Hyperplasia is what? Glandular hyperplasia of the endometrium. Endometrial focal hyperplasia

Hyperplasia is a condition characterized by an increase in the number of cells in the tissue or organ (excluding tumor tissue). The result of the development of this disease is neoplasm or a noticeable increase in the size of the organ.

Develops hyperplasia after a variety of influences that affect the reproduction of stimulating cells. Thus, antigenic stimuli, oncogenic substances, tissue growth stimulators or loss of organ or tissue part for any reason can provoke development. Physiological hyperplasia is the growth of the epithelium of the mammary glands during pregnancy, the manifestation of glandular hyperplasia before or during menstruation and other similar manifestations.

As an example of hyperplasia, progressing in pathological conditions, one can name an increase in the volume of structural elements in patients with certain forms of anemia of myeloid tissue. In addition, hyperplastic processes can occur in the lymphatic tissue of the lymph nodes, as an immune response in the spleen, in the case of infectious diseases.

Variety of shapes

In medicine, there are several main types:

1. Physiological hyperplasia. There is a proliferation of tissues, which is functional or temporary. For example, mammary gland hyperplasia, during the period of feeding or during pregnancy.
2. Pathological hyperplasia. Due to a number of provoking factors, tissues proliferate.

In addition, this disease can be focal, diffuse and polyposive:

1. With a focal shape, a clear localization of the process is observed in the form of separate sections.
2. When diffuse hyperplasia affects the surface of the entire layer.
3. For the polypous form, the uneven growth of the connecting elements is characteristic. In this case, hyperplasia can provoke the development of poor-quality formations and cysts.

Diffusive thyroid hyperplasia

This disease occurs in the case of a compensatory reaction of the thyroid gland to a shortage of iodine. The term "diffuse" means that the pathology affects the entire organ: its size increases due to the multiplication of the gland cells in order to maintain the secretion of thyroid hormones, which promote the metabolism of oxygen uptake that maintain the energy level.

The thyroid gland requires iodine to maintain its hormonal activity. The lack or absence of iodine intake promotes the growth of the gland cells and in the subsequent can lead to its dysfunction.

Hyperplasia of the adrenal glands

This disease can be nodular or diffuse. It accompanies the invariable tissue of the adrenal gland in the case of a tumor of the pineal body and Cushing's syndrome. In adults, this form of hyperplasia, especially the left-sided, is very difficult to recognize by ultrasound and remains an object of study by MRI and CT.

Sometimes diffuse hyperplasia of the adrenal glands is accompanied by an increase in the organs with the preservation of the normal type of glands - in the form of hypoechoic formations, surrounded by fatty tissue. In the case of nodular hyperplasia, in the region of the "fat triangle" one can see rounded, homogeneous hypoechoic formations. They are quite difficult to distinguish from an adenoma on an echographic picture.

Prostate - benign hyperplasia

About 85% of men over 50 years of age are affected by this disease. Benign prostatic hyperplasia is characterized by the formation on the prostate of several small nodules (or one), which, gradually spreading, begin to press on the urethra, which subsequently causes difficulties with urination.

This disease does not cause metastasis, this factor distinguishes his prostate cancer, so it was called benign hyperplasia. However, it does not have a clear cause of occurrence and, as a rule, is associated with the male menopause.

Endometrium of the uterus

Hyperplasia is a benign increase in the thickness and volume of the inner lining of the uterus. It can occur as a result of the multiplication of both glandular and other tissue cells. This disease can lead to a violation of the functional activity of the endometrium (problems with conception, violation of menstruation).

Under normal conditions, the endometrium under the action of estrogen grows in the first period of the cycle, under the influence of progesterone in the second cycle period is restrained. In pathology, the growth of the endometrium occurs uncontrollably, is capable of capturing both the entire inner membrane and individual parts (focal hyperplasia).

Types of endometrial hyperplasia

By the predominance of some elements in the growing endometrium, there are:

1. Glandular hyperplasia. Endometrial glands proliferate in excess.
2. Polypous hyperplasia. There is focal proliferation of the endometrium, which has a glandular, glandular fibrous, and fibrous character. This kind of hyperplasia rarely becomes malignant, but can serve as a basis for the development of gynecological diseases.
3. Adenomatous hyperplasia with the presence of atypical cells, precancerous. In this case, degeneration into cancer of this type of hyperplasia can reach about 10%.
4. Cystic-glandular hyperplasia. The glands and cysts grow about the same way.

Causes

To date, the main cause of this disease is the excess with a relative lack of progesterone physiological level of estrogen. This state can lead to:

1. Transient age with a violation of hormonal metabolism and hormonal bursts.
2. Female obesity.
3. Polycystic ovary syndrome.
4. The period of menopause.
5. Taking medications containing estrogen without taking progesterone.

Very often, endometrial hyperplasia (experts' reviews confirm this) is manifested in women before menopause and in young nulliparous girls.

Concomitant diseases, which increase the manifestation of hyperplasia, are problems with the adrenal and breast, thyroid disorders, diabetes mellitus of both types, as well as hypertension. The development of hyperplasia can also lead to factors such as:

1. Heredity for genital diseases.
2. Adenominosis.
3. Uterine fibroids.
4. Abortion and curettage.
5. Inflammatory processes of the genitals.

Causes of development and types of glandular hyperplasia of the endometrium

The main causes of glandular hyperplasia:

1. Anovulation.
2. Overweight.
3. The presence of follicular cysts.
4. Menopause.

Also, the danger is a syndrome of follicle persistence, glycemia and tumors of granulosa cells.

The lack of treatment and untimely diagnosis of this disease are fraught with such a dangerous consequence as the development of endometrial cancer. Mostly at risk are girls suffering from atypical adenomatous hyperplasia, and women in the post-menopausal period. It is focal and diffuse hyperplasia - these are the precancerous forms of this disease.

Other forms of endometrial hyperplasia are the intensive proliferation of glandular epithelium, cystic-enlarged glands, and also glandular-cystic hyperplasia.

Symptoms

In most cases, glandular hyperplasia occurs without pronounced clinical symptoms. At the same time, dysfunctional uterine bleeding caused by menstrual irregularities (delay in menstruation) is considered a common manifestation. These bleedings can be both profuse, and prolonged, and blood loss - abundant or moderate. As a result, anemic symptoms develop: loss of appetite, fatigue, weakness.

Between menstruations, you can see spotting. Quite often in women in connection with anovulation occurs infertility. That is, infertility is the reason for going to the doctor, who subsequently diagnoses the disease. Among the symptoms, you can also note pain in the lower abdomen.

Diagnosis of glandular hyperplasia can be carried out by means of diagnostic scraping, which is performed immediately before menstruation. Quite often in diagnosis, ultrasound and hysteroscopy are used.

Hyperplasia of focal

Focal hyperplasia (reviews of specialists suggest this) can threaten cancer and infertility. Poorly expressed character or asymptomatic leakage allows to detect this disease only during ultrasound or gynecological examination.

Focal hyperplasia usually develops after a hormonal disorder, after the transfer of somatic diseases and abortions or against a background of glandular type hyperplasia.

Focal hyperplasia of the epithelium of the uterus is diagnosed on the basis of the following symptoms:

• Bloody discharge after stopping menstruation;
• Acyclic or cyclic disorders of the menstrual cycle.

Treatment of this disease is carried out in two main ways:

1. Drug method - with the help of special drugs, including hormonal.
2. Surgical or surgical method - by scraping the uterine cavity.

Diagnosis of endometrial hyperplasia

The basis for diagnosing this disease is an examination by a doctor-gynecologist, conducting instrumental and laboratory studies.

The main methods of diagnosis are:

1. Ultrasound of the appendages and uterus with a vaginal sensor.
2. Hysteroscopy with material extraction for histological examination.
3. Diagnostic scraping of the uterine cavity.
4. If it is necessary to clarify the type of hyperplasia, an aspiration biopsy is performed .

One of the most important laboratory studies is the determination in the blood serum of the level of sex hormones and thyroid gland, as well as of the adrenal glands.

It is important to remember that any form of hyperplasia needs to be accurately diagnosed and to identify the true cause that led to an increase in tissues.

Treatment

If hyperplasia was diagnosed, the treatment is performed immediately. The method is chosen based on the manifestations of the disease and the age of the patient.

The most effective method is diagnostic curettage or hysteroscopic removal in the diffuse process of the endometrium.

If the treatment process is of a multistage nature, then, first of all, an emergency or routine curettage is carried out. The first option is used for anemia or bleeding.

As soon as the results of histology are obtained, the specialist can prescribe the following treatment methods:

1. At the age of more than 35 years, antagonists of gonadotropins are prescribed.
2. The intrauterine device "Mirena" with gestagens.
3. In the second period of the cycle, gestagenic preparations are prescribed (Dufaston, Utrozhestan).
4. For the purpose of non-surgical stopping of bleeding in girls at a young age, oral contraceptives are permitted in fairly large doses.
5. Combined oral contraception ("Regulon", "Yarina", "Zhanin") is appointed for 6 months with a traditional intake scheme.

The drugs mentioned above create an effect similar to the climacterium, but it is reversible.

After curettage, the control is carried out for half a year; if there is a relapse of the adenomatous form of hyperplasia, removal of the uterus is indicated . With other recurrent forms and ineffectiveness of other methods of treatment, the endometrium is artificially destroyed (ablation).

Prognosis and complications

The most dangerous complication of endometrial hyperplasia is the transformation of the endometrium into uterine cancer. However, no less dangerous are bleeding and relapses with the development of infertility and anemia.

In most cases, the prognosis is favorable: as a result of surgical intervention and prima drugs for 6-12 months, the disease can be completely cured.

Prevention

The most important measures to prevent endometrial hyperplasia are the prevention of stressful situations, the active struggle against excess weight and the immediate treatment of the disorders of the monthly cycle. In addition, a timely gynecological examination of women is very important.

Sometimes young girls can be recommended for prevention hormonal drugs, which contribute to reducing the risk of hyperplasia and endometrial cancer. Any woman should realize that when there is a uterine bleeding it is necessary to immediately contact a specialist. Remember that timely access to a doctor will help in the future to avoid most problems.