Glandular endometrial hyperplasia is a pathology in which the anatomical structure of the tissue of the inner layer of the uterus is disturbed. This disorder consists in the excessive growth of glandular cells, as a result of which the endometrial tissue itself increases in volume.
The content of the article:
Classification of endometrial hyperplasia
Causes of endometrial glandular hyperplasia
Symptoms of glandular endometrial hyperplasia
Diagnosis of glandular endometrial hyperplasia
Treatment of glandular endometrial hyperplasia
Prevention of glandular endometrial hyperplasia
Glandular endometrial hyperplasia
In general, cyclic changes in endometrial tissue are a normal phenomenon. Cells grow for a certain period of time under the influence of hormonal regulation. The growth process ends with the onset of menstruation and the rejection of excess cells. In this case, we are talking about natural hyperplasia. However, if the glandular layer begins to grow spontaneously (that is, outside the cycle and without the influence of hormones), then it is safe to talk about a violation in a woman’s body. Such cell proliferation can lead to the inability to realize reproductive function, and in the worst case, it can develop into an oncological disease.
Classification of endometrial hyperplasia
Glandular endometrial hyperplasia is just one of the varieties of pathological proliferation of cells of the inner layer of the uterus. Other forms are also known:
glandular-cystic hyperplasia;
adenomatosis;
endometrial polyps.
Glandular-cystic hyperplasia of the endometrium occurs when the growing cells take the form of cysts.
Adenomatosis is a proliferation of cells, accompanied by their structural transformation. As a result, polymorphism of cell nuclei and a decrease in stromal components are observed.
Endometrial polyps are a manifestation of focal hyperplasia, in which not only the glandular epithelium grows, but also the integumentary, as well as the underlying tissues.
There is another classification — by the presence of atypia (changes in the structure of cells). The adenomatosis mentioned above will refer to complex endometrial hyperplasia. Simple glandular hyperplasia of the endometrium, in turn, consists in the quantitative proliferation of cells. Glandular-cystic, as a rule, also does not carry atypia.
Causes of endometrial glandular hyperplasia
The main factor provoking increased growth and the rate of division of endometrial cells is hormonal failure. A similar situation may arise if the female body lacks progesterone, and estrogen, on the contrary, is produced too much.
Against this background, women after 45 who are approaching menopause are at risk. In addition, there are frequent cases of diagnosis of glandular endometrial hyperplasia in girls during puberty. Patients of both age categories are affected by hormonal adjustment.
May provoke the development of glandular endometrial hyperplasia and some background genital processes. These include:
endometritis (inflammation of the inner mucous layer of the uterus);
endometriosis (abnormal proliferation of endometrial cells);
uterine fibroids (benign neoplasm);
PCOS (polycystic ovary syndrome);
follicle persistence syndrome (continuation of follicle life despite the fact that ovulation did not occur);
formation of follicular cysts.
Gynecological surgical interventions, such as abortions or diagnostic curettage, can also cause the appearance of this deviation. Unborn women, as well as women whose menopause came late, are more likely to become victims of glandular endometrial hyperplasia. Abrupt discontinuation of the use of hormonal contraceptives increases the risk of disease.
It is worth noting other diseases, against the background of which glandular endometrial hyperplasia develops more likely:
fatness;
hyperglycemia (high blood sugar, including diabetes mellitus);
granulosa cell tumors;
hypertension (high blood pressure);
mastopathy (benign pathology of the breast);
diseases of the thyroid gland;
diseases of the adrenal glands;
kidney diseases;
liver diseases.
A large role in this violation is assigned to such a condition as hyperestrogenism.
Symptoms of glandular endometrial hyperplasia
The symptoms of this pathology are often confused with the manifestations of uterine fibroids. The main sign of both is blood discharge or bleeding that is not associated with the onset of menstruation. Severe bleeding is more likely to haunt young girls, and women of preclimatic age usually face smearing secretions.
When it comes directly to menstruation, the bleeding becomes too abundant and lasts longer than usual. Active glandular hyperplasia of the endometrium often leads to the development of anemia in the patient due to large blood losses. The menstrual cycle itself in some cases gets lost: menstruation can be absent for a long time, and, conversely, be too frequent.
Since glandular endometrial hyperplasia occurs under the influence of hormonal failure, the patient may experience a lack of ovulation and, as a consequence, infertility. In addition, the hyperplastic layer of the uterus becomes an insurmountable obstacle for the egg, even if it has been fertilized.
But even if pregnancy has occurred, hyperplasia (especially focal) in most cases leads to miscarriage. In the presence of such a disease, even in vitro fertilization will not help to have a child — doctors with this diagnosis do not even undertake the procedure.
Diagnosis of glandular endometrial hyperplasia
It should be noted right away that such a diagnosis cannot be made on the basis of a visual examination, therefore the diagnosis must necessarily be histological. Of course, gynecological and ultrasound examinations should not be neglected, but the final word will be the results of histological analysis.
Initially, the gynecologist can only determine by touch the increase in the size of the uterus or its compaction. This will be the reason for a more detailed examination. With the help of a transvaginal ultrasound, he will assess the thickness of the walls of the uterus, as well as the condition of the endometrium. Abdominal examination in this case will be uninformative. In addition, the gynecologist with the help of ultrasound needs to simultaneously clarify the presence of cysts or signs of PCOS.
For histological examination, a woman is sent for diagnostic curettage or aspiration biopsy. These procedures are carried out on the eve of the next menstruation. The informative value of hysteroscopy exceeds 94 percent.
This diagnostic method is practically painless, does not require observation in a hospital and in just a few minutes allows you to obtain material that will give an accurate picture of the disease. The results of the analysis can be ready both in 2 days (with sufficient availability of laboratory resources) and in 2 weeks.
Treatment of glandular endometrial hyperplasia
If such a diagnosis as glandular endometrial hyperplasia is made, treatment should follow immediately, since this disease is fraught with a transition to oncological. If atypia is not detected, then the goal of treatment will be to prevent uterine bleeding and prevent changes in cellular structures. In this case, after undergoing hormone therapy, a woman may even become pregnant.
If hyperplasia is atypical, a surgical method of treatment is most often used, namely, removal of the uterus. Although with the development of medicine, it is increasingly possible to conduct organ-preserving therapy, which allows the patient to experience the joy of motherhood in the future.
It is impossible to give an unambiguous treatment regimen — the fight against glandular endometrial hyperplasia is carried out on an individual basis, taking into account the peculiarities of the anamnesis of a particular woman. Hormone therapy may include several means to stop the proliferation of endometrial cells and simultaneously adjust the level of estrogen in the body.
For these purposes , the following are used:
progesterone and its synthetic analogues (progestogens);
combined oral contraceptives;
gonadotropin releasing hormone agonists.
Surgical methods do not always involve complete removal of the uterus. The following options are possible::
scraping of the pathological layer;
cryopreservation on the affected areas;
laser moxibustion.
It is worth noting that hormone therapy allows, if not to prevent, then at least to reduce the volume of surgical intervention. At the same time, after surgery, a course of hormonal medications may be required for more effective recovery.
There are also folk methods for the treatment of glandular endometrial hyperplasia, but it is by no means impossible to replace traditional treatment with them. Phytotherapy, including tinctures and decoctions for oral administration and douching, can only have a supportive effect and accelerate recovery. However, if you focus on folk methods and completely abandon medical ones, you can cause huge damage to your health. We must not forget about the risk of hyperplasia degenerating into cancer.
Prevention of glandular endometrial hyperplasia
Obviously, in order to prevent the development of this pathology, it is necessary to closely monitor your hormonal background. And this means that every woman should listen to the slightest changes in her body. But it is also not worth postponing a scheduled examination until the first symptoms of a malfunction appear.
Competent use of hormonal contraceptives and strict adherence to the doctor’s instructions on refusal from them will also help to avoid such a dangerous outcome.
A lot also depends on the doctor: the correct selection of means of protection, timely referral for histological examination, careful management of pregnancy — all this helps to prevent the appearance of glandular endometrial hyperplasia in the patient.
