosa, consisting in diffuse or focal growth (proliferation) of glandular and stromal structures with a predominant lesion of the glandular component in the functional (superficial), much less often in the basal layer of the endometrium. The thickness of the endometrium during hyperplasia exceeds the norms of indicators depending on the phase of the menstrual cycle - up to 2-4 mm in the early proliferation phase and domm during the secretory phase.

In recent decades, there has been a steady increase in the number of pathological hyperplastic processes in the uterine mucosa, due to an increase in the average age of life of the female population, an unfavorable environment, an increase in the number of somatic chronic diseases, many of which are to some extent associated with the hormonal system or have influence on her.

The frequency of pathology is 10-30% and depends on its form and age of women. It occurs in girls and women of childbearing age, but most often - at 35 - 55 years of age, and according to some authors - in half of women who are in the late reproductive or menopausal period.

In recent years, an increase in the number of cases of the disease has been noted. Moreover, this growth occurs in parallel with an increase in the number of cases of cancer of the body of the uterus, which among all malignant tumors in women occupies the 4th place, and among the malignant neoplasms of the genital organs - the 1st place.

Various forms of hyperplasia of the uterine mucosa - is it cancer or not?

Pathological changes in the endometrium are benign, but at the same time it is noted that against their background, malignant tumors develop much more often. So, simple endometrial hyperplasia without atypia in the absence of treatment accompanies cancer of the uterine body in 1% of cases, with atypia - in 8-20%, a complex atypical form - in 29-57%. The atypical form is considered a precancerous condition.

How is endometrial hyperplasia different from endometriosis?

If the first is localized only within the uterine mucosa, then endometriosis is a chronic progressive relapsing benign disease that, by its growth and spread, resembles a malignant tumor.

The cells of the endometrioid tissue are morphologically and functionally similar to the cells of the endometrium, however, they germinate into the wall of the uterus, spread and grow beyond its borders - in the fallopian tubes and ovaries. They can also affect neighboring organs (peritoneum, bladder, intestines) and be carried by the blood stream (metastasize) to distant organs and tissues.

Causes of endometrial hyperplasia and its pathogenesis

Due to the presence of a specific receptor apparatus in the uterine mucosa, it is a tissue that is highly sensitive to changes in the endocrine status in the female body. The uterus is the "target organ" for the action of sex hormones.

Periodic cyclic changes in the endometrium are due to a balanced hormonal effect on the receptors of the nuclei and cytoplasm of cells. Menstruation occurs as a result of rejection of only the functional layer of the endometrium, and the restoration of glandular structures occurs due to the growth of the glands of the basal layer, which is not rejected.

Therefore, the occurrence of a hormonal imbalance in a woman's body can cause a violation of the differentiation and growth of endometrial cells, which leads to the development of their limited or widespread overgrowth, that is, local or diffuse endometrial hyperplasia develops.

Risk factors for the occurrence of pathological processes of cell proliferation in the endometrium are:

hypothalamic-pituitary syndrome or Itsenko-Cushing's disease;
chronic anovulation;
the presence of hormonally active ovarian tumors;
polycystic ovary syndrome;
therapy with tamoxifen (antineoplastic and antiestrogen drug) and replacement therapy with estrogens;
chronic inflammatory processes of the internal genital organs, frequent abortions and diagnostic curettage (occur in 45-60% of women with hyperplasia);
starvation and psycho-emotional stress conditions;
thyroid disease, the hormones of which modulate the effect of female sex hormones (estrogens) at the cellular level;
violation of the metabolism of fats and carbohydrates, in particular diabetes and obesity;
pathology of the liver and biliary system, which results in a slowdown in the processes of utilization of estrogens in the liver, which leads to hyperplastic processes in the uterine mucosa;
hypertonic disease;
postmenopausal period - due to an increase in the hormonal activity of the adrenal cortex;
immune changes, which are especially pronounced in women with metabolic disorders.

Hormones play a major role in the development of endometrial tissue proliferation. Among them, the primary role belongs to estrogens, which, by their participation in the metabolic processes of cells, stimulate the division and growth of the latter. At different periods of life, absolute or relative hyperestrogenism can be provoked by one or another of the above factors.

During puberty

Cycles of anovulation lead to hyperplastic processes in this period, and they, in turn, are associated with a disorder in the activity of the hypothalamic-pituitary system. The latter is accompanied by long-lasting unstable frequency and amplitude of GnRH (gonadotropin-releasing hormone) emissions, which is the cause of inadequate secretion of follicle-stimulating hormone (FSH) by the pituitary gland.

The result of all this is premature (before reaching the stage that corresponds to ovulation) atresia of the follicles in many menstrual cycles. In this case, there is a relative excess of estrogen (as a result of the monotony of its production) with the secretion of progesterone (deficiency), which does not correspond to the stages of the menstrual cycle, which causes an inferior growth of the endometrium. The predominantly glandular epithelium grows with a lag in the growth of the stromal component. Thus, adenomatous, or cystic hyperplasia of the endometrium is formed.

In the reproductive period

Excess levels of estrogen in the reproductive period may result from:

hypothalamic disorders, hyperprolactinemia, frequent stress conditions, starvation, chronic somatic diseases, etc., leading to dysfunction of the hypothalamus-pituitary system;
disturbances in the hormonal feedback mechanism, as a result of which, in the middle of the menstrual cycle, the secretion of luteinizing hormone is not activated, which means that ovulation is also absent;
changes directly in the ovaries themselves with the growth of their stroma, follicular cysts, ovarian polycystosis, etc.

During premenopausal and perimenopausal periods

Cycles of non-ovulation are caused by age-related changes in the activity of the hypothalamic-pituitary system, resulting in changes in the intensity and frequency of GnRH release. According to these cycles, both the secretion of FSH by the pituitary gland and the effect of the latter on ovarian function change.

Insufficient levels of estrogens in the middle of the menstrual cycle, which is the cause of a decrease in stimulation of the release of luteinizing hormone, as well as depletion (by this age) of the ovarian follicular apparatus, lead to anovulation. In the postmenopausal period in women, the activity of the adrenal cortex increases, which also plays a role in the development of endometrial hyperplasia.

In addition, recent studies indicate the primacy of tissue resistance to insulin, which is caused by hereditary or immune factors, for example, insufficiency of insulin receptors in tissues, the presence of specific antibodies against insulin receptors or blockade of the latter by growth factors similar to insulin and inherited, etc.

These genetic and immune disorders can cause metabolic disorders (disturbance of carbohydrate metabolism and diabetes mellitus, male-type obesity, atherosclerosis, etc.), as well as functional and structural changes (hypertension, coronary heart disease, etc.). They are considered to be secondary to tissue resistance of insulin action, which automatically leads to more insulin secretion in the body.

An increased concentration of insulin, acting on the corresponding ovarian receptors and growth factors, stimulates multiple follicles, causing the development of polycystic, excessive production of androgens in cysts, which are transformed into estrogens. The latter cause the absence of ovulation and hyperplastic processes in the endometrium.

Along with this, the state of uterine hormonal receptors is of no small importance, which is not least influenced by mechanical damage (abortions, curettage) and inflammatory processes. Due to the deficiency of receptors, hormonal treatment of endometrial hyperplasia (in 30%) is very often ineffective, since its sensitivity to hormonal drugs is insufficient.

An important role in the development of pathological proliferation is played not only by the intensification of the growth processes of the endometrial cells themselves, but also by gene dysregulation of their apoptosis (programmed timely cell death).

Thus, the mechanism of proliferative processes in the uterine mucosa is due to the complex interaction of many factors, both systemic (neurondocrine, metabolic, immune) and local (cellular receptor and genetic apparatus of the uterine mucosa) character.

This mechanism is realized mainly as a result of:

excessive influence of estrogens with insufficient counteraction of progesterone;
an abnormal reaction of the glandular structures of the uterine mucosa in response to a normal level of estrogen;
due to the high activity of insulin growth factors with insulin resistance, accompanied by a high concentration of insulin (metabolic syndrome, type II diabetes mellitus, polycystic ovary syndrome).

Classification of endometrial hyperplasia

Pathologically and cytologically, the following forms of hyperplasia are distinguished:

simple glandular - cystic enlargement of the glands is mostly absent; if proliferative processes are pronounced, then cystic expansion is possible in some parts of the mucous membrane; this form, in this case, is called glandular-cystic and is the stage of a single process;
glandular-stromal, characterized by proliferation of both glandular and stromal structures; depending on the severity of this process, the glandular-stromal form is divided into active and resting; thickening of the endometrium occurs due to the surface layer;
atypical, which is also called atypical glandular and adenomatous; this form is characterized by the severity of proliferative changes and a wide variety of morphological patterns.

Depending on the severity of proliferative and atypical changes, mild, moderate and severe degrees of the pathological condition are distinguished, and diffuse and focal forms are distinguished from its prevalence.

In 1994, the World Health Organization (WHO) proposed a classification, which is generally followed today. However, in practical gynecology and oncology, the terminology of other authors is often used in parallel.

According to the WHO classification, endometrial proliferation can be:

No cytologically detectable atypical cells (non-atypical).
With atypical cells (atypical).

The first, in turn, differs as:

Simple hyperplasia of the endometrium, which corresponds to the previously accepted term "glandular cystic hyperplasia." In this form, the volume of the mucous membrane is increased, there is no atypia of cell nuclei, the structure of the endometrium differs from its normal state by the activity and uniform growth of the glandular and stromal components, the uniform distribution of vessels in the stroma, the uneven location of the glands and moderate cystic expansion of some of them.
Complex, or complex hyperplasia, or I degree. Corresponds to adenomatosis (in other classifications). In this form, the proliferation of the glandular epithelium is combined with a change in the structure of the glands, in contrast to the previous form. The balance between the growth of glands and stroma is disturbed in favor of the former. The glands are structurally irregular, and there is no cellular nuclear atypia.

Atypical proliferation is divided into:

Simple, which corresponds (according to other classifications) to atypical hyperplasia of the II degree. It differs from a simple non-atypical form by a significant growth of the glandular epithelium and the presence of atypical cells. Cellular and nuclear polymorphism are absent.
Atypical complex (complex), in which changes in the endometrium are of the same nature as in non-atypical, but, unlike the latter, atypical cells are present. Signs of their atypia are violation of cell polarity, irregular multi-row epithelium and its resizing, nuclear cell polymorphism, enlarged cell nuclei and their excessive staining, expanded cytoplasmic vacuoles.

In the WHO classification, local hyperplasia (single or multiple polyps) is not distinguished as an independent variant. This is due to the fact that polyps (polypous hyperplasia - a term sometimes used by practitioners) are considered not as a variant of endometrial hyperplasia as a result of hormonal disorders, but as a variant of a productive process in chronic endometritis, which requires appropriate bacteriological examination and anti-inflammatory and antibacterial treatment.

Clinical picture

In the vast majority of cases, the main symptom in women of different ages is dysfunctional uterine bleeding and/or spotting from the genital tract. The nature of menstrual disorders does not depend on the severity of proliferative processes in the endometrium.

Violations of the menstrual cycle are possible in the form of a delay in menstruation up to 1-3 months, which is subsequently replaced by bleeding or spotting discharge (in % of women with endometrial hyperplasia). Somewhat less often, cyclic bleeding lasting more than 1 week, corresponding to menstrual days, is possible. They are more common among women who do not have metabolic disorders.

Menstruation with endometrial hyperplasia is usually long. Their intensity can be different - from moderate bleeding to heavy, with a large blood loss (profuse). On average, 25% of bleeding occurs against the background of anovulatory menstrual cycles or the absence of menstruation (in 5-10% of women with hyperplasia).

Menopausal women have irregular periods followed by continued bleeding or spotting. During menopause, short-term or long-term scanty bleeding is possible.

Other, less significant and uncharacteristic signs of uterine endometrial hyperplasia are pain in the lower abdomen and bleeding after intercourse, heavy lifting, long walking (contact bleeding).

In addition, general complaints are possible, which are caused by both blood loss for a long time, and metabolic and/or neuroendocrine disorders. These can be headaches, thirst, palpitations, high blood pressure, sleep disturbance, decreased performance and fatigue, psycho-emotional instability, excessive weight gain, the appearance of pink striae and pathological hair growth, the development of pelvic pain syndrome, psycho-emotional disorders, reduced quality of life.

A small percentage of patients have no symptoms. Pathological changes in the mucous membrane of them are detected during random examinations, sometimes not even associated with gynecological diseases.

hyperplasia and pregnancy

Is it possible to get pregnant with the development of this pathology?

Considering the etiology and pathogenesis of the development of the pathological condition under consideration, it becomes clear that endometrial hyperplasia and pregnancy are practically incompatible. Infertility is connected not only with the fact that the altered mucous membrane does not allow the implantation of the fetal egg. The reasons, mainly of a hormonal nature, that caused these pathological changes, are at the same time the causes of infertility.

Therefore, endometrial hyperplasia and IVF are also incompatible. However, the preliminary course of the necessary treatment at the stage of preparation for pregnancy most often contributes to conception and the successful resolution of pregnancy.

In some cases where there is moderate hyperplasia, implantation of a fertilized egg is possible in a relatively healthy area of the uterine mucosa. But this usually leads to spontaneous abortion or fetal developmental disorders.

Hyperplasia of the endometrium after childbirth develops relatively rarely. However, its recurrence is quite possible even in the form of an atypical form. Recurrent endometrial hyperplasia, especially its atypical forms, is dangerous due to its tendency to transform into a malignant hyperplastic process. Therefore, in the postpartum period, it is necessary to be under the supervision of a gynecologist, conduct additional examinations and, if necessary, undergo a course of prescribed therapy.

Diagnostics

The diagnosis is made on the basis of various methods, the results of which are specific for the corresponding age period.

The main diagnostic methods are:

Ultrasound examination using a transvaginal probe

According to various sources, its information content is from 78 to 99%. The thickness of the endometrium during hyperplasia in the secretory phase exceeds 15 ± 0.4 mm (up to 20.1 ± 0.4 mm), in the postmenopausal period, a thickness of more than 5 mm indicates a hyperplastic process. Exceeding the value of 20.1 ± 0.4 mm already raises the suspicion of the possibility of the presence of adenocarcinoma. Other M-echo signs of hyperplasia are a heterogeneous structure of the uterine mucosa, inclusions similar to small cysts, or other ECHO-positive formations of various sizes.

Separate diagnostic curettage of the mucous membrane of the cervix and uterine cavity

The study is most informative on the eve of menstruation. Further histological examination of the obtained material allows us to more accurately determine the nature of the ongoing morphological changes. Cytological examination reveals the presence of cellular atypia. Indications for repeated curettage are recurrent bleeding in the postmenopausal period and monitoring the effectiveness of the course of hormone treatment.

Read more about the procedure in our previous article.

Being a fairly informative technique (informativeness ranges from 63 to 97.3%), the study significantly increases the diagnostic value of separate curettage. It is desirable to carry it out on the 5-7th day of the menstrual cycle. Hysteroscopy with endometrial hyperplasia allows to differentiate the morphological forms of transformation of the uterine mucosa. Hysteroscopic signs are:

with simple hyperplasia - the thickness of the endometrium is more than 15 mm, its uneven surface with the presence of multiple folds of pale pink or, less often, bright red color, the severity of the vascular pattern, the uniform arrangement of the excretory ducts of the glands;
with cystic - a folded bright red surface, an increase in thickness, uneven vascular network, in the projection of superficial vessels - a large number of cysts.

Treatment

Can endometrial hyperplasia go away on its own?

Given that it is not a disease, but a pathological condition of the endometrium, due to the above factors and mechanisms of development, self-healing does not occur. Moreover, this pathology often has a recurrent character.

When choosing treatment tactics, the presence of somatic pathology and diseases of the internal genital organs, the age period and the morphological state of the uterine mucosa are taken into account.

Conservative therapy

The principle of treatment consists of three main stages:

Stop bleeding, the methods of which largely depend on the age period. They can be non-hormonal, hormonal and surgical.
Restoration or suppression of the menstrual cycle.
Carrying out the prevention of recurrence of the pathological process.

puberty

In adolescence, endometrial hyperplasia is treated without curettage. To stop bleeding, first of all, symptomatic therapy is used, for which, for no more than 5 days, drugs are prescribed that increase the tone of the muscular wall of the uterus (uterotonic drugs). These include Oxytocin, Dinoprost, Methylergometrine.

In addition, pharmaceutical hemostatic preparations are used (Vikasol, aminocaproic acid), vitamin therapy (folic acid, vitamin "B 1", pyridoxine, vitamin "E", ascorbic acid) and additionally - traditional medicine that helps stop bleeding (nettle nettle, shepherd's bag, etc.).

If there is no effect, progesterone preparations are prescribed, and if necessary, a combination of them with estrogens (Regulon, Femoden, Marvelon, Rigevidon, etc.). In some cases, progesterone preparations are prescribed in shock dosages, which leads to separation of the uterine lining, similar to curettage or menstruation (hormonal curettage). Further treatment in order to prevent relapse is carried out by means of gestagenic or complex (estrogen-progestin) hormonal preparations.

Reproductive and menopausal period

In women of reproductive and menopausal periods, the treatment of endometrial hyperplasia begins with a separate therapeutic and diagnostic curettage. After a histological examination of the mucosal preparation, certain hormonal agents are selected in individually selected dosages in order to prevent recurrence of the pathology or surgical treatment.

In reproductive age, therapy is aimed at both eliminating hyperplasia of the uterine mucosa and restoring ovulation cycles, and at perimenopausal age, it is aimed at restoring the regularity of menstrual-like reactions or suppressing them.

For this purpose, drugs such as Utrozhestan (micronized natural progesterone), the complex estrogen-gestagen preparation Jeanine, as well as Norkolut (norethisterone), Duphaston (dydrogesterone), Depo-provera, antigonadotropic hormones, GnRH agonists (stimulants) (Goserelin, Buserelin) are used. , Luprid depot, Zoladex, Diferelin), etc.

How to take Duphaston with endometrial hyperplasia?

Dufaston, like Norkolut, should be taken from the 16th to the 25th day of the menstrual cycle at a daily dose of 5-10 mg. The drug is prescribed for six months (at least 3 months), followed by control ultrasound examinations in six months and 1 year.

The greatest difficulty is the treatment of hyperplasia in women with metabolic disorders (overweight) and elevated serum insulin levels. For such patients, annual monitoring of blood levels of lipoproteins, glucose, a test for glucose tolerance and testing of insulin levels in the blood are necessary.

Of great importance is the normalization of body weight by increasing physical activity, especially in the fresh air, which helps to reduce the concentration of lipids in the blood, and proper nutrition. The diet for endometrial hyperplasia should be balanced, but in such a way that its daily calorie content is limited to dokkal. This must be ensured by limiting the content of carbohydrates and fats in food and increasing the amount of protein.

Surgery

Indications for surgical treatment are:

In reproductive age - the lack of effectiveness of conservative treatment of simple atypical and complex non-atypical forms for six months, as well as 3 months - an atypical complex form of pathology.
In the menopausal period - the absence of the effect of a six-month conservative therapy of complex non-atypical and simple atypical hyperplasia, as well as a 3-month therapy of an atypical complex form of pathology.

Of the surgical methods in cases with atypical forms of hyperplasia, removal of the uterus is indicated. In women with non-atypical forms of pathology, especially those of reproductive age, in recent years, mainly such sparing surgical methods as endometrial ablation and hysteroresectoscopy have been used.

Alternative treatment

Many women, not wanting to take hormonal drugs, carry out repeated curettage or accept a proposal for surgical treatment (if necessary), use treatment with folk remedies (infusions and decoctions of medicinal plants and their collections) or homeopathic preparations - Genikochel, Kalium carbonicum, Mastometrin, Atsidum nitricum, etc. .

Folk remedies include, for example, an infusion of nettle leaves, a decoction of burdock roots or a tincture of its leaves, a decoction of a collection consisting of calamus, calamus leaves, common knotweed, white cinquefoil root, shepherd's purse (grass) and snake knotweed, and others medicinal plants.

However, it must be understood that folk remedies, as well as the treatment of homeopaths, are possible only with a symptomatic purpose - stopping bleeding, replenishing vitamins and trace elements, increasing the tone of the myometrium.

Their use for the treatment of endometrial hyperplasia is not only ineffective, but contributes to the delay of the process, to the risk of significant blood loss and associated complications, as well as the transformation of a benign pathological condition of the endometrium into a malignant formation.

In the process of development of adenomatosis, the tissues of the mucous membrane of the uterus (endometrium) enter the uterine muscle layer and begin to grow. This process is accompanied by a violation of the synthesis of hormones, a decrease in immunity. Symptoms of adenomatosis include pain during intercourse, pain in the pelvic area before menstruation, dark and after them, menstrual irregularities, abundant.

So far, the exact growths of the uterine tissue have not been identified. However, it is believed that there is a genetic predisposition to this disease. At risk are women engaged in heavy physical labor. The development of adenomatosis is affected by constant stressful situations, the abuse of solariums and sunbathing.

Ultraviolet radiation can cause a number of reactions in the body that are not dangerous for young people. After 30 years, the body is more susceptible to exposure to sunlight, so older women are advised to refrain from visiting resorts in the hot season, it is better to postpone the rest for the “velvet season”. Mud baths can negatively affect the condition of the endometrium. Increase the risk of developing adenomatosis uterine surgery, curettage after abortion, miscarriage.

Treatment of adenomatosis

Uterine adenomatosis requires mandatory treatment, otherwise it can provoke a more serious disease - cancer. With adenomatosis, a woman will not be able to become pregnant, if conception does occur, there is a high risk of miscarriage. The disease is treated by 2 methods: drug therapy and surgery. At an early stage, hormonal drugs are prescribed, which must be taken for at least 2-3 months. Such therapy avoids surgery. When used correctly, hormonal agents are safe for the body and do not cause side effects.

Surgical treatment consists in carrying out curettage of the uterine cavity with the removal of the altered endometrium. The effectiveness of the operation will depend on the degree of development of adenomatosis: the more affected areas, the more difficult the surgical intervention and the less likely a woman is to become pregnant. Then the patient is prescribed hormone therapy to prevent the growth of the endometrium. If the disease is severe, the uterus is removed. This method of treatment is applicable if a woman does not plan to have children or her life is in danger.

Polyps in the uterus are of different types, they act as a localized manifestation of hyperplasia of the endometrial mucosa. The adenomatous polyp differs little from other types, given the clinical and macroscopic symptoms. But, there is something that distinguishes it from other species. Adenomatous hyperplasia of the endometrium is a dangerous neoplasm that tends to degenerate and become malignant.

Adenomatosis of the uterus: what is it?

Not so often, women who undergo a control gynecological ultrasound find out that they have endometrial adenomatosis. Therefore, it is necessary to know what it is, what are the signs of the disease and how to treat it.

An adenomatous endometrial polyp is a benign neoplasm. Pathology manifests itself in the form of cells that grow inside the uterine cavity. Namely, with the threat that a benign formation can easily degenerate into a malignant one, treatment cannot be delayed.

Adenomatosis of the uterus, as a rule, is one overgrown neoplasm or numerous growths. It was then that the polyposis passes into the anedomatous stage. No matter how many formations in the cavity, they carry an equally unfavorable threat.

Quite often, women aged 30 to 50 face such a delicate problem, more risks starting from the age of 50. But there are cases when an adenomatous polyp is diagnosed in young girls.

The shape of such a polyp looks like a mushroom, it has legs and a body. Dimensions are not particularly large from 5 to 10 mm, but sometimes it can block the exit to the cervical canal when the size is up to 30 mm. Adenomatous polyps, as a rule, are localized in the corners or on the bottom of the uterus, closest to the mouth of the fallopian tubes.

In gynecological practice, ademonatous polyps are found not only on a thin stalk, but also on a large base. As a rule, those formations that are located on a thick base become cancerous.

The risks of degeneration into a malignant tumor directly depend on the size of the polyp. Somewhere in 2% of cases, this happens when the neoplasm is 1.5 cm. And also in 2-10%, when the size is up to 2.5 cm. In the event that the size is more than 5 cm, then the risks are already more than 10% .

It is also believed that children whose parents suffered from an adenomatous polyp are 50% predisposed to pathology.

Adenomatous polyp: causes and symptoms

There are many reasons for the formation of these types of polyps. The most common reason is a disregard for your body and reproductive organs, including.

Possible reasons:

hormonal imbalance;
problems in the work of the endocrine system;
as a consequence after a surgical operation - abortion, cleansing;
spontaneous miscarriage in early pregnancy;
regular, not fully treated inflammatory diseases in the reproductive organs;
venereal diseases - recurrent;
regular depression, stress and psycho-emotional swings;
malfunction of the immune system;
intrauterine device and its long wearing;
diseases of a protracted nature in the absence of appropriate treatment;
genetics, heredity.

With adenomatosis, heredity is not an unimportant thing. In fact, in 50% of patients, the diagnosis is confirmed by the fact that it was inherited from relatives or parents.

Therefore, if the family has a predisposition to the formation of polyps, the younger generation should monitor their health. Polyps can be not only in the uterus, but anywhere.

When the build-up becomes large, symptoms immediately appear that should not be ignored.

Symptoms in the presence of uterine adenomatosis:

profuse vaginal spotting that is not associated with menstruation;
pain in the lower abdomen, impulsive type, pain may increase after intimacy;
systematic bleeding after intercourse;
excessively heavy menstruation, especially at a young age (dangerous uterine bleeding);
problems with conception.

Also, a large polyp limits the space in the uterus, which reduces the chances of carrying the fetus to the end.

How to diagnose an adenomatous polyp?

It is necessary to visit a doctor who will prescribe a series of laboratory and medical examinations in order for the clinical picture to become clear.

To get started with standard research:

biochemistry and complete blood count;
study of hormones contained in the blood;
routine gynecological examination and swab sampling;
ultrasound procedure.

Only after all the tests, taking into account the results, complaints and the clinic, the correct diagnosis is made.

When combined with other diseases of the uterus or genital organs, a biopsy may be prescribed.

Also today there is a quick way to recognize the problem - this is hysteroscopy. A special contrast enzyme is poured into the uterus. Then he installs a hysteroscope through the neck, through which you can perfectly see all the changes, as well as their size.

Adenomatous polyp: how is it treated?

Polyps in the uterus of this type are treated by surgery. Because adenomatosis of the uterus is a precancerous condition. Either surgery or cleaning (curettage) is performed using a hysteroscope.

After the growth is removed, its location is cauterized with current or liquid nitrogen, such manipulations are necessary to prevent the recurrence of the disease.

If an adenomatous type polyp occurs in a woman who is in the postmenopausal or premenopausal period, the doctor may decide to remove the uterus completely. In cases where failures in the endocrine system are detected and cancer is possible, the uterus and appendages are removed.

After surgery, hormone replacement therapy is prescribed. It is advisable to follow a diet, eat right and lead a healthy lifestyle, refrain from sexual intimacy.

In some cases, in order to avoid complications after surgery, a treatment course with antibacterial drugs may be prescribed.