Hormonal changes associated with the onset of postmenopausal women may trigger the development of pathological changes in the uterine lining, which is commonly called endometrial hyperplasia, or adenomyosis in the scientific community. You can learn more information about this ailment from the material below.
Features evolved changes in the mucous membrane of the uterus
The endometrium, or the single-layer epithelium lining the female genital organ, is very sensitive to hormonal fluctuations. Against the background of neuroendocrine disorders, the central regions of the brain no longer properly control the functioning of target organs, ovaries, uterus, which ultimately leads to an unreasonable growth of the epithelium. Pathology of the endometrium in postmenopause can have the following forms:
- Glandular - characterized by simple growth of the epithelium.
- Glandular cystic - involves an increase in glandular tissue with the appearance of multiple nodules.
- Focal - implies hyperplasia of the connective tissue, in which the formation of polyps.
- Adenomatous, in which atypical cells are found.
It should be borne in mind that involutive changes in the reproductive organs in women fall at the age when the main immune organ, thymus, decreases the intensity of T-lymphocyte production. As a result, the malignancy of overgrown endometrium cells becomes possible. Cancer is considered the main and most dangerous consequence of the pathology of a single-layer epithelium of the uterine cavity.
Why endometrial hyperplasia occurs in menopause
Today, doctors do not have a clear understanding of the causes of hyperplastic changes in the uterine lining. Nevertheless, it is considered that endometrial pathology in postmenopause and menopause results from dysregulation of the hormonal regulation of the menstrual cycle. It is important to note that epithelium thickening is often diagnosed during the onset of menopause. This phenomenon is considered quite normal for menopause.
Over time, enlarged areas of the mucous are rejected and the endometrium becomes normal thickness. In a situation when adenomyosis is found in postmenopausal women, doctors recommend that patients undergo a full examination for the presence of comorbidities of the reproductive organs. Among the provoking factors of pathology can be identified:
- hereditary predisposition
- hormone therapy
- Complications after scraping.
How is postmenopausal endometrial hyperplasia
The danger of proliferation of the uterine mucosa is the almost complete absence of symptoms of the development of this disease. The only sign of a thickening of the endometrium during postmenopausal is a sudden abundant discharge, often turning into uterine bleeding. As a rule, women go to the doctor when symptoms of background pathology appear. Patients may experience:
- fatigue and irritability,
- pulling pains in the abdomen,
Reliable information about the state of the uterine mucosa can be obtained by visual inspection of the organ, which became possible after the hysteroscopy method was introduced into gynecological practice. In contrast to the usual cure, this procedure allows you to completely remove the endometrium that was changed due to the hormonal imbalance.
The biomaterial obtained at the end of hysteroscopy is usually sent for research. In a situation where the thickness of the endometrium during postmenopause reaches 10-15 mm, curettage with subsequent histology of the removed tissue samples is indicated. In addition to visual inspection, patients with symptoms of pathology of the uterine mucosa undergo abdominal and transvaginal ultrasound.
Causes of pathologies
Endometrial pathology often appears due to:
- infectious diseases
- endocrine disruption,
- polypous growths
- effects of estrogen
- hereditary factor.
Inflammatory processes can occur due to:
- sexually transmitted diseases
- childbirth with complications.
When a woman outgrows a certain age line, she is faced with changes in the functioning of the sexual, hormonal systems. Changes in the menstrual cycle, lead to changes in the work of hormonal levels. The first signs of deterioration of the reproductive system are:
- general weakness
- excessive irritability,
- weight gain.
The development of endometrial pathology aggravates these symptoms and a woman has gynecological complaints. Among these symptoms can be observed blood discharge of a dark color, thick consistency, turning into bleeding. Such bleeding has a spontaneous nature and can be abundant, with secretions of pieces, clots of the mucous membrane.
These bleedings are accompanied by strong pulling pain in the uterus. The woman feels worse, in particular appear:
- irresistible thirst
- abundant bleeding for a long time
- degradation of performance
If a woman ignores the symptoms, she develops:
- blood pressure surges,
- weight gain due to accumulations of excess fluid.
What pathologies are
A woman should be aware of what endometrial pathologies are, because it is the state of this layer of the uterus that largely determines her health and ability to bear children.
- Hyperplasia is a pathology in which mucous membrane cells begin to actively divide under the influence of internal factors, as a result of which the endometrium thickens. Anomaly appears when there is an insufficient amount of progesterone in the body, an overabundance of estrogen. The patient is prescribed hormone therapy.
- Hypoplasia - thinning of the endometrial layer, accompanied by severe pain during menstruation, reducing the likelihood of fertilization, possible infertility. Treatment is carried out by hormonal drugs, often they are the same as in the treatment of hyperplasia.
- Endometritis of the uterus - an infectious lesion of the uterus due to ingestion of infection, fungus, virus. Drug therapy is prescribed, combining antibiotics and anti-inflammatory drugs. Read more in the article ""
- Hypertrophy - a thickening of the entire mucous membrane of the uterus.
- Hypotrophy - endometrial failure. Pathology is treated hormonally.
- Focal fibrosis of the stroma - the appearance on the stroma of a hollow formation filled with fluid. Perhaps drug, surgical treatment.
- Endometriosis - endometrial thickening by dividing unchanged cells. If atypical cells are present in the scraping, one should speak of the precancerous condition.
Treatment of endometrial pathology can be surgical and conservative. It all depends on the individual development of the disease. Conservative therapy includes the appointment of hormonal drugs. It is necessarily accompanied by antibacterial and detoxification therapy.
Treat pathology need a complex. So you can achieve the desired result without fear of relapse.
Endometrial pathology can be treated by surgery. There are three common methods:
- therapeutic and diagnostic curettage, used for uterine bleeding. His goal is to stop bleeding, get a biomaterial for research,
- hysteroresectoscopy, in the course of which the polyps are removed, the pathological layer of the endometrium,
- removal of the uterus, which is carried out when a large number of atypical cells are detected during hysteroresectoscopy.
Pathology in menopause
During menopause, the normal thickness of the uterus should not exceed 5 mm. If its thickness increases by 2 mm, it is necessary to undergo regular examinations. In cases where there are deviations from the norm of more than 3 mm, the woman needs full therapy, because endometrial hyperplasia develops.
Pathology of the endometrium in menopause in a woman quite often develops in the form of uterine dysplasia. In the normal state, the basal layer consists of rounded cells containing a single nucleus. As it ripens, moving to the surface layer, the nucleus decreases. In case of violation (dysplasia), a large number of atypical cells are formed, gradually replacing healthy cells with sick ones. Dysplasia can be of three forms:
Reviews of patients who are faced with endometrial abnormalities show that timely and correct diagnosis of the disease gives a high chance of getting rid of it.
Irina 40 l, Omsk
After the research - hysteroscopy and diagnostic curettage, the specialist diagnosed adenomyosis, chronic endometritis. Assigned after hormonal treatment, which is an improvement. Thanks to timely treatment competent, the uterus was saved.
Tatyana 30 l, Ekaterinburg
Last winter, endometrial hyperplasia was diagnosed. Hormone treatment was prescribed for 3 months. Followed the recommendations of the doctor, saw pills. Repeated ultrasound after 3 months showed that the extra endometrium was gone.
Antonina 32 g, Perm
After the diagnosis of hysteroscopy, the doctor prescribed the Janine course for 4 months without a break. The treatment was successful, after it almost immediately became pregnant. Complications have arisen.
Treatment of endometriosis pathologies should be comprehensive, timely. Regular examinations at the gynecologist, attentive attitude to your own well-being will help prevent the development of the disease or detect it in the initial stages.
When comes postmenopause
Menopause is the time of the last physiological menstruation.
About 50% of women have menopause between the ages of 45-50 years old, 20% have it after 50 years, and 25% have an early (before 45 years) menopause.
Periods of female development
On the causes and treatment of endometrial hyperplasia in menopause, read in detail in the article: Endometrial hyperplasia in menopause.
What is endometrial hyperplasia - a brief overview
The endometrium is the inner lining of the uterus, more precisely, the mucous layer of the uterine wall adjacent to the myometrium (muscle layer). It is represented by a stroma, the uterine glands and blood vessels immersed in it.
Endometrial hyperplasia is a benign hormone-dependent proliferative transformation of the uterine mucosa in violation of its structure and functions.
Endometrium is a variable tissue that is highly sensitive to the action of sex hormones. Estrogen stimulation contributes to its growth due to proliferation of the uterine glands. Progesterone, on the contrary, stimulates the maturation and growth of the stroma, but inhibits the proliferation of the epithelium of the glands.
Read more about the different forms of endometrial hyperplasia, the causes of the development and treatment of this disease in the article: Treatment of endometrial hyperplasia.
The main volume of estrogen and progesterone in women is produced in the ovaries.
In childbearing age, the key point in the development of typical hyperplasia is hormonal imbalance, more precisely, estrogenia: endometrial hyperstimulation with estrogen with a lack of progesterone deterrent activity.
The causes of postmenopausal endometrial hyperplasia after extinction of the hormonal activity of the ovaries are not always explicable.
Genetic predisposition plays a leading role in the development of oncological diseases of the female genital organs and hyperplastic pathology of the endometrium in postmenopausal women.
Postmenopausal endometrial hyperplastic processes
The structure of the hyperplastic processes of the endometrium in postmenopausal
Atypical endometrial hyperplasia is a precancerous process. It can occur independently, as well as against the background of diffuse, focal typical hyperplasia, polyposis and endometrial atrophy.
On the risks, prognosis and treatment of endometrial hyperplasia with atypia, read in detail in the article: Atypical endometrial hyperplasia.
Causes of diffuse endometrial hyperplasia in postmenopause
The appearance of diffuse hyperplasia of the uterine lining at an older age in the first place makes you look for a source of pathological secretion of estrogen. Causes of hyperestrogenia in postmenopausal women:
- Ovarian pathology: hormonally active ovarian tumors, tekomatoz, stromal ovarian hyperplasia.
- Diencephalic pathology: age-related restructuring of the central nervous system and related endocrine-metabolic disorders.
- Obesity: extragonadal production of estrogen in adipose tissue.
Causes of focal endometrial hyperplasia in postmenopause
Focal hyperplasia of the uterine lining at an older age most often occurs in the form of polyposis.
Polyposis is a form of focal hyperplastic process caused by the benign transformation of the basal layer of the endometrium.
Typical focal hyperplasia or endometrial polyposis in postmenopause develops against the background of chronic inflammation of atrophied parts of the uterine mucosa (chronic atrophic endometritis).
Local factors in the development of local endometrial pathology in postmenopausal women:
- Changes in endometrial hormone receptor apparatus: an increase in the number and sensitivity of estrogen receptors to small doses of the hormone.
- Increased activity of insulin-like growth factors.
- Slowing down the planned cell death (apoptosis).
- Violation of local immunity.
Physiological changes in the endometrium
Endometrium is the tissue that lines the uterus, that is, its inner mucosa. It is abundantly shrouded in a network of blood vessels and plays an important role in the process of gestation and fetal development.
This tissue contains a large number of receptors that ensure its sensitivity to hormones that are produced in the ovaries (estrogen and progesterone). The receptors are contained in the endometrial cells themselves. The number of receptors that perceive hormones of the estrogen series increases significantly by about the middle of the menstrual cycle, and the receptors responsible for the perception of progesterones in its second half.
During the whole menstrual cycle, the endometrium increases its thickness, and by the end of the cycle it becomes about 10 times thicker compared to the first phase. The change in the thickness of the mucous membrane proceeds in stages: the first half of the cycle refers to the phase of proliferation, and the second to the phase of secretion. In the secretion phase, the endometrial tissue contains a large number of glands. The stages of endometrial growth are determined by conducting a histological examination (examining tissue pieces under a microscope). During menstruation, the functional layer of the mucous membrane is rejected, which gives rise to menstrual bleeding. Then, due to residual cells of the glands, preserved in the basal (deepest) layer of the endometrium, its growth begins again.
In menopause, after a woman has a supply of follicles in the ovaries, the production of estrogens stops. Therefore, no changes occur in the uterine mucosa, its thickness remains constant.
When is the process pathological?
The most common pathology faced by women in menopause is the continuation of the growth of endometrial cells, leading to an overgrowth of the uterine lining. More often, this disorder develops in women who are in the premenopausal period, when major hormonal changes occur.
Prerequisites for excessive growth of the endometrium are:
- overweight (as you know, adipose tissue has the ability to synthesize its own estrogens),
- diabetes and other endocrine pathologies,
- hypertension and a number of other somatic diseases,
- uterine fibroids.
The growth of the endometrium is called hyperplasia. This pathology is among the precancerous conditions, since the growth of endometrial cells can at any time take a malignant course. Often the pathological growth of tissue begins during the preparation of the body for menopause, and is detected after its occurrence.
Experts identify several types of endometrial hyperplasia:
- Ferruginous. Manifested by the growth of glandular cells of the tissue, which change their shape, become crimped. Of these, the secret stands out freely. Cells of the connective tissue layer of the endometrium remain normal. This form has the most favorable projections, the risk of malignancy is minimal.
- Glandular cystic. On the background of the proliferation of glandular cells form cysts. They are the accumulation of the secret of overgrown glands and result from the disruption of the process of its outflow.
- Cystic form. Glands enlarged in size resemble bloated bubbles. The epithelial tissue of the uterus is affected. High risk of malignancy process.
- Focal growth. Mucosa grows in certain areas that have the highest sensitivity to the action of hormones. Polyps are formed that can degenerate into cancerous tumors.
- Atypical form. Manifested by the growth of not only functional, but also a deeper layer of the endometrium. In every second case, this form gives rise to the development of a malignant tumor.
To differentiate the type of mucosal changes, various examination techniques are used.
Principles of treatment
In the fight against endometrial hyperplasia, two main methods are used: conservative and surgical.
Conservative treatment involves the use of hormonal drugs that contribute to the normalization of the cells of the mucous membrane. Hormone treatment significantly reduces the risk of cancer.
Surgically, only the mucous membrane of the uterus is scraped or the organ is completely removed. As a rule, radical operations are performed only after obtaining the results of a histological analysis of the endometrium.
Other methods of surgical treatment are used, in particular, laser ablation. This operation allows you to destroy the foci of pathological tissue growth with minimal damage to the woman's body.
In most cases, a combination of both methods is used, which significantly increases the effectiveness of treatment.
Manifestations of endometrial hyperplasia in pre-, post-and menopause, diagnosis and treatment of the disease
The climacteric period for a woman is a time when the number and proportion of sex hormones, which provided her with a fairly good state of health, varies greatly. Now she must be especially vigilant about her health and pay attention to those changes that were brief in youth and did not cause concern.
Most of all it concerns menstruation: their strengthening, the appearance after a long break or the situation when they repeat twice a month is dangerous.
This may be the manifestation of endometrial hyperplasia in menopause, a disease that can “degenerate” into cancer without proper treatment.
Particularly at risk are women who have had heavy menstruation, had or have uterine fibroids, endometriosis or a breast tumor.
What is endometrial hyperplasia?
The term “hyperplasia” refers to an increase in the thickness of the tissue (in this case, the endometrium) due to the excessive formation of its constituent cells.
Endometrium is called the inner lining of the uterus, which is designed to ensure that the embryo appears conditions for nutrition and development.
The main responsibility for providing the fetus with nutrients is the internal, functional layer of the endometrium. Before the onset of menopause, it is subject to the following changes every month:
- Immediately after the end of menstruation, it is very thin - up to 1 mm.
- Prior to the release of a mature egg, the main hormones are estrogen. They cause a natural hypertrophy of the mucous membrane - an increase in its cells in volume. The thickness of this uterine membrane should be 4-5 mm.
- In the hope of fertilizing the egg in the ovary, a corpus luteum is formed - a temporary endocrine organ secreting progesterone into the blood. This hormone “commands” the endometrium to increase in volume, its glands to acquire a tortuous shape and begin to produce a clear liquid. Specific outgrowths on the upper cells of this layer - the cilia - actively “flicker”, helping to promote a fertilized egg. The thickness of the functional uterine zone here - up to 8 mm.
- If conception did not occur, what the endometrium “learns” by the absence of an increase in chorionic gonadotropin and progesterone, it becomes thinner, there are areas of hemorrhages and necrosis in it, and soon it completely exfoliates - menstruation occurs.
The lower, basal layer of the endometrium is almost unchanged. But it gives rise to new cells of the functional stratum, instead of exfoliated ones.
In menopause, the need for maturation of the eggs disappears, the levels of sex hormones are reduced, the menstrual cycles disappear. The functional endometrial layer should gradually atrophy, almost completely disappearing to postmenopausal.
But if there is an increased level of estrogen in the body, and progesterones cease to have an inhibitory effect, the “working zone” grows more and more. Often such situations occur long before the onset of menopause, therefore, endometrial hyperplasia is common in the premenopausal period.
Causes of endometrial hyperplasia
This disease is registered in more than 15% of women. Its causes are those conditions in which the level of estrogen in the blood rises:
- obesity (fat cells can convert the male hormone testosterone to estrogen),
- tekomatoz - the proliferation of functional ovarian tissue, which often occurs in women after 40 years of age due to an imbalance of “command” hormones produced by the hypothalamic-pituitary system,
- estrogen-producing ovarian tumors,
- hepatic diseases, in which the level of proteins in the blood decreases (it is the liver that produces them), which bind estrogens and prevent them from interacting with receptors,
- adrenal gland diseases, in which the level of estrogen increases,
- increased insulin levels in diabetes mellitus, which increases the working tissue of the ovaries,
- taking drugs with estrogen,
- genetic predisposition to increased estrogen production,
- frequent manipulation of the uterus (abortion, curettage), which lead to the replacement of normal epithelial connective tissue. Due to the decrease in the volume of functional tissue, the endometrium reacts worse to the commands of progesterones.
Endometrial hyperplasia is not always caused by an increase in the absolute amount of estrogen: the duration of the effect of estrogen on the uterine mucosa is more important.
Namely, in menopause and premenopausal, a situation arises when, due to anovulatory (without ovulation) cycles, their first phase is extended, and a low level of progesterone is not able to transform the endometrium into secreting glands.
The disease manifests itself most often in perimenopause - the period covering premenopause and menopause (actually menopause). Postmenopausal endometrial hyperplasia is rare.
Fibroids, uterine fibroids, endometriosis and mastopathy, even when they are cured, are not causes of pathology, but markers indicating that a woman has a high chance of developing hyperplasia in perimenopausal women.
Another indicative condition is an earlier (earlier 45 years old) menopause. All these women need to undergo preventive gynecological examinations 2 times a year, and ultrasound of the reproductive organs - 1 time per year.
Based on the division of pathology into species according to the histological structure, the gynecologist selects the treatment of endometrial hyperplasia in menopause. So, there are 5 types of pathology:
- Glandular hyperplasia. Characterized by the proliferation of the endometrial glands. They become tortuous, but do not clog, highlighting their secret into the lumen of the uterus. This type has the most benign course and good prognosis.
- Cystic type. In this case, the glands do not grow much, but they become blocked, forming cysts. Much more malignant form than the previous one.
- Glandular cystic hyperplasia. In this case, the glands and grow, and their excretory ducts are blocked. Can give rise to cancer in 5% of cases.
- Focal form of pathology. The endometrium expands and changes only at one or several sites in the uterus, in the form of polyps.
- Atypical type. The most malignant form (cancer develops in 60% of cases), attributable to precancerous.
How is pathology manifested in menopause?
Symptoms of endometrial hyperplasia in menopause are not very different from those that indicate this pathology after the absence of menstruation for 12 months. The main ones are bloody vaginal discharge. They are either abundant or scarce, but appearing after a lack of menstruation or, on the contrary, appearing twice a month, may indicate a disease.
Often, bleeding is accompanied by cramping pain in the lower abdomen. Very rarely, endometrial hyperplasia occurs without discharge - only with pain or such “common” symptoms such as headache, insomnia, weight gain, decreased performance, thirst, and particular irritability.
In premenopause, the presence of the disease can be suspected on the following grounds:
- menstruation became painful
- the cycle has become irregular
- appearance of bleeding twice per cycle
- there was a delay before the expected monthly periods, and then heavy bleeding began,
- menstrual flow with a regular cycle became abundant,
- "Monthly" lasts 10-14 days.
How is the diagnosis?
The diagnosis of endometrial hyperplasia is made by the gynecologist on the basis of instrumental examinations, which the specialist prescribes on the basis of the woman’s complaints or colposcopy data, when the doctor can detect formations similar to a polyp.
One of the main diagnostic methods is an ultrasound scan of the uterus, performed by a transvaginal probe.
If it reveals that the thickness of the M-echo (endometrium) is 6-7 mm in menopause, a hysteroscopy is prescribed - an examination of the uterine cavity using endoscopic equipment.
During this procedure, carried out under general anesthesia, it is possible to take several areas of the endometrium for histological examination.
If in menopause M-echo is 8 mm and higher, then diagnostic curettage of endometrial hyperplasia is performed to exclude cancer. It is also carried out under general anesthesia, and is at the same time a therapeutic and diagnostic procedure, allowing both to stop abundant bleeding and fully examine the “scraped” endometrium under a microscope.
Endometrial thickening of more than 10 mm - an indication for separate curettage and the study of the uterus with radioactive phosphorus. When introduced into a vein, it migrates to the “unhealthy” (where cells are modified) endometrial tracts, where it accumulates. For histological examination, it is these zones that are taken.
Treatment of the disease depends on its histological type (glandular, cystic, etc.), the age of the woman, the concentration of her sex hormones in the blood, the presence of breast cancer.
It is conservative when various types of hormones are prescribed, and operational - by burning out overgrown areas, by scraping them or by removing the uterus.
Women 40-45 years old
At the age when there is still menstruation, the following treatment tactics are applied:
- If an increased amount of estrogen is detected, there is no breast cancer, and there are no atypical (abnormal, precancerous or cancer) cells in the hyperplastic endometrium, oral contraceptives (Regulon, Novinet) are prescribed for a course of 3 months. If there is no effect, surgical treatment is carried out - laser burning out of overgrown foci (laser ablation) or curettage.
- If, in addition to an increased amount of estrogen, precancerous (atypical) cells are found in the functional layer of the uterus, oral contraceptives are prescribed for therapeutic purposes, or an intrauterine system of the Mirena type is placed. The course is 3 months, after which surgical treatment is carried out. In some cases, even the question of the removal of the uterus is considered.
- If a histological examination reveals cancer, it is treated with chemotherapy, radiotherapy, and surgical treatment. After that, hormones are prescribed, as if creating natural menstrual cycles and maintaining a woman's metabolism at a level that is sufficient at this age.
Good results in premenopausal endometrial hyperplasia are due to Duphaston. This progesterone drug blocks the effects of estrogen on the endometrium, stopping its growth. While taking this drug may intermenstrual blood.
Principles of treatment for women aged 46-52 in menopause
The treatment is aimed at achieving 2 main goals - to stop the bleeding and prevent its renewal. For the implementation of the first paragraph perform curettage, diathermic or laser ablation, after which hemostatic drugs are prescribed: Ditsinon, Calcium chloride, Calcium gluconate.
Prevention of recurrent bleeding is carried out using one of the types of hormones:
- combined oral contraceptives
- gonadotropin-releasing factor antagonists (Buserelin, Goserelin and others),
- sometimes - synthetic progesterone analogues (Duphaston, Norkolut).
Treatment of endometrial hyperplasia in postmenopausal patients in the absence of atypical cells in the endometrium is performed by surgical methods: laser ablation, curettage. After surgery, hormone replacement therapy is carried out, the intrauterine device can be placed.
If atypical cells are detected in the postmenopausal women in the endometrium, surgical treatment is carried out followed by chemotherapy or radiotherapy.
How to recognize and treat endometrial hyperplasia in menopause and postmenopausal: measures, prevention, reviews
Endometrial hyperplasia in menopause is a common problem that occurs in women in the age group after 50.
Hormonal changes that occur in the female body with the onset of menopause, lead to a weakening of local immunity, which increases the risk of gynecological diseases, which include menopause hyperplasia.
This pathology can be dangerous, so it is important to know the signs of this disease and contact a specialist in a timely manner.
Endometrial hyperplasia in women with menopause is a pathological condition with a concomitant proliferation of the mucous uterine layer. With the progression of the disease, the endometrium begins to grow into the muscle structures of the uterus. This pathology is a violation of the processes of division of cellular structures and rejection of the endometrium.
Normally, the endometrial layer grows in the first half of the menstrual cycle and, in the absence of the onset of pregnancy, is rejected, goes along with the menstrual blood.
Patients in the menopausal period may have a disturbance in the functioning of the reproductive system, in which the basal endometrial layer continues to grow, but delamination does not occur naturally, which leads to hyperplasia.
Such a pathological condition is fraught with the development of disorders in the functioning of the hormonal, reproductive, endocrine systems and can cause cancer.
Types of endometrial hyperplasia of the uterus in menopause:
- Glandular hyperplasia - accompanied by growth and deformation of the glands localized in the endometrium, which leads to its increase, penetration deep into the uterine muscular structures.
- Cystic hyperplasia of the endometrium - characterized by a specific growth of the epithelium, leading to the overlap of the openings of the exit gland with the subsequent formation of cystic tumors. This form of pathology can provoke oncology.
- Focal - accompanied by the formation of polyps, they form foci of endometrial growth.
- Basal - One of the rarest varieties of the disease, in which the inner layer of the epithelial membrane begins to grow deep into the uterus.
Symptoms and treatment of different forms of hyperplasia may differ slightly.
Causes of endometrial hyperplasia
Endometrial hyperplasia in postmenopausal and menopause can be triggered by numerous factors. Often the pathological process begins to develop long before the onset of menopause. The causes of endometrial hyperplasia in premenopausal and menopausal periods are:
- violation of exchange processes,
- diseases of the pancreas, thyroid, adrenal glands contribute to the production of an increased amount of estrogen and the development of adenomyosis,
- changes in the mucous membranes of the genital organs of an age nature with a concomitant decrease in local immunity,
- past cure, abortions, surgical interventions in the uterus,
- genetic predisposition
- autoimmune processes in which the body perceives uterine mucous membranes as an alien element, which activates the processes of their growth,
- hormonal disorders.
The cause of menopausal disorder can be a prolonged, uncontrolled use of drugs, the action of which is aimed at eliminating the manifestations of menopausal syndrome, the presence of tumor neoplasms, myomas, polyps, mastopathy.
To the greatest extent the disease affects the representatives of the weaker sex in the age category up to 50 years. Postmenopausal hyperplasia is a rare phenomenon.
The high-risk group includes patients diagnosed with early menopause, occurring in the age group under 45 years of age. For preventive purposes and for modern diagnostics, women with predisposing factors for the development of adenomyosis are recommended to undergo gynecological examinations and ultrasound examination of the genital organs at least 2 times a year.
Manifestations of pathology
The main manifestations of menopausal pathology are vaginal bleeding. There are other clinical symptoms characteristic of endometrial hyperplasia in menopause:
- uterine bleeding,
- painful sensations localized in the lower abdomen, which are predominantly cramping,
- increased fatigue
- increase in weight category
- обострение заболеваний, протекающих в хронической форме,
- приступы головных болей.
В редких случаях болезнь протекает без выделений. In this case, women complain of a pronounced pain syndrome, general weakness, migraine, causeless irritability.
Endometrial hyperplasia in premenopause can also be manifested by the following symptoms:
- failure of the menstrual cycle
- painful, prolonged periods, lasting about 2 weeks,
- excessively intense, heavy menstrual bleeding,
- discharge the bloody character twice throughout the cycle,
- delayed menstruation followed by profuse discharge.
An expert can make an accurate diagnosis and prescribe a therapeutic course after a preliminary examination, when echoal signs of endometrial hyperplasia are detected.
What to do if endometrial hyperplasia is suspected? Noticing the alarming symptoms characteristic of this disease, a woman should consult a gynecologist. The specialist will conduct an examination and for the formulation of an accurate diagnosis will appoint the following types of studies:
- Ultrasound procedure - using a transvaginal sensor allows you to measure the thickness of the endometrial layer. If the obtained figures exceed the limits of the norm and are more than 5 mm, the procedure is repeated several times. With indicators of about 10 mm, the patient is prescribed curettage or a course of drug therapy.
- X-ray of the uterine cavity - allows you to assess changes in the structure of the endometrial system, to identify the presence of polyps and other neoplasms.
- Scraping uterine cavity - recommended at high risk of developing malignant processes, as well as for diagnostic purposes. The resulting endometrial cells are sent to the laboratory for histological examination.
- Ehosalpingography - conducted to determine the patency of the fallopian tubes. During the procedure, the cavity is filled with a contrast fluid through a catheter.
The most informative diagnostic method is ultrasound, the accuracy of which is about 80%. Experts identify the following echographic signs of endometrial hyperplasia:
- the presence of polyps of 16 mm - 17 mm,
- change of relief of the mucous,
- disturbances in the conductivity of the ultrasonic signal,
- heterogeneity of the endometrial layer.
Based on the results obtained, the specialist diagnoses the patient and develops a therapeutic course that is optimal for a particular clinical case. Pathology treatment is carried out by different methods, depending on the form and stage of the pathological process.
With endometrial hyperplasia during menopause, drug treatment is advisable in the glandular and cystic forms, in the absence of polyps and tumors. Patients are prescribed medications that increase blood clotting, means that normalize the functioning of the liver.
Patients are prescribed a course of hormone therapy. Such a complex therapy can reduce the negative effect of estrogen hormones on the endometrial layer. Preparations and their dosage, the duration of use of the attending physician selects on an individual scheme.
Indications for surgical intervention are frequent recurrences of the disease, endometrial detachment, lack of effectiveness of drug therapy, suspicion of oncological processes.
To treat endometrial hyperplasia, use the following methods:
- Scraping - surgical removal of polyps, growths, tumor neoplasms. Curettage is performed under general anesthesia and takes about half an hour.
- Removal of the uterus, ovaries - radical surgery, is carried out in exceptional cases with the development of a malignant tumor.
- Cryotherapy - it is effective at the focal form of GPE. Exposure to liquid nitrogen leads to necrosis and death of expanding tissue structures, polyps localized in the mucous membrane of the uterine membrane.
- Laser therapy - also used for focal hyperplasia. The procedure deserved good feedback from patients due to its painlessness, minimal trauma and efficiency.
The treatment of postmenopausal endometrial hyperplasia is carried out exclusively by surgery. Patients are recommended curettage or laser ablation followed by hormone replacement therapy.
Methods of traditional medicine
Treatment by folk methods is allowed, but only as an auxiliary component of the complex therapy. The use of herbal medicine, infusions and decoctions based on nettle, burdock, golden whisker gives a good effect.
It is impossible to cure the endometrial hyperplastic pathology in the menopausal and postmenopausal period with folk remedies alone, and self-medication can lead to extremely serious, unfavorable consequences.
To prevent endometrial hyperplasia with menopause, patients in the age group over 45 years old are recommended to undergo regular physical examination by a gynecologist and donate blood for a hormonal study. The following expert recommendations will be helpful:
- keep track of your weight, avoid overeating, live a mobile lifestyle,
- refrain from using medication, especially hormonal drugs, without a doctor's prescription,
- eat well balanced
- to lead a regular, but at the same time moderate intimate life.
You should pay attention to nutrition, reducing the content in the diet of dairy products, brewer's yeast, considered sources of estrogen. The menu should include tomatoes, olive oil, beets.
Endometrial hyperplasia in menopause is a disease that occurs on the background of hormonal changes. In the absence of adequate therapy, the pathology progresses and can lead to serious consequences, including the development of oncological processes.
Women who have been treated for endometrial hyperplasia confirm that the pathology is curable, provided that they seek medical attention in a timely manner:
"I am 52 years old. I had a hyperplasia of the endometrial layer, frolicking against the background of menopause. Tormented by severe pain, mood swings, weakness, bleeding. After the curettage procedure and the course of medications prescribed by the doctor, the condition stabilized. ”
"I am 49 years old. The signs of endometrial hyperplasia showed up early, even before menopause. She appealed to the doctor in time, which is why she managed to avoid the operation, and only managed hormone therapy. ”
"I am 53 years old. A year ago, on examination, focal hyperplasia was discovered. Has passed the procedure of laser therapy. Very effective and not at all painful. Now everything is fine with health, there is no relapse. ”
Endometrial hyperplasia during menopause
In the period of menopause, age-related changes of the female body occur - the reproduction of sex hormones is reduced, the cyclic processes of renewal of the internal mucous membranes of the uterine cavity stop.
With the onset of the climatic period, the likelihood of developing serious diseases increases. Endometrial hyperplasia is most commonly diagnosed in menopause.
Not all patients, having heard this diagnosis, know what it is, what symptoms and treatment of the disease.
What is menopause and when does it occur
Menopause is a 12-month period after the last natural periodic discharge in women, occurring between the ages of 45 and 55 years. It is caused by the depletion of the follicle reserve. If menopause occurs before the age of 40, then this process is called ovarian exhaustion syndrome. Some women have a late menopause after 55 years.
There are cases when the pause is caused by artificial means. In this case, the woman stops menstruating due to surgical removal of the ovaries, chemotherapy, or medication.
During menopause, the female body changes. Changes caused by a lack of hormones, changes in the functioning of the ovaries. It is at this time that the risk of developing many gynecological pathologies, such as uterine cancer, endometrial hyperplasia, increases.
General information about the disease
The term "hyperplasia" physicians imply the growth of tissues. It arises due to excess cell production. The endometrium is the inner lining of the uterus. It provides the fetus optimal conditions for full development. Each menstrual cycle the thickness of the endometrium varies.
The thinnest layer is immediately after the end of menstruation. During ovulation, the endometrium thickens to 8 mm under the influence of the hormone estrogen.
If conception did not occur, the level of hormones decreases due to the production of progesterone, the internal mucous membranes of the organ are depleted, the egg cell leaves the body - menstruation begins.
During menopause, hormones are disturbed. Under the influence of elevated estrogen levels, the endometrium increases in volume. Due to the reduced level of progesterone, this process does not stop.
In most cases, the growth of the endometrium is characterized by premenopause.
Indeed, despite the presence of a monthly discharge in the body of a woman, age-related changes occur, accompanied by changes in the hormonal background.
During menopause, the endometrium becomes thinner. Its thickness varies within 5 mm. It is this indicator that doctors consider normal. Sometimes the growth of the endometrium with menopause reaches 7-8 millimeters.
This indicator indicates a possible beginning of the pathological process, but is not yet classified as hyperplasia. For some patients, tissue thickness of 7-8 millimeters is the norm.
But doctors recommend periodically undergoing ultrasound (every 3-6 months) to exercise dynamic control over the growth of tissues.
If the thickness of the endometrium reaches more than 8 mm, gynecologists recommend that the patient be curetted. It is necessary to confirm the development of the pathological process, study the structure of tissues and prescribe treatment.
There are several types of endometrial hyperplasia. They differ in the direction of tissue growth:
- Glandular hyperplasia of the endometrium is diagnosed if the layer of the inner lining of the uterus increases due to the modification of the glands located in it. The increase in volume occurs in the direction of the muscles of the organ.
- Cystic form. Cystic formations begin to form in the lining cavity. This kind of pathology is dangerous, since the cells produced by an excess of hormones can turn into malignant ones.
- Basal hyperplasia. During menopause, this form of the disease is rarely diagnosed. During its development, an increase in the thickness of the basal layer of the uterus is observed.
- Focal form. The thickness of the membrane increases irregularly, forming growths (polyps) on the walls of the uterus.
- Atypical hyperplasia. With climax, this type of pathology is rare. It is the most dangerous of all types of manifestations of the disease, as it quickly turns into cancer of the uterus. If the atypical form of endometrial hyperplasia has been confirmed, doctors remove the organ.
Most often, menopause is diagnosed with a glandular and cystic form of the disease. The main reasons for the development of these types of pathology is hormonal failure.
Causes of hyperplasia during menopause
There are several factors that cause endometrial hyperplasia in menopause. In most cases, they begin to form before the onset of menopause (in premenopause).
- Hormonal disbalance. This is the most common cause of pathology. In women after 45 years of age, there is a decrease in progesterone production and an increased level of estrogen. This imbalance provokes a modification of the endometrium.
- Metabolic disease. With age, most women have an overweight problem. Fat tissue provoke the production of estrogen, thereby exacerbating the hormonal failure, manifested in menopause.
- Malfunction of the endocrine system. For this reason, endometrial hyperplasia is often observed in postmenopausal women.
- Frequent invasion of the uterus (gynecological surgery). Due to the frequent mechanical action, the membrane receptors no longer respond to progesterone levels. The more an abortion and curettage woman had to endure, the higher the likelihood of GGE development in the climatic period.
- Predisposition to pathology at the genetic level. Doctors confirm that this disease is more often diagnosed in patients whose relatives had the same problem.
Also, the growth of mucous membranes is observed against the background of fibroids and mastopathy. In some cases, the pathology of a malfunction of the immune system can be provoked.
The symptoms of postmenopausal endometrial hyperplasia are manifested individually. The main symptom of a hyperplastic pathological process is bloody discharge. But they are not observed in all patients. Sometimes thickening of the shell occurs without discharge. Other manifestations of the disease include:
- Very painful menstruation. In this case, the pain is spastic.
- Irregular menstrual cycle. Sometimes spotting appears twice in a month.
- Abundant and prolonged periods (10-14 days).
Sometimes the symptoms of endometrial hyperplasia of the uterus are accompanied by general malaise, insomnia, migraine, decreased performance, irritability. A woman feels intense thirst.
Author: ® Barto R.A. 2012
The patient is 57 years old. Last menstruation 9 years ago. I went to the doctor with complaints about the omission of internal genital organs. Sent to ultrasound of the pelvic organs.
When ultrasound: Uterus normal size. M-echo = 7 mm, the uterus cavity is uniformly expanded with homogeneous anechoic contents. In the bottom of the uterus, on the left side of the uterus, a polypoid formation of 4x6 mm of increased echogenicity with clear even contours of moderately heterogeneous structure is determined.
Conclusion: Echo picture of serosometers in postmenopausal. Polyp endometrium.
Fig.1 In the cavity of the uterus, a round polypoid inclusion is clearly defined. Three-dimensional reconstruction.
Video 1. Polyp endometrium.
Endometrial polyps - are single or multiple benign exophytic growing glandular formations emanating from the pathologically changed basal layer of the mucous membrane of the uterus. Develop by proliferating epithelial glands of the basal layer of the endometrium.
From the author: “In order to better understand and understand what an endometrial polyp is, you need to draw an analogy between the menstrual cycle and the seasons. At the beginning of the next menstrual cycle (spring), the mucous uterus grows and thickens, like grass in spring (it becomes lush and beautiful). By the end of the cycle (autumn), the mucous membrane of the uterus, which has matured and fulfilled its function, is rejected during menstruation - this can be compared to grass that dries out and falls off by autumn. For some reason, in one place the mucous membrane of the uterus does not reject during menstruation and remains until the next cycle, like overripe grass, turned into a thick bush (polyp), remaining for the next year (menstruation). We often see a similar picture in the spring when, against the background of snow, a dense weed bush sticks out of the ground. This bush (polyp) flourishes splendidly and grows next year in spring (in the next menstrual cycle). And so on".
At the initial stage of development, polyps are located in the basal layer on the border with myometrium. Subsequently, the thickened lesions of this layer are drawn, penetrating into the mucous membrane of the body of the uterus, lengthened and take the form of polyps.
At the initial stages of development, polyps are located on a broad basis. Then, as a result of the contractile activity of the uterus, the base becomes thinner and a polyp is formed on the "leg". It is the presence of the leg, consisting of fibrous and smooth muscle tissue, an indispensable anatomical property of polyps. Thanks to the pedicle, the polyp acquires a sign of “organoidity,” distinguishing it from the polypiform form of glandular endometrial hyperplasia.
The formation of polyps is due, apparently, to the pathological condition of the vessels of the basal layer and the local change in the receptor apparatus of the uterine mucosa, manifested by an increase in the concentration of estrogen receptors.
In the exophytic part, the polyp is often covered with a thinned layer of the functional endometrium, which is involved in cyclic changes occurring in the surrounding endometrium.
Endometrial polyps exhibit a certain hormonal dependence. which depends on the histological type of the polyp. If the glandular polyp is dominated by a highly prismatic proliferative-type epithelium, then it responds to estrogenic / progestin-like stimulation like endometrium. They are also called functional type polyps. In the case of the prevalence of low prismatic epithelium, as well as pronounced fibrosis of the stroma, the polyps may be hormone-independent. They are called basal polyps. Morphologically, proliferating glandular as well as stromal endometrial polyps are also isolated.
Most frequent localization endometrial polyps is the mucous membrane of the bottom and corners of the uterus. Sometimes the length of a polyp reaches 6-8 cm, and they partially end up in the cervical canal or even outside the external os. Polyps of the mucous membrane of the isthmic part of the uterus are less common.
Polyp shape different.Sometimes polyps are located on a broad base, and for large sizes hang from the bottom into the uterine cavity. More often polyps have a short or long leg or are located on a broad base.
Endometrial polyps can be single or multiple and most often located in the bottom and pipe corners of the uterus. More typical are single polyps. The sizes of polyps are varied - from microscopic, determined in scrapings in the form of small fragments of glandular tissue, to large exophytic formations that perform the entire uterine cavity and penetrate through the cervical canal into the vagina. In most cases dimensions polyps vary in the range of 3-10 mm. The base of the polyps (leg) is usually narrow, occasionally there is a broad base of the polyp.
The risk of malignant degeneration of endometrial polyps in childbearing age is low (2-5%). However, it increases significantly in postmenopause (up to 10%).
Ultrasound examination for suspected endometrial polyp is best carried out in phase I of the menstrual cycle (in the first days after its termination). Usually this is a 5-7 day cycle.
Causes and symptoms of postmenopausal endometrial pathology
The climacteric period occurs in the life of every woman who overcomes the age line of forty-five to fifty-five years. This means entering a qualitatively new life, where there is no menstruation, fear of delaying them due to the occurrence of an unwanted pregnancy, or, conversely, regular periods, which indicate the absence of fertilization. However, during this period, it is also necessary to carefully monitor their female health, as well as during the fertile age. Pathology of the endometrium in postmenopausal develops very often.
Causes of endometrial pathology
Menopause comes with the extinction of the childbearing function. This is due to a decrease in estrogen and progesterone production by the female sex glands. These processes lead to a natural decrease in the activity of benign tumor processes in the uterus, for example, fibroids, fibroids. The intensity of the growth of nodules is reduced, since it is a hormone-dependent process.
Climax is not a reason to relax. It is associated with many pathological processes in the endometrium. Most often it is a hypertrophic proliferation of the endometrium in postmenopausal women.
Due to hormonal imbalance, the thickness of the endometrium increases. The rate in postmenopause is about half a centimeter. Excessive activity of the formation of endometriocytes leads to the appearance of a layer whose thickness exceeds ten fifteen millimeters, that is, two to three times higher than the normal layer.
Causes of excessive formation of the inner layer of the uterus can be found in several sources:
The effect of estrogen is manifested in a small percentage of women. This is due to the slow pace of reducing the amount of hormone produced in the blood and parallel processes of involution of the uterus. The endometrium continues to grow, and the follicle does not mature as rapidly. The resulting layer is not rejected, accumulates.
Any violations of the regulation of the metabolic system, one way or another, affect the female genital area. Diseases of the thyroid gland, hypothalamus, pituitary, neoplasms in them lead to menstrual disorders. Negative effects may also occur with the extinction of the childbearing function. Disorder in the formation of sex hormones causes the endometrium during menopause in a hypertrophied state.
Pathology of the endometrium may occur with the onset of climacteric changes. Often during premenopause, approximately thirty to forty years of age, polypous growths develop on the cervix or inside the uterus. Removal of these structures is a gynecological surgery.
The woman's body is designed in such a way that external intervention in the internal genital organs does not pass without a trace. Therapeutic or diagnostic surgeries adversely affect the state of the inner lining of the uterus.
Gynecologists note that endometrial pathology often occurs for hereditary reasons. Observed inheritance of problems of this kind for several generations of the same family.
Symptoms of endometrial pathology
With the advent of a certain age line, a woman begins to feel changes in her body and the functioning of the sex hormonal system. There are restructuring of the menstrual cycle, and with them the entire work of the hormonal system. In the period of extinction of reproductive function, many women subjectively feel the deterioration of the condition:
If endometrial pathological changes develop, all these phenomena are aggravated by gynecological complaints. The bleeding has a dark color, a thicker consistency at the beginning of the bleeding, gradually turning into blood that does not stop.
Hypertrophic formation of the endometrium is accompanied by the appearance of sudden bleeding. And they are spontaneous, can be abundant, with the separation of clots, pieces of mucous.
Bleeding of this kind is very painful, accompanied by drawing pains in the projection of the uterus. The general state of health also suffers: a steady feeling of thirst, weakness, a significant decrease in the ability to work and quality of life appears. It may be disturbed by the presence of heavy, bloody discharge of bloody nature for a long time.
With a long, neglected process, anemia, edema develops, and blood pressure jumps are observed. Weight gain may be present due to excessive accumulation of fluid in the body.
Forms of endometrial pathology
To establish the type of pathological proliferation of the epithelium of the inner layer of the uterus, you can use histological examination. To do this, you must immediately consult a doctor for advice. This will help establish exactly what hyperplasia is present in this case:
Iron-cystic and glandular forms are benign. This means that the possibility that these cells will acquire a malignant form is not more than five percent.
Cystic form is less favorable. It is accompanied by more sad statistics about the transition to oncological pathology. At the same time, the cyst has normal cells inside, and the gland significantly increases in size outside.
Focal form develops due to the uneven sensitivity of individual sections of the endometrium to the action of hormones. Formed areas resembling glandular cysts. Their sizes can reach several centimeters in diameter. The location of such formations over the entire area of the endometrium converts the process into a diffuse form.
Atypical form of the disease is practically direct indications for radical surgical intervention. Here the maximum risk of transition into the cancerous form is revealed, therefore the removal of the uterus at the earliest stage of diagnosis and histological examination is recommended.
What is Postmenopause -
Estrogen deficiency as part of the involutionary processes in a woman's body after menopause, on the one hand, can be regarded as a regular physiological process, and on the other, it plays a pathogenetic role for many disorders, including climacteric. Neurovegetative, metabolic-endocrine, psychoemotional manifestations of the climacteric syndrome, urogenital disorders, osteoporosis, skin changes occur in a certain chronological sequence and significantly reduce the quality of life of a postmenopausal woman. Various symptoms associated with the decline of ovarian function are observed in more than 70% of women.
What triggers / Causes of Postmenopause:
The frequency of menopausal syndrome varies with age and the duration of menopause. If in premenopause it is 20-30%, after menopause 35-50%, then 2-5 years after menopause decreases to 2-3%. The duration of menopausal syndrome averages 3-5 years (from 1 year to 10-15 years). Manifestations of climacteric syndrome (estimated on a scale of a modified menopausal index by EM Uvarova) are distributed according to frequency as follows: tides - 92%, sweating - 80%, increase or decrease in blood pressure - 56%, headache - 48%, sleep disorders - 30%, depression and irritability - 30%, asthenia symptoms - 23%, sympathetic-adrenal crises - 10%. In 25% of cases, the course of climacteric syndrome is severe.
One of the consequences of an estrogen-deficient state in postmenopausal women is an increase in the frequency of cardiovascular pathology caused by atherosclerosis (ischemic heart disease, cerebrovascular accident, arterial hypertension). For women after menopause, this is catastrophic: if women under 40 years old have a myocardial infarction rate 10-20 times less than men, then after the extinction of ovarian function, the ratio gradually changes and is 1: 1 by 70 years.
It is believed that prolonged estrogen deficiency in old age may be involved in the pathogenesis of Alzheimer's disease (brain damage). The prophylactic effect of estrogens in postmenopausal women has been noted, but this issue requires further research in evidence-based medicine.
Currently, questioned the validity of hormone replacement therapy, even estrogen for both prophylactic and therapeutic purposes. At the same time, hormone replacement therapy remains the only effective method for correcting menopausal disorders. Long-term HRT may increase the risk of breast cancer. In recent years, there has been evidence of an increase in the frequency of cardiovascular pathology (thrombosis, thromboembolism, heart attacks, strokes) during hormone replacement therapy, the 1st year of taking the drugs is most dangerous.
Prior to the appointment of hormone replacement therapy, the features of history are revealed, including smoking, a physical examination is performed, the condition of the venous system of the legs is evaluated, an ultrasound scan of the pelvic organs, mammography, and blood coagulation are performed. The side effects of hormone replacement therapy smooth out estrogens (as a monotherapy), estrogen gestational gene preparations, combinations of estrogens and androgens, as well as the administration of drugs in injections and transdermally.
New technologies (ultrasound, Doppler sonography, hydrosonography, MRI, hysteroscopy, histochemistry, etc.) make it possible to objectively evaluate the state of the internal genitalia in women of different ages and, in particular, in the postmenopausal period. You can study involutive changes of the uterus, ovaries, depending on the length of the postmenopausal period, develop standard indicators, identify the pathology of the uterus and appendages in the early stages.
With a short duration of postmenopause, myometrium has an average echogenicity, which increases with an increase in the duration of postmenopause. Multiple hyperechoic areas corresponding to myometrial fibrosis appear. In postmenopausal blood flow is significantly depleted in the myometrium (according to the Doppler study) and recorded in its peripheral layers. Myoma nodes that have arisen in premenopause are also subject to involution — their diameter decreases, and the nodes that initially had increased echo density (fibroma) undergo the smallest changes, and nodes with moderate or decreased echogenicity (leiomyoma) decrease most noticeably. At the same time, the echo density increases, especially the capsules of myomatous nodes, which can lead to a weakening of the echo signal and impede visualization of the internal structure of myoma and uterus nodes. Visualization of small fibroids with decreasing size and changes in echo density (close to myometrium) can become difficult. Against the background of hormone replacement therapy (if it is carried out), the echographic picture of myoma nodes is restored in the first six months. Cystic degeneration of the myoma node (subserous localization) with many cavities and hypoechoic contents is rarely found. In the study of blood flow in myomatous nodes subjected to atrophy, intranodular registration of color echoes is not typical, perinodular blood flow is scarce. With interstitial nodes, atrophic processes in the uterus after menopause can lead to increased centripetal tendencies and the appearance of the submucous component of the myomatous node. The submucous arrangement of myoma nodes in postmenopausal women can lead to bleeding. The echography does not allow to adequately assess the M-echo, which is difficult to differentiate from the capsule of the myoma node and determine the cause of the bleeding (submucous node, concomitant endometrial pathology). Diagnostic difficulties allow resolving hydrosonography and hysteroscopy.
An increase in the uterus and / or myomatous nodes in postmenopausal women, unless it is stimulated by hormone replacement therapy, always requires the exclusion of hormone-producing pathologies of the ovaries or uterine sarcoma. When sarcoma, in addition to the rapid growth of the node or uterus, is determined by a homogeneous "cellular" echostructure of medium sound conductivity with increased echogenicity of thin strands corresponding to the connective tissue layers. In Doppler studies throughout the tumor volume, the medium-resistance blood flow is diffusely enhanced.
Endometrium after menopause ceases to undergo cyclical changes and undergoes atrophy. The longitudinal and transverse dimensions of the uterine cavity are reduced. With ultrasound, the anteroposterior size of the M-echo is reduced to 4-5 mm or less, the echogenicity is increased (Figure 5.2). Severe endometrial atrophy during prolonged postmenopausal disease may be accompanied by the formation of synechiae, visualized as small linear inclusions in the structure of the M-echo of increased echo density. The accumulation of a small amount of fluid in the uterus, visualized during sagittal scanning as an anechoic strip against the background of atrophic thin endometrium, is not a sign of endometrial pathology and results from a narrowing / infestation of the cervical canal that prevents the contents of the uterus cavity from flowing out.
Endometrial hyperplastic processes occur against a background of elevated estrogen concentrations (classical and non-classical steroids), which act on the estrogen receptors in the endometrial tissue. The frequency of detection of estrogen and progesterone receptors, as well as their concentration, varies depending on the type of endometrial pathology and decreases as the proliferative processes of the endometrium progresses (endometrial glandular polyps — glandular-fibrous polyps — glandular hyperplasia — atypical hyperplasia and endometrial polyps — cancer). Postmenopausal hyperestraemia may be due to:
The spectrum of intrauterine pathology in postmenopause: endometrial polyps - 55.1%, endometrial glandular hyperplasia - 4.7%, atypical endometrial hyperplasia - 4.1%, endometrial adenocarcinoma - 15.6%, endometrial atrophy in bleeding - 11.8% , submucous myoma of the uterus - 6.5%, adenomyosis - 1.7%, endometrial sarcoma - 0.4%.
The clinical forms of endometrial precancer are glandular hyperplasia and recurrent glandular endometrial polyps.
The reason for the recurrence of proliferative processes of the endometrium are both tumor and non-tumor (tekomatoz) hormone-producing structures of the ovaries
To properly assess changes in the ovaries, one should know the normal echographic picture of the ovary and its dynamics in the postmenopausal period. In postmenopausal the size and volume of the body is reduced, there are changes in echostructure.
With changes in the ovary of the atrophic type, its size and volume are significantly reduced. With changes in the hyperplastic type, the linear dimensions decrease slowly, the sound conductivity of the ovarian tissue is average, small liquid inclusions are possible.
Для диагностики образований придатков матки применяют сочетание трансабдоминального и трансвагинального УЗИ. The echography with Doppls research, along with the definition of tumor markers, is the main method of preoperative examination with the aim of eliminating the cancer process, while the accuracy of diagnosis is 98%. In malignant neoplasms, signs of vascularization are detected in 100%, blood flow curves with low resistance (IL
How to diagnose
In most cases, a gynecologist diagnoses a suspected endometrial hyperplasia, to whom a woman complains of painful or irregular menstruation. There are several methods for diagnosing the disease:
- Ultrasound. If during this diagnostic study it is found that the thickness of the endometrial layer is 7-8 mm, the gynecologist will prescribe an additional examination.
- Hysteroscopy. During the procedure, the doctor makes a visual inspection of the uterine cavity using endoscopic equipment. The examination is performed under general anesthesia. In most cases, a tissue biopsy is performed simultaneously with the examination of the membrane.
- Curettage (diagnostic curettage of the endometrium). The procedure is prescribed in those cases if the thickness of the growing tissues exceeds 8 mm. Scraping is performed to further study the endometrium and eliminate the appearance of cancer cells.
If the thickening exceeds 10 mm, gynecologists recommend to undergo a separate curettage procedure, followed by irradiation of the organ cavity with radioactive phosphorus. The reagent is injected into the patient's vein, migrates through the body and accumulates in pathogenic areas of the membrane. The doctor for the histological examination takes biological material from these areas.
How to treat the disease during menopause
If the diagnosis of endometrial hyperplasia in menopause is confirmed, treatment is started immediately. After all, this is the pathology of the endometrium, during the development of which there is a high probability of the degeneration of cells into malignant oncological formations. Depending on the stage of the disease, doctors use one of the methods of therapy.
It is recommended to treat endometrial hyperplasia with drugs if the tissue thickness does not exceed 6-7 mm.
Therapy is based on the use of hormonal medications that trigger an increase in progesterone levels.
The patient during the entire period of treatment (6-8 months of continuous medication intake) must undergo a scheduled ultrasound scan, during which the doctor keeps a constant check on changes in the tissue proliferation rates.
Drug treatment does not give 100% of the results. The probability of recurrence of the disease is high.
Additional therapy with folk remedies
Most patients are not in a hurry to use traditional treatment of pathology, preferring to use traditional medicine recipes. Gynecologists advise not to regard herbs as the main therapy, but to use them in combination with medicines. The most common recipes of traditional medicine, proven to be effective in the treatment of HPE, are:
- Fresh juice from burdock root and golden mustache. These liquids are mixed in equal proportions and taken twice a day, 1 tablespoon. A significant disadvantage of this recipe is the possibility of therapy only in the warm season.
- Alcohol tincture of nettle (prepared independently). 200 gr. Medicinal raw materials (fresh leaves and sprouts) pour 500 ml. alcohol (strong moonshine). Kept for three weeks in a warm dark place, occasionally shaking a container of liquid. Ready infusion filter and take 1 teaspoon twice a day.
Treatment of folk remedies should be accompanied by regular examination by a doctor. This will provide an opportunity to track the dynamics of the disease.
Does the disease itself go through menopause?
Even if the disease is not accompanied by pronounced symptoms and was diagnosed by chance, it alone cannot pass.
Pathological changes occurring in the female body, without hormonal drugs will not be able to return to normal. Sometimes women believe that if the menopause passes, the hormones normalize and the endometrial layer becomes thinner.
This is nothing more than a delusion. The earlier the treatment of the disease is started, the higher the chances of recovery.
Is relapse possible with menopause?
The possibility of recurrence of endometrial hyperplasia during menopause increases. Depending on the type of treatment chosen by the doctor, after which the growth of tissues continued, further actions are determined:
- If the disease recurs after drug therapy, and the layer thickness increases by more than 8 mm, it is recommended to undergo a curettage procedure.
- If after curettage the situation is repeated, complete removal of the uterus is carried out.
The percentage of recurrent cases of pathology with initially well-chosen treatment is low. To prevent the possibility of relapse, the patient must constantly undergo a follow-up examination.
What is the danger
The growth of the menopausal endometrium is very dangerous for a woman. It is an insidious disease that tends to relapse and degenerate into oncological formations.
Even after the cessation of monthly discharge, hyperplasia of the uterine membranes is dangerous for at least premenopausal menus.
Therefore, women in the 12-month period after the end of the last menstruation must undergo a gynecological routine examination and ultrasound.
I was diagnosed with PCE several years ago. Appointed reception "Diferelin". On the Internet I read contradictory reviews about this drug, but I still started to drink. Endometrial thickness does not increase. And it pleases. There is hope to avoid scraping.
Oh, you were lucky. I was assigned both “Danazol” and “Zoladex” - everything turned out to be unsuccessful. I had to agree on scraping. The procedure is not the most pleasant, I must say. Now I take pills to avoid relapse.
And there are cases in which the endometrium itself returned to normal, without treatment? I'm just wondering, I've already passed 2 cleanings. A friend was treated only with herbs, so she went into the tumor ...
I think if you go to a doctor in time and drink pills, you can do without cleaning. At least, I have so far. Constantly observed, pass ultrasound. There is hope that everything will return to normal after menopause. But not by itself, of course, I still take medication.
Endometrial hyperplasia in menopause: causes, symptoms, treatment
Menopause is an unusual period in a woman’s life. At this time, the woman observes special changes in the body, and learns to live with them. Unfortunately, a frequent satellite of menopause is endometrial hyperplasia of the uterus. Endometrial hyperplasia is an abnormal growth of the endometrial body in the uterus.
Diseases are women of different ages. However, endometrial hyperplasia in menopause is especially dangerous, since during this period there is a high risk of developing cancer. So, in order for this not to happen, a woman needs to know about the causes, symptoms and signs of this disease, as well as how it is treated.
In this article, these issues are disclosed in order.
The reasons for which the disease occurs during menopause
During menopause, more than 15% of women suffer from this disease. With menopause, there is a risk of atypical hyperplasia developing into cancer in 40% of cases. In other cases, the risk is up to 5%. Hyperplasia happens:
- Ferrous. This is the most common form that is not so difficult to cure. Glandular hyperplasia of the endometrium is not generally recurrent.
- Glandular cystic In this case, cysts form in the uterus and on the ovaries.
- Atypical. Pre-cancerous and most dangerous form of the disease.
- Focal. Formation of polyps is characteristic of this form.
So what are the causes of endometrial hyperplasia? The main and most important reason is the hormonal imbalance in menopause. During this period, estrogens are produced in large quantities.
This process is aggravated by taking medications that relieve climatic manifestations, as well as hormonal contraceptives. The second most important reason is heredity.
After this, there are a number of significant reasons that precede pathology in menopause:
- Violation of the metabolic processes of the body. With age, the body lays fat, because it is not able to work in full force. These metabolic processes provoke the development of diabetes, abnormalities in the functioning of the liver and the growth of the endometrium.
- Failure in the endocrine system. There are certain organs that produce hormones for the normal functioning of the body. These are pancreas and thyroid glands, adrenal glands. Failure in these organs leads to hormonal imbalance, which in turn causes hyperplasia.
- The change in the mucous membrane of the genital organs associated with age. The membranes of the organs become thinner and more sensitive. This leads to the fact that the organs become susceptible to influencing factors and often become infected with infectious diseases. These diseases contribute to the proliferation of endometrial layer cells.
- Frequent mechanical intervention in the uterus. Much depends on how much a woman has had abortions and scraping. Less is better. With each scraping, mucosal receptors become thinner and fail to produce enough progesterone. This affects the development of hyperplasia.
- Immunity failure. This failure is characterized by the fact that the body perceives the lining of the uterus as a foreign body. As a result, he actively begins to produce his own kind, which leads to an increase in the endometrium.
- The onset of menopause up to 45 years old.
Diseases such as fibroids and mastopathy precede endometrial hyperplasia.
Women who are predisposed to this disease should be diagnosed by a doctor at least once a year.
Symptoms and signs of pathology
Often the disease is asymptomatic. Interestingly, the formation of endometrial hyperplasia of the uterus occurs long before the onset of menopause. Menopause pushes the disease to development. Due to the absence of symptoms, a woman can lately go to a doctor, which leads to neglect of the disease and the enormous amount of time spent on treatment.
A woman who has entered the period of menopause is obliged to undergo an examination once a year!
However, there are a number of major signs of endometrial hyperplasia in this period:
- any discharge during menopause is a signal to see a specialist,
- weakness, lethargy, fatigue,
- weight change.
Any of these signs should alarm the woman. Do not think that this will pass, and be sure to contact the doctor. It depends on whether a woman gets cancer.
Certain features have endometrial glandular-cystic hyperplasia in menopause:
Echo signs of hyperplasia during menopause
For accurate diagnosis, doctors use ultrasound. Its correctness is 90%. Symptoms that a doctor sees in a woman in old age:
- high sound conductivity
- M-echo contour is uneven,
- the endometrium is heterogeneous,
- relief of uterine mucosa modified.
These signs on ultrasound indicate the presence of hyperplasia in menopause.
Postmenopausal endometrial hyperplasia, symptoms
Postmenopause lasts as many years as the body decides (sometimes until the end of life), and leads to the complete attenuation of the viability of the female organs. During this period, hormones completely cease to be produced, and a malfunction of the sexual, nervous and endocrine systems occurs. During this period, hyperplasia may be asymptomatic, but some still manifest themselves:
- bloody issues,
- abdominal pains like contractions
- large polyps in the uterus,
- single polyps due to atrophy.
Treatment of endometrial hyperplasia in postmenopausal and during menopause have the same principles. Doctors are trying to do everything possible without surgery, and only when a relapse is prescribed an operation. So, how to treat pathology?
Treatment by folk methods
Herbal treatment is effective in the sense that in some plants there are phytohormones, which adjust the hormonal background in women.
This type of treatment is effective in combination with other drugs prescribed by the doctor. Do not self-medicate.
Usually for the establishment of hormones using plants:
- boron womb,
- ortilla is one-sided.
Make broths according to the scheme, which is the doctor, and take over the crescent-month.
Usually these are preparations containing hormones. A single scheme that fits all does not exist. The doctor makes an appointment individually. The principle of hormone therapy is the appointment of progesterone drugs. Common Medicines:
They are synthetic analogues of the hormone progesterone and gonatropin releasing hormone (GnRH). Their price ranges from 500-700 rubles.
Postmenopausal women usually take:
Drugs have their own characteristics for women of such a period. The price for drugs ranges from 3-8 thousand rubles.
During treatment, women are prescribed vitamins, antidepressants, and sedatives.
Scraping is the most effective method. The picture shows a schematic of the procedure.
The operation is performed under local anesthesia. Its duration is about half an hour. During this period, the removal of the mucosa up to 10 mm.
Treatment of endometrial hyperplasia without curettage is ineffective and does not lead to full recovery.
Consequences and complications
After treatment, in order to avoid complications, a postoperative period is required. It lasts two weeks. You should take vitamins to restore general strength. Also prescribed physiotherapy:
At the same time prescribed anti-inflammatory drugs.
After six months, do control tests. A woman in the climatic period should avoid products containing hormones, namely beer and dairy. On the contrary, it is better to eat anti-cancer products, such as olives, pineapples and beets.
With successful treatment and following all the rules, hyperplasia does not return.