The endometrium is the mucous layer that lines the inside of the uterus. Its functions include ensuring implantation and development of the embryo. In addition, the menstrual cycle depends on the changes taking place in it.
One of the important processes in a woman's body is the proliferation of the endometrium. Violations in this mechanism cause the development of pathology in the reproductive system. The proliferative endometrium marks the first phase of the cycle, that is, the stage that occurs after the end of menstruation. During this stage, endometrial cells begin to actively divide and grow.
The concept of proliferation
Proliferation is an active process of cell division in a tissue or organ. As a result of menstruation, the mucous membranes of the uterus become very thin due to the fact that there has been a rejection of the cells that make up the functional layer. This is what causes the process of proliferation,as cell division renews the thinned functional layer.
However, a proliferative endometrium does not always indicate the normal functioning of a woman's reproductive system. Sometimes it can occur in the case of the development of pathology, when cells divide too actively, thickening the mucous layer of the uterus.
Causes of occurrence
As mentioned above, the natural cause of proliferative endometrium is the end of the menstrual cycle. Rejected cells of the uterine mucosa are excreted from the body along with the blood, thereby thinning the mucous layer. Before the next cycle comes, the endometrium needs to restore this functional area of \u200b\u200bmucosa through the process of division.
Pathological proliferation occurs as a result of excessive stimulation of cells by estrogen. Therefore, when the mucosal layer is restored, the division of the endometrium does not stop and thickening of the walls of the uterus occurs, which can lead to the development of bleeding.
Process phases
There are three phases of proliferation (in its normal course):
- Early phase. It occurs during the first week of the menstrual cycle and at this time, epithelial cells, as well as stromal cells, can be found on the mucous layer.
- Middle phase. This stage begins on the 8th day of the cycle and ends on the 10th. During this period, the glands enlarge, the stroma swells and loosens, and the cells of the epithelial tissue are stretched.
- Late phase. The proliferation process stops on the 14th day from the beginning of the cycle. At this stage, the mucous membrane and all glands are completely restored.
Diseases
The process of intensive cell division of the endometrium can fail, as a result of which cells appear in excess of the required number. These newly formed "building" materials can combine and lead to the development of tumors such as endometrial proliferative hyperplasia.
It is the result of a hormonal breakdown in the monthly cycle. Hyperplasia is a proliferation of endometrial glands and stroma, can be of two types: glandular and atypical.
Types of hyperplasia
The development of such an anomaly occurs mainly in women in menopausal age. The main reason most often becomes a large amount of estrogens, which act on endometrial cells, activating their excessive division. With the development of this disease, some fragments of the proliferative endometrium acquire a very dense structure. In particularly affected areas, the seal can reach 1.5 cm in thickness. In addition, the formation of a proliferative type of polyps on the endometrium, located in the cavity of the organ, is possible.
This type of hyperplasia is considered a precancerous condition and is found most often in women during menopause or in old age. In young girls, this pathology is diagnosed very rarely.
Atypical hyperplasiaa pronounced proliferation of the endometrium is considered, which has adenomatous sources located in the branching of the glands. Examining scrapings from the uterus, you can find a large number of cells of the tubular epithelium. These cells can have both large and small nuclei, and in some they may be stretched. The tubular epithelium in this case can be both in groups and separately. The analysis also shows the presence of lipids on the walls of the uterus, it is their presence that is an important factor in making a diagnosis.
The transition from atypical glandular hyperplasia to cancer occurs in 3 out of 100 women. This type of hyperplasia is similar to the proliferation of the endometrium during a normal monthly cycle, however, during the development of the disease, decidual tissue cells are absent from the uterine mucosa. Sometimes the process of atypical hyperplasia can be reversed, however, this is only possible under the influence of hormones.
Symptomatics
With the development of proliferative endometrial hyperplasia, the following symptoms are observed:
- The menstrual functions of the uterus are disturbed, manifested by bleeding.
- There is a deviation in the menstrual cycle, in the form of intense cyclical and prolonged bleeding.
- Metrorrhagia develops - unsystematic and non-cyclical bleeding of varying intensity and duration.
- Bleeding occurs between periods or after their delays.
- There are breakthrough bleeding with clots.
- The constant occurrence of bleeding provokes the developmentanemia, malaise, weakness and frequent dizziness.
- An anovulatory cycle occurs, which can cause infertility.
Diagnosis
Due to the similarity of the clinical picture of glandular hyperplasia with other pathologies, diagnostic measures are of great importance.
Diagnosis of endometrial hyperplasia of the proliferative type is carried out by the following methods:
- Study of the anamnesis and complaints of the patient related to the time of onset of bleeding, their duration and frequency. Accompanying symptoms are also being studied.
- Analysis of obstetrical and gynecological information, which includes heredity, pregnancy, contraceptive methods used, previous diseases (not only gynecological), operations, sexually transmitted diseases, etc.
- Analysis of information about the beginning of the menstrual cycle (age of the patient), its regularity, duration, pain and profusion.
- Gynecologist performing a bimanual vaginal examination.
- Gynecological smear collection and microscopy.
- Assignment of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of proliferative endometrial polyps.
- Ultrasound determines the need for an endometrial biopsy to make a diagnosis.
- Performing separate curettage using a hysteroscope that scrapes or completely removes the pathological endometrium.
- Histological examinationscrapings to determine the type of hyperplasia.
Treatment methods
Therapy of glandular hyperplasia is carried out by various methods. It can be both operational and conservative.
Surgical treatment of pathology of the proliferative type of endometrium involves the complete removal of areas that have undergone deformation:
- The cells affected by pathology are scraped out of the uterine cavity.
- Surgical intervention by hysteroscopy.
Surgical intervention is provided in cases:
- the age of the patient allows her to perform the reproductive function of the body;
- woman is "on the verge" of menopause;
- in cases of heavy bleeding;
- after the discovery of a proliferative type of glandular polyps on the endometrium.
The materials obtained as a result of scraping are sent for histological analysis. According to its results and in the absence of other diseases, the doctor may prescribe conservative therapy.
Conservative treatment
This therapy provides for certain methods of influencing the pathology. Hormone Therapy:
- Oral hormonal combined contraceptives are prescribed to be taken for 6 months.
- A woman takes pure gestagens (progesterone preparations), which help reduce the body's secretion of sex hormones. These drugs should be taken for 3-6 months.
- A gestagen-containing intrauterinea spiral that affects the endometrial cells in the body of the uterus. The duration of such a spiral is up to 5 years.
- Prescription of hormones intended for women over 35 years of age, which also have a positive effect on treatment.
Therapy aimed at general strengthening of the body:
- Intake of vitamin and mineral complexes.
- Taking iron supplements.
- Prescribing sedative medications.
- Carrying out physiotherapeutic procedures (electrophoresis, acupuncture, etc.).
In addition, to improve the general condition of overweight patients, a therapeutic diet is being developed, as well as activities aimed at physical strengthening of the body.
Prevention measures
Measures to prevent the development of proliferative endometrial hyperplasia can be as follows:
- regular gynecological examination (twice a year);
- taking preparatory courses during pregnancy;
- selection of suitable contraceptives;
- seek immediate medical attention if any abnormalities occur in the functioning of the pelvic organs.
- quit smoking, alcohol and other bad habits;
- regular, feasible physical activity;
- he althy eating;
- careful monitoring of personal hygiene;
- taking hormonal drugs only after consulting a specialist;
- avoid abortion procedures by using appropriate contraception;
- annuallyundergo a complete examination of the body and, if a deviation from the norm is detected, immediately consult a doctor.
To avoid recurrence of endometrial hyperplasia of the proliferative type, it is necessary:
- consult a gynecologist regularly;
- to be examined by a gynecologist-endocrinologist;
- consult a specialist when choosing contraceptive methods;
- lead a he althy lifestyle.
Forecasts
The prognosis of the development and treatment of endometrial proliferative gland hyperplasia directly depends on the timely detection and treatment of the pathology. By contacting a doctor in the early stages of the disease, a woman has a high chance of being completely cured.
However, one of the most serious complications of hyperplasia can be infertility. The reason for this is the failure of the hormonal background, leading to the disappearance of ovulation. Timely diagnosis of the disease and effective therapy will help to avoid this.
Relapses of this disease are very common. Therefore, a woman needs to regularly visit a gynecologist for an examination and follow all his recommendations.
