Reactive changes in the epithelium are dangerous for women's he alth. And at the same time, they rarely show themselves in any way. Asymptomatic course at times complicates the diagnosis. Therefore, it is recommended that all women go to the gynecological office at least once a year to conduct a cytological examination of the microflora.
Why do these changes occur at all? What are the prerequisites and reasons? Are there any symptoms? This and many other things will be discussed now.
Normal indicators
First you need to talk about them. The uterus consists of three layers - the inner mucosa (also called the endometrium), muscle and integumentary.
Normally, the surface of her cervix is pink and smooth. This is due to a uniform layer of basal epithelium. Normally, the Schiller test indicator (diagnostic event) turns brown.
During the cytological analysis, a single amount ofleukocytes, as well as squamous epithelial cells.
Leukocytes are normally characterized by whole nuclei and pure cytoplasm. There are no signs of phagocytosis. Swabs may contain cells with transformed cytoplasm and mucus.
Pathogenesis
Reactive changes in the epithelium occur due to infection by a woman with an infection. This happens, as a rule, due to unprotected intercourse with an unverified partner.
About 50% of all infections are of bacterial origin. Inflammation of the vaginal membranes provokes a similar process that occurs in the cervix.
Interestingly, in some cases even bacteria that make up the natural microflora of the genital tract are infectious agents. But this only happens when the immune system is weakened.
Primary examination, aimed at identifying reactive changes in the epithelium, reveals inflammation. An analysis for cytology shows the content of a large number of leukocytes with destroyed nuclei, eosinophilic and lymphoid elements. If we talk about the microflora, then with reactive changes in the epithelium, it becomes mixed.
If the inflammation is detected in time, it can be successfully overcome with the help of adequate antibacterial treatment. Therapy is completed with the restoration of microflora - for this, prebiotics are used.
Classification
After cytological analysis, such reactivesquamous changes:
- Exudative. A woman has destroyed neutrophilic leukocytes. The smear contains fragments of cells and nuclei. Surviving, whole, in a state of phagocytosis.
- Reparative. The name of this type of changes was given by the repair occurring in the defective surface of the layers and subsequent epithelialization. As a result of the analysis, cells of increased size are found. It is because of them that tissue grows, which replenishes the affected areas. The nuclei become larger, but do not lose their clear contours. Chromatin accumulation is not observed. By the way, it has a soft-grained structure.
- Degenerative. Manifested by wrinkling of the cell nucleus. There are also violations of the structure of the nuclear membrane and chromatin. Proliferation of the epithelium indicates a chronic inflammatory process.
Talking about reactive changes in the squamous epithelium, it must be noted that cytological analysis also often reveals a combination of inflammatory changes. Often, reparative ones are combined with degenerative and proliferative ones.
In such cases, multinucleated cells with large nuclei are detected. The cytological picture strongly resembles dysplasia or cancerous conditions. If we talk about inflammatory atypia, then it is distinguished by a uniform distribution of chromatin. The lumps have fuzzy contours.
Proliferation
This is the name of reactive changes in the glandular epithelium. How does it manifest itself? An increase in the number of cellular glandular components localized in the cervical canal. itnot an independent disease, but a complex of cytological changes.
So, moderate proliferation indicates pseudo-erosion. During the examination, it is possible to detect signs of the disease in the vaginal segment, where they are absent in the norm. As part of the diagnosis, a visual examination, smear cytology and colposcopy are performed.
If a woman develops inflammation accompanied by proliferation, she may feel pain in the vaginal area and discomfort. When hormonal imbalances are the cause, bleeding between periods, amenorrhea and other symptoms also appear.
The cause is not always trauma or infection. Even a he althy woman can proliferate if she takes OCs and often disregards pharmaceutical regulations.
The treatment prescribed by the doctor is always aimed at eliminating the cause of this disease. If, for example, it arose due to an infection, then antibiotic therapy will be effective.
Erosion
So, what does "reactive changes in the epithelium" mean - it's clear. Now we should delve into the study of this topic and consider specific diseases.
Cervical erosion is a defect that damages the notorious squamous epithelium around the external os.
Of course, the cause is inflammation. Erosion occurs in most women who have had cervicitis and endocervicitis. Although there is still a version according to which the reason is a changelevels of steroid sex hormones. There is some truth in this, since clinical observations have helped to identify the symptoms of erosion during pregnancy. In the postpartum period, they pass, as the hormonal background stabilizes.
Erosion is characterized by a recurrent, long, persistent course. This disease is not amenable to conservative therapy. But unfortunately, the diagnosis is difficult, since there are no characteristic complaints in women. In addition, this disease, which is caused by reactive changes in epithelial cells, is also asymptomatic.
You can detect pathology during a visual examination of the cervix, as well as through colposcopy.
Erosion treatment
The basis of therapy aimed at eliminating this disease is a mechanism aimed at destroying the cells of the cylindrical epithelium. The goal is to reject them and further restore the squamous epithelium.
There are several methods to help achieve the result:
- Diathermocoagulation. During the procedure, the altered tissue is cauterized with an alternating high-frequency electric current. It provokes tissue heating, due to which the desired effect occurs. This procedure is contraindicated in nulliparous patients, as scars form as a result, and they prevent the opening of the cervix at the time of delivery. Also, the method is traumatic. Healing lasts approximately 1.5-3 months. Often the consequence is endometriosis, so it is desirable to carry out the procedure in the second phase of the menstrual cycle.
- Laser vaporization. This is "cauterization"laser erosion. Ideally, it should be carried out on the 5th-7th day of the cycle. Sanitation of the cervix and vagina is preliminarily prescribed. The whole procedure is painless and does not leave scars. Full regeneration is observed after a month.
- Radio wave treatment. During this procedure, high frequency electromagnetic oscillations act on the pathological focus. They cannot be physically felt. The procedure takes less than a minute, and there is no need for anesthesia or postoperative treatment.
- Cryodestruction. It implies the freezing of erosion tissues with liquid nitrogen or its oxide. The procedure is not fraught with pain, blood, or scars. During the first day, the patient will experience abundant liquid discharge and swelling. But it will pass quickly. It takes one to one and a half months to heal.
It should be noted that any of the above procedures is prescribed only after a detailed diagnosis of reactive changes in epithelial cells.
It is important to carry out all procedures - from targeted biopsy to colposcopy, in order to exclude the oncological process. If the doctor reveals the prospect of malignant degeneration, then the patient will be prescribed surgical intervention.
Leukoplakia
Continuing to talk about reactive changes in the cervical epithelium, it is necessary to pay attention to this disease.
What is it? Leukoplakia is a pathological change in the exocervix, which is characterized by proliferation and keratinization of the multilayerepithelium.
The cause may be traumatic, chemical or infectious effects, as well as the influence of endogenous factors (impaired immune and hormonal regulation). The violation of the functional relationship between the uterus, ovary, pituitary gland and hypothalamus also plays a role. Because it is fraught with anovulation, hyperextrogenia and progesterone deficiency.
Predisposing factors are promiscuous sex and diseases suffered by a woman. Squamous cells with reactive changes are seen in patients suffering from any of the following:
- Adnexitis.
- Endometritis.
- Oligomenorrhea or amenorrhea.
- Chlamydia.
- Ureaplasmosis.
- Herpes.
- Mycoplasmosis.
- Cervicitis.
- Colpitis.
- Ectopia.
Usually this ailment is asymptomatic, but sometimes accompanied by contact discharge and leucorrhoea. The principles of diagnosis are the same as in the case of erosion. Additionally, scrapings and a biopsy are examined, which are taken for histological examination of the material.
Treatment of this reactive change in the epithelium of the cervix is aimed at eliminating background diseases, as well as the complete removal of foci where the pathology has manifested itself. According to the doctor's indications, antiviral, antibacterial and anti-inflammatory therapy is carried out. They often resort to one of the procedures shown during erosion (they were discussed above).
Erythroplakia
Studying the states in which there aresquamous epithelial cells with reactive changes, it is necessary to talk about this disease. Erythroplakia is a precancerous pathological condition in which the mucosa of the exocervix atrophies.
Also asymptomatic. Mucous discharge and bleeding are sometimes observed. The causes of occurrence are the same as in the previous cases, but burdened heredity may still occur. Scientists have not yet been able to prove the connection of erythroplakia with chromosomal and gene aberrations. However, according to statistics, the likelihood of developing an ailment is much higher in those girls in whose family it has already occurred in women.
By the way, another cause of inflammation with reactive changes in the epithelium can be trauma. Rupture of the cervix often occurs during childbirth, hysteroscopy, abortion and curettage.
When erythroplakia violated all natural renewal processes, as well as maturation and further rejection of exocervix cells. This leads to an imbalance between the cells of several layers of the membrane at once. Over time, the mucous membrane of the vaginal part becomes very thin.
The disease is asymptomatic, only severe, advanced cases are accompanied by bleeding.
If squamous cells with reactive changes are found, and it turned out that this led to erythroplakia, surgical treatment is prescribed. Conservative therapy is meaningless. Either minimally invasive intervention or cervical conization is indicated.
Cervical dysplasia
With this disease, a cytogram with reactive changes in the epithelium demonstrates the formationatypical cells in those places where the single layer is mated with the multilayer.
Develops in three stages. At the last stage, there is a columnar epithelium with reactive changes of such a serious nature that it eventually leads to cervical cancer.
This condition occurs initially due to the herpes virus or HPV. Provoking factors include:
- Severe, long-term chronic diseases.
- Early intercourse and childbirth at a young age.
- Active or passive tobacco abuse.
- Immunodeficiency.
- Hormonal imbalances due to pregnancy, menopause or hormone abuse.
- Cervical injury.
When talking about reactive changes in the cells of the columnar epithelium and other aspects of the topic under discussion, it must be noted that dysplasia does not have an independent clinical picture. It proceeds secretly in about 10% of women. But often a microbial infection joins, each of which almost always makes itself felt. In many cases, these are gonorrhea, warts, chlamydia.
As part of the diagnosis, examination of the cervix, cytological examination of the Pap smear, colposcopy, biopsy study, and also resort to immunological PCR methods are carried out.
What about treatment? With extensive lesions, the use of interferons and their inducers, as well as immunomodulators, is indicated. In severe cases, surgical intervention is indicated - either the dysplasia zone or the entire cervix is removed.
Cervical polyps
Much has been said above about reactive changes in squamous and columnar epithelium. There is another pathological condition - it is characterized by the formation of polyps in the cervical canal.
These are tumor-like formations that come from the columnar epithelium. They grow right into the gap.
This pathology is faced mainly by women over 40 years old. It is generally accepted that the cause is age-related changes, hormonal disorders, immune problems, stress. Mechanical trauma, diagnostic curettage, and chronic endocercivites are considered predisposing factors.
Approximately in 75% of cases, polyps are combined with erosion, fibroids, ovarian cysts, atrophic colpitis, pseudo-erosion. Still at risk are women with candidiasis, herpes, mycoplasmosis, ureaplasmosis, trichomoniasis, HPV, etc.
Asymptomatic. Polyps are visually detected. Diagnosis is performed using colposcopy, cervical biopsy, ultrasound.
Any polyp is an indication for its removal. After this procedure, scraping is carried out so that the leg does not remain inside. The polyp bed is additionally treated with a radiofrequency or cryogenic method. When revealing echographic signs, hysteroscopy is indicated. Then curettage of the uterine cavity is also performed.
Flat cervical papilloma
This neoplasm is very dangerous, as it is quite capable ofprovoke the development of cancer. It all starts with the penetration of HPV into the body. The virus infects the cells of the mucosa and skin, causing tissues to grow.
Provoking factors include:
- Alcohol abuse.
- Pregnancy.
- Taking cytostatics.
- Smoking.
- Lack of vitamins.
- Earlier onset of sexual activity.
- Atopic dermatitis.
- Removal of papilloma.
- Disturbed microflora in the vaginal cavity and in the intestines.
- Local manifestations of diseases.
Symptoms may not be present for a long time. Flat papilloma can be detected during the examination, during the above diagnostic measures.
Symptoms appear only when the neoplasm has reached a large size. The woman begins to feel a burning sensation in the genital area, her inguinal lymph nodes increase, and a specific mucus begins to stand out from the vagina.
After the discovery of papilloma, it is necessary to start drug treatment. Doctors often prescribe Gardasil. It is important to combine it with taking drugs that increase the body's defenses. As a rule, it is recommended to use such means:
- Immunomodulators - "Interferon" or "Genferon".
- Cytostatics - 5-fluorouracil, Bleomycin and Podophyllin.
- Antiviral - Panavir and Isoprinosine.
Destructive drugs can also be prescribed, the intake of which contributes to the destruction of growths. But in severe cases, of course, surgery is prescribed.treatment.
Prevention
Every girl is recommended to have a gynecological examination at least once a year. Based on the foregoing, it could be understood that many serious ailments can be asymptomatic, and when they make themselves felt, it will be too late for conservative therapy.
Treatment is also always given on an individual basis. The origin of the inflammation, the age of the patient, whether she is planning a pregnancy and, of course, the type of pathology are taken into account.
But the most important thing is a responsible approach to the choice of sexual partners. There may not be a permanent man, but it is always necessary to defend yourself. Because it is STDs that lead to reactive changes.
And you also need to constantly maintain your immunity, regularly strengthen it. Because the weakened defenses of the body provide the best conditions for the development of the virus.
And of course, it is necessary to carefully select oral contraceptives. Their selection is handled by a doctor. The wrong choice of pills can be fraught with serious consequences. A disturbed hormonal background is one of the reasons for reactive changes.
