Simple endometrial hyperplasia and pregnancy. The onset of pregnancy with endometrial hyperplasia: the possibility of conception and bearing

It is often diagnosed when examining a woman for infertility. With such a pathology, it is not only very difficult to get pregnant, but it is absolutely impossible to do this.

However, do not be upset. Endometrial hyperplasia and pregnancy are well combined, but after a course of treatment. To date, therapy regimens have been developed that allow you to successfully conceive and bear a baby.

Hyperplasia of the endometrium is its excessive growth. The cause may be chronic inflammation, but most often this condition occurs with an absolute or relative high level of estrogen.

These female sex hormones just promote the growth of the endometrium in the first phase of the cycle. They are produced in the ovaries by maturing follicles. However, after ovulation, progesterone becomes the main one, which protects the endometrium from hyperplasia.

Therefore, this disease occurs with prolonged exposure to the uterus of estrogen, when there is no protective effect of progesterone. This is possible both with inadequate hormone therapy with estrogens, and with various diseases, for example, obesity, PCOS.

Hyperplasia of the endometrium is a consequence of prolonged and progesterone in the body. In addition, it produces estrogen, especially when there is a lot of it. In the presence of ovarian tumors that produce hormones, their number also increases, causing hyperplasia.

With such ovulation, as a rule, does not occur. And even if it happens, then implantation of the embryo and its development become almost impossible in the altered endometrium.

And even if pregnancy has come, then there is a very high probability that it will develop with pathologies. In addition, bearing a baby in the presence of benign formations is contraindicated, as it accelerates the onset of a malignant process. Therefore, endometrial hyperplasia and pregnancy can trigger the development of uterine cancer.

For the prognosis and development of tactics for the treatment of this disease, its form is very important. You can determine it when you get it with the help of scraping. It is better to perform this procedure under the control of hysteroscopy. This increases the efficiency of the operation.

This manipulation is also the first stage in the treatment regimen. Then hormonal therapy is carried out. When choosing drugs, the age, weight, concomitant diseases of the patient are taken into account.

The goal of treatment is to prevent the development of cancer and infertility. If the patient wants to become pregnant, prepare her for this.

Pregnancy is also best combined, since it is the least likely to lead to cancer and is easier to treat. If complex atypical hyperplasia is diagnosed, then the treatment will be longer and more complicated. After performing the reproductive function, the patient may be offered the removal of the endometrium or uterus, especially with relapses of the disease.

If the examination is diagnosed with endometrial hyperplasia, and IVF, ICSI is planned by the couple in the future, then the disease must first be treated, otherwise the attempts will be unsuccessful. After successful therapy, conception occurs.

However, endometrial hyperplasia and pregnancy can only be combined with a successful outcome of treatment. But how well the disease responds to therapy depends on neglect and individual characteristics. Relapses, the need to change the drug, increase the dose are possible. Constant medical supervision is essential.

Thus, endometrial hyperplasia and pregnancy are compatible, but only after successful treatment of the disease. Conception with such a diagnosis is not only problematic, but also highly undesirable, since the likelihood of pregnancy complications and cancer development increases.

Endometrial hyperplasia and pregnancy are considered mutually exclusive concepts. However, planning women always have hope for a successful conception. Clinical cases of the disease once again confirm that it is possible to become pregnant with endometrial hyperplasia, but in the process of gestation, a high risk of difficulties remains.

Hyperplasia - what is it?

The balance of female sex hormones determines the menstrual and reproductive function of the uterus. Immediately after the end of menstruation, under the influence of estrogens, the endometrium begins to grow - the mucous layer, which is the soil for a fertilized egg.

By the time of ovulation, it reaches the ideal thickness for implantation. In this way, interdependent natural processes take place in the body of a healthy woman. Under the influence of certain factors, the mucosa may thicken excessively, which is manifested by hyperplastic syndrome.

Endometrial hyperplasia is a gynecological disease, accompanied by a change in the glandular part and stroma of the uterine mucosa. Pathology is characterized by excessive growth and thickening of the inner layer of the reproductive organ in comparison with the normal state.

Is pregnancy possible with endometrial hyperplasia?

For successful conception, the layers that make up the uterine cavity must be healthy and perform their function correctly. When the structure of one of them is disturbed, there are difficulties with conception.

Since the causes of hyperplasia are most often reduced to hormonal and infectious-inflammatory diseases, there are practically no chances for implantation in this pathology. The determining factor in whether it is possible to get pregnant with an unnaturally thick layer of the endometrium is the type of pathological process:

Insignificant uniform growth of the mucous layer, not compatible with conception.

Glandular cystic.

Cystic formations form in the growing stroma, pregnancy is impossible.

Focal.

Thickening occurs in separate areas, implantation is not excluded.

Atypical.

The most dangerous form, often leading to malignancy of the mucosa.

Of all the forms, focal hyperplasia is the most likely to cause pregnancy. With it, thickening occurs in foci with the preservation of the natural thickness of the endometrium in some areas.

It is in them that the implantation of the fetal egg is carried out. In other forms of the disease, conception is impossible, since the thickening of the mucous layer occurs on the entire inner surface of the reproductive organ.

Risks for the woman and the unborn child

Pregnancy with endometrial hyperplasia throughout the entire period is at serious risk. Due to the fact that in this disease a large amount of estrogen is produced, progesterone is suppressed.

The latter is responsible for maintaining pregnancy and prevents uterine hypertonicity. Implantation that occurs with this pathology can fail at any time.

If conception occurred during hyperplasia, a woman should immediately consult a doctor to receive individual prescriptions. Most patients require maintenance and maintenance therapy with progesterone drugs.

Due to the focal growth of the mucosa in the placenta formed by the second trimester, circulatory and metabolic disorders occur. As a result, hypoxia occurs, which negatively affects the brain of the unborn child. In the process of formation of the organs and systems of the embryo, irreversible disorders can occur, threatening congenital malformations.

The impact of pregnancy on the disease

Endometrial hyperplasia and pregnancy are mutually regulating conditions. Just as excessive growth of the uterine mucosa can affect the course of gestation, so conception affects the pathology. It is impossible to predict the outcome of the current situation in advance.

Assessing the individual condition of the woman, the gynecologist may recommend termination of pregnancy with hyperplasia. The final decision always rests with the patient, but women need to be aware of the consequences.

Conception is dangerous because it can turn the disease into a malignant form. Under the influence of hormonal changes, glandular foci grow, forming atypical cells. In such a situation, pregnant women are at risk of death, so you should listen to the recommendations of a gynecologist.

Nevertheless, there are a huge number of officially confirmed clinical cases when gestation had a positive effect on the disease. Gestation and further lactation, preserving the production of estrogen by the ovaries, adjusted the natural hormonal background.

Endometrial thickness for conception

If the patient has endometrial hyperplasia, is it possible to get pregnant - the doctor will answer. You can't generalize about women by giving an exact answer to this question. Of no small importance is the indicator of proliferation of the mucosa.

For successful conception, the thickness of the mucous layer should be 16-18 mm. This value is determined approximately one week after ovulation. At the time of the release of the egg, the thickness of the "soil" for the fetal egg is about 13 mm.

With a diffuse and focal form, an increase in the endometrium up to 20 mm is observed. The atypical form is characterized by a thickness of the mucous layer of 30 mm. Polyps and cysts are manifested by thickening of individual layers up to 60 mm.

An increase in the thickness of the mucosa with a visual change in echogenicity is an ultrasound symptom of endometrial cancer.

Usually, the disease is accompanied by prolonged menstruation, breakthrough bleeding, menstrual irregularities and abdominal pain, but may occur without clinical manifestations.

The identified pathology should first be cured, and then proceed to planning. In therapy, hormonal agents, anti-inflammatory drugs are used, special nutrition and physical activity are organized. If necessary, surgical treatment is carried out. After the therapy, the chances of successful conception increase.

Alternative medicine offers separate recipes suitable for women with hyperplasia during the planning period:

• Reception containing phytohormones regulates the balance of estrogen and progesterone;
• Douching with a decoction of celandine has an anti-inflammatory effect, however, before carrying out manipulations, it is necessary to exclude infectious diseases of the vagina;
• The use of nettle normalizes blood circulation, helps to shorten and reduce the volume of menstruation.

In non-traditional treatment of gynecological diseases, sage is often used. However, with hyperplasia, it is contraindicated to take it, since the herb helps to increase estrogen levels.

The effectiveness of the treatment of pathologically enlarged endometrium will be the higher, the sooner it becomes known about the existing disease.

Endometrial hyperplasia is a disease of the uterus caused by improper production of the hormones progesterone and estrogen in a woman's body. At the same time, progesterone is produced in insufficient quantities, and estrogen, on the contrary, is produced in excess. This leads to changes in the mucous layer of the uterus - the endometrium. On its surface, new cells are formed, which, growing, form a benign tumor.

Sometimes hyperplasia may not be expressed in any way and not bother a woman, but in most cases the disease is manifested by uterine bleeding, menstrual irregularities and infertility.

Endometrial hyperplasia and pregnancy are phenomena that are extremely rare at the same time. As a rule, a woman suffering from hyperplasia suffers from infertility, and only after a cure does a long-awaited pregnancy occur.

No matter how unpleasant the symptoms of the disease, one cannot but admit that in some cases they are a kind of boon for a woman. After all, many ladies delay the visit to the gynecologist until the last moment, not suspecting the danger of endometrial hyperplasia. Meanwhile, modern medicine is increasingly considering this disease as a precancerous condition. Indeed, in addition to infertility, an increase in the thickness of the endometrium during hyperplasia can lead to the transition of a benign growth into a malignant tumor.

Types of endometrial hyperplasia and the impact on pregnancy

There are several types of endometrial hyperplasia:

• glandular hyperplasia;
• glandular cystic hyperplasia of the endometrium;
• endometrial polyps - the so-called focal hyperplasia;
• atypical hyperplasia.

The most dangerous for a woman's health is atypical endometrial hyperplasia. It is this type of disease that leads to malignant tumors and, in fact, is a precancerous condition. According to recent observations, the danger of cancer also arises with focal endometrial hyperplasia, although until recently this form of the disease was not considered as a cause of oncology.

The remaining varieties of hyperplasia do not pose an immediate threat to life, however, they are direct causes of a woman's infertility. With glandular cystic hyperplasia, as with glandular hyperplasia of the endometrium, pregnancy does not occur due to the cessation of the development of the egg, although the thickness of the endometrium in these types of disease does not exceed one and a half to two centimeters.

Pregnancy with endometrial hyperplasia occurs extremely rarely and is observed mainly in the focal form, when the egg develops on an intact area of ​​the uterine mucosa. Focal endometrial hyperplasia and pregnancy is a rare exception to the rule and the only form of hyperplasia, during which a woman can become pregnant. Such cases are rare and require careful and gentle treatment under the supervision of a specialist.

With timely diagnosis and proper treatment, favorable conditions appear for pregnancy after endometrial hyperplasia. Here in the first place is a regular examination by a doctor, passing the necessary tests and following all the recommendations.

At the slightest suspicion of endometrial hyperplasia, an ultrasound diagnosis is performed. This method allows you to examine the structure of the endometrium, measure its thickness and make an accurate diagnosis. In addition, intrauterine ultrasound is a reliable prevention of hyperplasia if it is performed at least once every six months.

Pregnancy with endometrial hyperplasia is caused by disorders in the mucous membrane of the uterine cavity. Normally, the thickness of the endometrium changes cyclically, depending on the monthly cycle. During the period of ovulation, the mucous membrane thickens, on other days the membrane is thinner. If the tissue structure of the uterus is constantly in a thickened state and further grows, then endometrial hyperplasia is diagnosed.

Causes of endometrial hyperplasia

• after curettage, abortion;
• due to polycystic formations;
• as a result of complications of uterine fibroids;
• due to the inflammatory process in the reproductive organs.

Is pregnancy possible with endometrial hyperplasia?

1. Glandular - is considered the least dangerous and is associated with some hormonal disorders, cystic formations are often observed. In this case, conception is impossible due to the lack of an ovulation period for the egg.
2. Focal hyperplasia is caused by the formation of polyps when the endometrium does not thicken everywhere.
3. Atypical pathology is the most dangerous, since as a result of significant structural changes in tissues, there is a danger of developing cancer cells.

In the case of diagnosing cystic formations against the background of hyperplasia, then drug therapy will not be enough, it will be necessary to remove the pathological sections of the mucosa using hysteroscopy.

Atypical endometrial hyperplasia will require a consultation with an oncologist to assess the condition of the mucosa and exclude the degeneration of cells into a malignant tumor. If the diagnosis of the presence of cancer cells is confirmed, then one of the methods of struggle is the removal of the reproductive organ, in order to prevent the growth of cancer cells.

Also, the subsequent conception depends on the type of pathological process. After hyperplasia and all medical procedures, doctors observe the woman for some more time in order to assess the monthly cycle. In the case of stable ovulation, a successful pregnancy occurs.

The female body is unique, because only it is able to give life to a new person, but at the same time it has amazing fragility. The slightest failure in a well-established system, a little more than one hormone, a little less than another, and now the most vulnerable place is already suffering - the uterus. Erosion, endometriosis, infectious inflammation and many other pathologies occur in women of all ages. Today we will add glandular hyperplasia of the endometrium to this list.

Characteristics of the disease

Glandular hyperplasia is not classified by medicine as an independent disease. It is part of a complex of hyperplasia that affects the endometrium. In fact, this is an overgrowth of the glands of the outer layer of the endometrium of the uterus, leading to an increase in its volume.

Video: endometrial hyperplasia This phenomenon belongs to the category of benign formations, but its effect on the body should not be underestimated.

Did you know?Princess E. Golitsyna in the 18th century became the founder of official Russian gynecology. She bequeathed all her property to the creation and development of the relevant science.

The uterine endometrium is represented by two layers - inner and outer. Internal (basal) is responsible for the elasticity and strength of the structure. After the completion of the menstrual cycle, the cellular structure of the inner layer is involved in restoring the outer integrity of the endometrium.

The outer layer (functional) has an extensive network of vessels and a large number of glands. It changes its structure and size depending on the phase of the menstrual cycle, and it is he who is most sensitive to hormonal changes.

That is, in fact, a change in the size and structure of the endometrium is a physiological process. But only as long as he moves from one phase of the cycle to another without hormonal disruptions.

The first half of the cycle is associated with the release of a large amount of the hormone estrogen, which prepares the uterus for the maturation of the egg and the adoption of the fetus into its womb. The outer endometrial tissue literally sprouts blood vessels and glands, and also increases in size.

After ovulation, estrogen levels drop and all of these processes decline.

This entire overgrown functional layer is rejected (this process is known to us as bloody discharge from the vagina - “monthly”). The second half of the cycle is regulated by the hormone gestagen.

When a cycle disorder occurs associated with endometrial hyperplasia, this means that the level of estrogen rises uncontrollably, that is, hyperestrogenism occurs. So the cycle only goes in one direction. Such hormonal disruptions most often indicate infertility.

The development of hyperplasia is characterized by the onset of anovulation, that is, the egg dies before its movement through the fallopian tube begins. If conception nevertheless took place, then the development of pregnancy is still in question.

Polyps can interfere with the attachment of an egg to the endometrium, not to mention the fact that a swollen, painful uterus is not able to give enough space and a nutrient medium for the development of the fetus.
There are still unique cases of pregnancy with the described pathology, but there is a high risk of uterine bleeding and even early termination of pregnancy.

Important!Before planning a conception, be sure to be examined by a doctor and pass all the necessary tests.

The disease affects both young girls and older women. Unfortunately, there are no age restrictions here, since hormonal imbalance can befall anyone for a number of objective reasons.

For example, the categories most susceptible to hyperplasia are adolescents and women in the period: that is, those whose body is undergoing hormonal “restructuring”.
Since the process of formation of the hormonal background in the body is very complex and multifaceted, even the slightest violation in one of the many links in this chain can lead to violations. The process originates from the brain (pituitary-hypothalamus), thus, even disorders in the brain can cause gynecological problems.

Among the objective reasons that affect the occurrence of endometrial hyperplasia, various pathologies of the ovaries, for example, or tumors, should be noted. External causes are often abortions, contraceptive coils, diagnostic curettage, and obesity (adipose tissue contributes to increased estrogen production).

Important!Uncontrolled and prolonged use of oral contraceptives increases the risk of developing gynecological pathologies!

There are also factors that can both influence the appearance of hyperplasia and accompany its occurrence. For example, these are disorders in the work of the thyroid and pancreas, dysfunction of the genitourinary system.

The state of the liver and biliary tract also needs to be carefully monitored, because disturbances in their work provoke hyperestrogenism (the liver cannot cope with the utilization of estrogen).

Classification of endometrial hyperplasia

Diagnosis of endometrial pathology is difficult, since in each case of the disease a lot of nuances and clarifications are provided. But there is a simple general classification that allows you to assess the degree of damage to the body and prescribe the most effective treatment.

The normal structure of the endometrium is vertically oriented, slightly elongated glands with small gaps. With the hormonal failure described above, the lumen of the glands expands.
The cellular structure is broken and the inner layer of the uterus grows. Sometimes the glands, changing shape, begin to intertwine with each other, forming whole groups of gaps.

Did you know?In the Arab state of Bahrain, a man is allowed to be a gynecologist. But with the condition that he can examine the female genital organs only as a reflection in a special mirror.

Glandular cystic

This pathology differs from the previous type of hyperplasia in that the gaps between the glands are filled with seals (). However, in medical reference books, the described species are considered equivalent and the cystic appearance may actually be the next stage of glandular hyperplasia.

The hyperplastic process spreads over the entire surface of the uterus, that is, it is diffuse. In an atypical condition, the division of endometrial cells is disrupted, they acquire a different size, and their correct interaction is difficult. It is at this stage that they speak of a precancerous condition, which in 10% of cases can develop into cancer..

The focal form is characterized by the fact that the pathology does not affect the entire endometrium, but is concentrated at separate points, "nodes". In these foci, overgrown tissue with deformed glands forms polyps up to 1.5 cm in size. Sometimes individual formations can reach 6 cm. When such polyps break through, sudden heavy bleeding occurs.

Symptoms of glandular hyperplasia

A number of symptoms characteristic of most gynecological diseases are also inherent in glandular hyperplasia of the endometrium. If at least one symptom is detected, it is imperative to consult a doctor.

1. Violation of the cycle of uterine bleeding.
2. Extra-cyclic spotting, sometimes with impurities of mucus.
3. Iron deficiency or anemia. The lack of hemoglobin against the background of constant blood loss leads to pallor of the skin, to constant fatigue and respiratory disorders.
4. Hormonal disruptions. The concentration of estrogen rises several times, while the level of progesterone, on the contrary, falls.

Diagnosis of glandular hyperplasia is a complex of various activities. Only after the clinical, laboratory, histological and hysteroscopic data converge, can we talk about the accuracy of the diagnosis.

When the diagnosis is made and it comes to treatment, it should be remembered that the process of development of pathology in the endometrium is complex and depends on many factors. Therefore, it is necessary to be examined and receive recommendations not only from a gynecologist, but also from a therapist, endocrinologist and neuropathologist.

The treatment itself depends on many factors, such as the age of the patient, the clinical picture of her disease, as well as comorbidities. The task of the doctor is not only to cure, but also to eliminate the very cause of the disease, as well as to prevent possible consequences.
Since the most common consequence of hyperplasia is infertility, then the restoration of reproductive function is impossible without the removal of the affected areas of the endometrium. This is a minor surgical procedure that requires anesthesia. Scraping the uterine cavity, the doctor eliminates the disease.

However, if additional measures are not taken to eliminate the cause of the disease, there will be a relapse. Therefore, after the operation, hormonal therapy is necessarily prescribed (according to individual indications).

So the body is helped to fight the uncontrolled growth of the endometrium. After this process returns to normal, it will be possible to talk about the complete restoration of the menstrual cycle.

If the patient is younger than 30 years old, the doctor may prescribe contraceptives (COCs) with gestagens and estrogens, if older - only with gestagens. Usually the course of treatment takes from three months to six months.
Along with medicines, additional measures are taken to restore the general condition of the body. They fight anemia, prescribe a vitamin complex, possibly acupuncture or electrophoresis. Only comprehensive measures can eliminate the disease.

It happens that medicines do not improve the situation. Then again, surgical intervention is necessary, for example, radio wave treatment or cauterization. Control ultrasound helps to evaluate the effectiveness of treatment.

Possible Complications

Complications can occur in the presence of concomitant diseases, such as fibroids or endometriosis. If the patient wants to subsequently be able to become pregnant and bear a child, then doctors can apply ablation or laser resection of the endometrium in case of recurrence of hyperplasia.

When the biphasic monthly cycle is fully restored, it may well be about ovulation and pregnancy. In rare cases, special drugs are used - ovulation stimulants.

Unfortunately, once diagnosed with endometrial hyperplasia, it will accompany you all your life. It is impossible to forget about it, and all preventive measures should be aimed at avoiding relapse. It is also important to prevent the development of a malignant tumor.

Therefore, regular visits to the gynecologist-endocrinologist, correction of contraception and careful monitoring during pregnancy are required.
Modern medicine is developing so rapidly that there are fewer and fewer diseases that cannot be diagnosed early. But still, gynecological pathologies are still kind of leaders in coding symptoms: sometimes the disease manifests itself too late, when an operation is needed, or even doctors are powerless to help.

That is why you should not neglect regular examinations and tests, which gynecologists recommend to carry out at least every six months. Remember that a reverent attitude to your health is not a privilege, but a duty.