Focal endometrial adenomatosis. Endometrial hyperplasia

After a long ordeal with doctors and hospitals, I was finally diagnosed with uterine adenomatosis. Please tell us more about this disease.

Adenomatosis is an inflammatory hormonal-dependent process in the muscular layer of the uterus, one of the cases of endometriosis. It is also called internal genital endometriosis.

With this disease, endometrial tissue - the mucous membrane of the uterus - enters other parts of the body (in your case - into the uterine muscle layer) and begins to grow there. This is usually accompanied by a disruption in the production of hormones and a drop in immunity, which leads to the appearance of painful symptoms.

Adenomatosis mainly develops in women aged 35–40 years and older. After all, at a young age, the immune and other systems are much more resistant to negative influences and can overcome them on their own. With age, the body's resistance decreases.

Causes of adenomatosis

Scientists still cannot determine exactly what causes the growth of uterine tissue beyond its mucous membrane. It is believed that there is a genetic predisposition to this disease. However, not all women whose mothers or other close relatives are diagnosed with adenomatosis develop it. This means that there are not only hereditary, but also other causes of adenomatosis.

It can be assumed that constant stressful situations can affect the development of adenomatosis. The risk group includes mainly women who work a lot and at the same time raise children and engage in heavy physical labor.

Abuse of sunbathing and solariums can lead to adenomatosis. Ultraviolet irradiation for tanning causes a number of reactions in the body. They are not dangerous for young girls. But after 30 years, the female body is more susceptible to radiation. Therefore, it is advisable for older women to refrain from visiting various resorts during the hot season and postpone their vacation to the velvet season.

Various mud baths also pose danger. When used excessively or incorrectly, they usually do more harm than good. Therefore, before starting mud therapy, it is advisable to consult with a gynecologist: whether this procedure is suitable for you or not.

Any uterine surgical intervention or curettage increases the risk of adenomatosis: after a miscarriage, abortion, mechanical trauma.

Symptoms of adenomatosis:

* pain in the pelvic area before menstruation, during, and also a few days later;

* dark brown discharge before and after menstruation;

* various menstrual cycle disorders;

*painful sensations during sexual intercourse.

40% of women diagnosed with adenomatosis have excessively heavy menstruation.

Adenomatosis is one of the most common causes of infertility.

Treatment of adenomatosis

For adenomatosis, there are two treatment options - therapy and surgery. Hormonal therapy for adenomatosis is usually prescribed in the early stages of the disease. It is mandatory and allows you to avoid surgery. Its main advantage is that after such treatment you can become pregnant. In addition, hormonal drugs, when used correctly, are safe for the body and do not cause side effects. But treatment will take a long time, at least 2–3 months.

When surgically treating adenomatosis, the surgeon has to restore the normal structure of the internal genital organs and remove foci of the disease. The effectiveness of surgical interventions largely depends on the degree of development of adenomatosis. The more areas affected, the more difficult the operation and the less chance of pregnancy in the future.

How to prevent the development of adenomatosis?

Once every six months you need to visit a gynecologist - this is the main prevention of many diseases, including adenomatosis.

Adenomatous endometrial hyperplasia is one of the forms of hyperplasia of the endometrial layer, which is accompanied by intensive growth of the glands of the uterine mucosa. This type of pathology is characterized by the presence of pre-cancer cells in endometrioid tissues, which increases the risk of developing cancer.

Causes and symptoms of the disease

In recent years, endometrial hyperplasia has been increasingly diagnosed in the fairer sex and this is observed for various reasons. This is explained by the fact that the environmental situation has deteriorated greatly, which affects women’s health. Medical practice shows that most often this pathology is diagnosed in girls in adolescence, as well as in patients at the onset of menopause, which is accompanied by changes in hormone levels.

The main reason for the progression of endometrial hyperplasia is considered to be an increase in the content of estrogen in a woman’s blood and this occurs under the influence of the following factors:

• Changes in the central regulation of sex hormones with increasing age;
• A sharp increase in estrogen levels with a low level of progesterone;
• Development of polycystic ovary syndrome and hormone-producing tumors in the female body;
• Insufficient functioning of the adrenal cortex;
• Violation of the rules for taking hormonal medications;
• Mechanical interventions in the uterine cavity in the form of abortions and diagnostic curettages;
• Genetic factor, that is, the disease can be inherited;
• The development of various inflammatory processes in the genital area.

In addition, hyperplasia can be diagnosed against the background of such pathological conditions of the body:

• Diabetes;
• Excess weight;
• Breast diseases;
• High blood pressure;
• Problems with the thyroid gland.

Only a specialist is able to identify the cause that caused the progression of such a female illness, after conducting tests and deciphering the results.

As endometrial hyperplasia progresses, characteristic symptoms appear. One of the characteristic signs of the disease is bleeding from the uterus, which can occur periodically. Discharge mixed with blood may bother the patient during the period between menstruation and immediately after its end. Sometimes such discharge is spotting and lasts for a long time.

With the development of endometrial hyperplasia in girls in adolescence, discharge with blood clots may appear. With such constant bleeding frequency, anemia develops, which further worsens the general condition of the patient.

Often this pathology becomes the cause of infertility, since the process of egg maturation is suppressed by a sex hormone such as estrogen. Only in rare cases, such a female illness does not cause the appearance of characteristic symptoms in a woman and is detected only when examining a woman due to a long period of non-pregnancy.

When the endometrioid layer grows during menopause, patients, after a long stop, begin to discharge blood again. We should not forget that hyperplasia is considered a complex and dangerous disease, which is a precancerous condition. It is for this reason that when diagnosing such a pathology, it is necessary to be under the supervision of the attending physician, which will help prevent its transition to oncology.

There is a certain classification of this endometrial pathology, thanks to which a specialist can determine the form of the disease based on the studies and characteristic symptoms.

Endometrial hyperplasia can be divided into the following types:

• A simple disease is accompanied by a strong increase in the volume of the glands, but at the same time their architecture is not disturbed;
• In case of complex pathology, accumulations of heterogeneous glands occur in the endometrioid layer;
• A simple and complex disease in combination with atypia causes not only an enlargement of the glands, but also the formation of signs of an atypical state of the nuclei in the endometriosis layer.

Endometrial hypertrophy can develop:

• In the glandular;
• In atypical;
• In focal;
• In cystic;
• In the glandular-cystic form.

The diagnosis and prescription of one or another drug therapy is determined by the form of the pathology, and it may differ. If glandular hyperplasia is detected in the patient’s body, the disease is eliminated using hormonal agents, and to eliminate atypical hyperplasia, only surgery with removal of the uterus is indicated.

Often, representatives of the fairer sex are diagnosed with glandular hyperplasia, in which there is a proliferation of glandular tissue in the endometrioid layer. In addition, there is a strong thickening and a significant increase in volume. Glandular hyperplasia causes the appearance of characteristic symptoms in the form of prolonged and heavy bleeding during menstruation, as well as the development of amenorrhea.

As this disease progresses, glandular cells grow in the body and this occurs due to proliferation in the layer of the reproductive organ. The insidiousness of this pathology lies in the fact that with its further development, its degeneration into a cancerous disease is observed.

Glandular hyperplasia can occur in patients of different age categories under the influence of unfavorable factors.

This disease mainly develops in the following cases:

• The appearance of fibroids in the cavity of the reproductive organ;
• Progression of endometriosis;
• Carrying out gynecological operations of various types;
• Frequent abortions.

In addition, glandular hyperplasia often results from a long absence of labor in a woman’s history, artificial termination of pregnancy and late onset of menopause.

Glandular hyperplasia, which is accompanied by hormonal changes, in most cases indicates infertility. A clear sign of such a disease is considered to be a disturbance in the menstrual cycle and is expressed in significant bleeding with clots. In addition, glandular hyperplasia causes pain of a cramping nature.

Thanks to the achievements of modern medicine, it is possible to diagnose endometrial pathology in a timely manner and preserve the reproductive system of the body.

Cystic endometrial hyperplasia is a pathological form of female disease in which lesions occur at the cellular level in the endometrioid layer. In modern medicine, there are cystic and glandular-cystic forms of pathology, which are similar to each other. With cystic hyperplasia, the appearance of cystic formations is observed as a consequence of disturbances in the endometrial layer. The basal cystic form is characterized by an increase in the thickness of the basal layer of the endometrium.

With this form of the disease, in addition to cysts, large nuclei begin to appear in the endometrioid layer. To identify the cystic form of the disease, a specialist takes tissue for histological examination.

The disease is often diagnosed using a method such as a biopsy. In addition, another method for determining cystic hyperplasia is ultrasound.

As a disease such as focal endometrial hyperplasia progresses in the body, a thickening of the uterine layer lining the inner surface of the organ is observed. Mostly this disease develops in women as a result of hormonal imbalance in the body.

Focal hyperplasia causes the development of various changes in the uterine cavity and disruption of the menstrual cycle. The main reason for the progression of this disease is the uneven proliferation of endometrial cells, which causes increased formation of polyps. Focal hyperplasia is dangerous because there is a danger of polyps transforming into cystic formations, which can subsequently degenerate into oncological tumors. When diagnosing an atypical form of the disease, complete removal of the uterus becomes an effective method of eliminating the pathology.

If the diagnosis is incorrect or there is no effective therapy, then the glandular and cystic forms of the pathology can transform into adenomatous endometrial hyperplasia. The transition of pathology to this particular form of female illness increases the risk of malignant degeneration of the tissues of the reproductive organ.

Elimination of pathology

Treatment of endometrial hyperplasia is determined by the form of the disease and the stage of its progression.

In modern medicine, treatment of such a female illness is carried out using the following methods:

• Carrying out separate diagnostic curettage and hysteroscopy;
• Hormonal treatment, which is selected based on the results of studies;
• Surgical intervention and complete removal of the reproductive organ is carried out if all other methods of therapy have not brought the desired result.

Timely diagnosis of the disease and identification of the causes of the pathological condition of the uterus allows you to prescribe effective treatment and prevent the development of various complications and side effects.

Treatment by pathologists can go through several stages:

1. The main task of the first stage is to stop bleeding and this is done with the help of oral contraceptives, which contain estrogens and gestagens. If taking medications does not improve women's health, then curettage of the uterine cavity is performed.
2. At the second stage, the patient is prescribed hormonal medications, which helps reduce further growth of the endometrial layer. To eliminate pathology, gestagens are most often used: Duphaston; Progesterone; Norkolut.
3. At the third stage, the woman’s treatment is aimed at restoring ovulation, the menstrual cycle and the level of hormones in the woman’s body.
4. At the last stage of therapy, the patient must undergo regular examinations, ultrasounds and take vitamins

Often, a hormonal drug such as Duphaston is prescribed for the treatment of endometrial hyperplasia. With its help, it is possible to increase the content of such a sex hormone as progesterone in the female body. Duphaston is an effective drug for the treatment of various menstrual disorders and dysfunctional bleeding from the reproductive organ.

Focal endometrial proliferation in the form of glandular hyperplasia, polyposis and adenomatosis are precancerous conditions. Under the condition of exposure to exo- and endogenous carcinogenic factors, a tumor forms against their background.

In menstruating women, precancerous conditions of the endometrium are most often manifested by menstrual irregularities such as menopause and metrorrhagia, spotting and bleeding during menopause.

A gynecological examination usually does not detect any deviations from normal anatomical relationships; Sometimes with adenomatosis there is a slight increase in the body of the uterus, mainly in the anteroposterior size, and thickening of its walls.

Differential diagnosis of precancerous conditions of the uterine body carried out using cytological examination of smears from the uterine cavity (aspiration using a Brown syringe), hysterography and histological examination of scrapings from the uterine cavity (M. T. Kunitsa, 1966).

During a cytological examination of a smear from the uterine cavity in cases of endometrial hyperplasia and adenomatosis, isolated endometrial cells and groups of them are determined throughout the menstrual cycle and in menopause. In this case, significant fluctuations in the size of cells and various changes in the nuclei are noted. The nuclei are often hyperchromatic, sometimes enlarged to gigantic sizes. There are cells with two nuclei and atypical mitoses.

With endometrial polyposis, many isolated cells and groups of cells with significant polymorphism are determined. However, changes in the cell nucleus are minor and not as varied as with endometrial cancer.

The associated inflammatory process against the background of precancerous conditions of the endometrium contributes to significant deviations in the cellular structure, which complicates the diagnosis. In such cases, it is necessary to perform hysterography and histological examination of purposefully made scrapings.

With hysterography (under control in 2 projections - anteroposterior and lateral) with the introduction of 2-4 ml of iodolipol or diodon in women with hyperplasia and adenomatosis, the pictures reveal an uneven surface of the mucous membrane, the edges of the contrast shadow are jagged, pitted, and the shadow itself is heterogeneous. With endometrial polyposis, you can determine the size of the polyp and its location. In some cases, it is possible to establish the presence of a solitary polyp or several tumors.

The morphological characteristics of precancerous conditions of the endometrium are determined as a result of histological examination. Glandular and glandular-cystic hyperplasia of the endometrium is characterized by thickening of the mucous membrane, often with polypous growths, and an increase in the number of sharply tortuous and dilated glands. Polyps are covered with single-layer glandular epithelium, contain dilated cavities, and the endometrial stroma is swollen. In adenomatosis, the epithelium of the glands is multirowed and forms papillary growths; the changes are predominantly focal in nature. Adenomatosis is often combined with glandular endometrial hyperplasia.

Treatment for precancerous conditions of the endometrium should begin with curettage of all the walls of the uterine cavity.

Histological confirmation of the hyperplastic process in the endometrium is the basis for hormone therapy. Endometrial hyperplasia is the result of absolute or relative hyperextrogenism and insufficiency of corpus luteum function. Therefore, the use of progestins in the treatment of precancerous conditions of the endometrium is justified. Experience with the use of synthetic progestins and, in particular, oxyprogesterone capronate indicates a good effect of progestin therapy in patients with glandular, glandular polyposis, cystic and adenomatous endometrial hyperplasia.

The choice of a single and course dose of oxyprogesterone capronate is determined by the patient’s age, the nature and severity of morphological changes in the endometrium. Thus, in women of childbearing age with glandular endometrial hyperplasia, it is sufficient to administer 1 ml of 12.5% ​​oxyprogesterone capronate once a month on the 12th or 14th day of the menstrual cycle; the course of treatment lasts 5-6 months.

For endometrial hyperplasia with polyposis, cystic or adenomatous nature during childbearing age, the dose of the drug should be increased: 1 or 2 ml of a 12.5% ​​solution is administered intramuscularly 2 times a month (on the 12th and 19th or 14th and 21st day of the menstrual cycle depending on the length of the cycle). Women during menopause and menopause, depending on the nature of endometrial dysplasia, are administered 1-2 ml of a 12.5% ​​or 25% solution of oxyprogesterone capronate 1 or 2 times a week for 5-6 months, then the dose is gradually reduced (by half every 2 months ).

As a result of treatment, secretory and then atrophic changes in the glands occur. In women of reproductive age, the normal menstrual cycle is restored, and during the menopausal and menopausal periods, a cessation of bleeding is noted. In some cases, mainly in menopause, the use of androgens is possible.

Treatment of precancerous conditions of the endometrium is one of the important measures in prevention

What is uterine adenomatosis? Polyps in the uterus are small growths that do not cause severe pain, but still cause health problems. They are formed on the endometrial mucosa. Adenomatous polyp is not very different from other types of uterine polyps - it is distinguished only by clinical symptoms. However, uterine adenomatosis should be treated promptly, since the disease can quickly degenerate, thereby acquiring malignant properties. So, how to identify the development of adenomatosis and how is the disease treated?

About the disease

Often, during a preventive ultrasound, women find out that they have endometrial adenomatosis. However, they begin to claim that they did not feel any symptoms of the onset of the disease.

Adenomatosis of the uterine mucosa is a benign neoplasm that manifests itself as a violation of the base of the cells that make up the uterine cavity.

If focal adenomatosis develops quickly, benign polyps can quickly degenerate into malignant ones, which causes significant harm to health.

As a rule, this disease is characterized by an overgrown neoplasm or the appearance of growths on the walls of the uterus. This is what is considered the initial stage of the onset of the disease, since polyps gradually begin to form from such growths. Important: the outcome of treatment and the patient’s condition do not depend on how long the polyp is in the uterine cavity, since they can cause the same harm to human health.

Today, focal adenomatosis is mainly encountered by women whose age varies between 30-50 years, but sometimes the pathology also occurs in young representatives of the fairer sex.

The shape of the resulting polyp is similar to an ordinary mushroom:

1. The neoplasm has a thin stalk attached to the lining of the uterus.
2. The polyp has a body that resembles a mushroom cap.

The size of such a neoplasm is small and amounts to 5-10 mm. Basically, polyps are located on the uterine fundus, completely covering it.

Signs and causes of the disease

Treatment of the disease should be carried out after identifying the causes of adenomatosis, because the preparation of a treatment regimen depends on them.

The causes of the disease include:

• disturbances in the functioning of the immune system;
• performing an abortion or cleaning the uterine cavity;
• “jumps” of hormonal levels;
• frequent stress and depression;
• development of miscarriage in the first weeks of pregnancy;
• untreated inflammatory diseases occurring in the genitals;
• endocrine problems in women;
• untreated fibroids.

These are the main reasons for the development of pathology, but endometrial polyp also often occurs due to heredity. Doctors, first of all, pay attention to this reason, after which they prescribe additional tests.

Symptoms of this pathology include:

• problems with conceiving a child;
• copious vaginal discharge of the blood type, which cannot be associated with menstruation;
• constant bleeding after PA;
• pain in the lower abdomen, which often intensifies after sex or heavy exercise.

If the polyps are too large that they occupy the entire uterine cavity, this leads to the fact that the woman is unlikely to be able to fully bear the fetus.

How is pathology diagnosed and treated?

During the examination, the doctor prescribes several diagnostic methods to the patient:

• ultrasound examination of the uterine cavity;
• conducting a blood test;
• smear collection;
• study of hormonal levels;
• gynecological examination of the patient;
• biochemistry.

The doctor also takes into account all the patient’s complaints, after which he prescribes comprehensive treatment.

Polyps in the uterus come in different types; they are a localized manifestation of hyperplasia of the endometrial mucosa. Adenomatous polyp differs little from other types, given the clinical and macroscopic symptoms. But there is also something that sets it apart from other species. Adenomatous endometrial hyperplasia is a dangerous neoplasm that tends to degenerate and become malignant.

Uterine adenomatosis: what is it?

It is not so often that women who undergo a control gynecological ultrasound find out that they have endometrial adenomatosis. Therefore, it is necessary to know what it is, what are the signs of the disease and how to treat it.

Adenomatous endometrial polyp is a benign neoplasm. Pathology appears in the form of cells that grow inside the uterine cavity. Namely, with the threat that a benign formation can easily degenerate into a malignant one, treatment cannot be delayed.

Adenomatosis of the uterus, as a rule, is one overgrown neoplasm or numerous growths. It is then that the polyposis enters the anedomatous stage. No matter how many formations there are in the cavity, the threat they pose is equally unfavorable.

Quite often, women between the ages of 30 and 50 face such a delicate problem; there are more risks starting from the age of 50. But there are cases when adenomatous polyp is diagnosed in young girls.

The shape of such a polyp looks like a mushroom; it has legs and a body. The dimensions are not particularly large from 5 to 10 mm, but sometimes it can block the exit to the cervical canal when the size is up to 30 mm. Adenomatous polyps are usually localized in the corners or at the bottom of the uterus, closest to the mouth of the fallopian tubes.

In gynecological practice, ademonatous polyps are found not only on a thin stalk, but also on a large base. As a rule, those formations that are located on a thick base become cancerous.

The risks of degeneration into a malignant tumor directly depend on the size of the polyp. In about 2% of cases, this happens when the tumor is 1.5 cm. And also in 2-10%, when the size is up to 2.5 cm. If the size is more than 5 cm, then the risks are already more than 10% .

It is also believed that children whose parents suffered from adenomatous polyp are 50% predisposed to the pathology.

Adenomatous polyp: causes and symptoms

There are many reasons for the formation of these types of polyps. The most common reason is a disregard for your body and reproductive organs, including.

Possible reasons:

• hormonal imbalance;
• problems in the functioning of the endocrine system;
• as a consequence after surgery - abortion, cleansing;
• spontaneous miscarriage in early pregnancy;
• regular, not fully treated inflammatory diseases in the reproductive organs;
• venereal diseases – recurrent;
• regular depression, stress and psycho-emotional changes;
• failure of the immune system;
• intrauterine device and its long-term wearing;
• diseases of a protracted nature in the absence of appropriate treatment;
• genetics, heredity.

With adenomatosis, heredity is not an unimportant thing. In fact, in 50% of patients the diagnosis is confirmed by the fact that it was inherited from relatives or parents.

Therefore, if there is a predisposition to the formation of polyps in the family, the younger generation should monitor their health. Polyps can be not only in the uterus, but anywhere.

When the growth becomes large, symptoms immediately appear that should not be ignored.

Symptoms in the presence of uterine adenomatosis:

• profuse vaginal bleeding that is not associated with menstruation;
• pain in the lower abdomen, impulsive type, painful sensations may intensify after intimacy;
• systematic bleeding after sexual intercourse;
• excessively heavy menstruation, especially at a young age (dangerous uterine bleeding);
• problems with conception.

Also, a large polyp limits space in the uterus, which reduces the chances of carrying the fetus to term.

How to diagnose adenomatous polyp?

It is necessary to visit a doctor who will prescribe a series of laboratory and medical examinations in order for the clinical picture to become clear.

To begin with, standard research:

• biochemistry and general blood test;
• study of hormones contained in the blood;
• routine gynecological examination and smear collection;
• ultrasonography.

Only after all the tests, taking into account the results, complaints and clinic, the correct diagnosis is made.

When combined with other diseases of the uterus or genital organs, a biopsy may be prescribed.

Also today there is a quick way to recognize the problem - this is hysteroscopy. A special contrast enzyme is injected into the uterus. Then he installs a hysteroscope through the cervix, through which you can clearly see all the changes, as well as their size.

Adenomatous polyp: how is treatment done?

Polyps in the uterus of this type are treated through surgery. Because uterine adenomatosis is a precancerous condition. Either surgery or cleaning (curettage) is performed using a hysteroscope.

After the growth is removed, its location is cauterized with current or liquid nitrogen; such manipulations are necessary to prevent relapse of the disease.

If an adenomatous type polyp occurs in a woman who is postmenopausal or premenopausal, the doctor may decide to remove the uterus completely. In cases where disruptions in the endocrine system are detected and cancer is possible, the uterus and appendages are removed.

After surgical treatment, hormone replacement therapy is prescribed. It is advisable to follow a diet, eat right and lead a healthy lifestyle, and abstain from sexual intercourse.

In some cases, to avoid complications after surgery, a course of treatment with antibacterial drugs may be prescribed.