With the onset of menopause in women, the content of sex hormones gradually decreases. In menopause, conception becomes impossible. Menstruation ceases, since cyclic changes associated with the renewal of the mucous membrane in the uterine cavity no longer occur. However, this does not mean that a woman can not have problems with the health of the reproductive organs. On the contrary, with the onset of menopause, the likelihood of the appearance of many serious diseases, such as endometrial hyperplasia and uterine cancer, increases significantly. It is important to detect them and start treatment in time.
What should be the normal state of the endometrium
The mucous membrane of the uterus protects the walls from damage and damage, and after the onset of pregnancy, it retains and nourishes the embryo. The endometrium consists of the outer (functional) and inner (basal) layers. In a woman of reproductive age, the functional epithelium periodically exfoliates (if conception did not occur) and is displayed in the form of menstruation. After this, a new endometrium appears from the developing basal cells.
With the onset of menopause, it remains only a protective function. It begins atrophy (reduction in volume and thickness). If before the beginning of menstruation, the thickness reached 18 mm, then during menopause it is 5 mm. Such changes are considered the physiological norm. However, sometimes the thickness of the mucous does not decrease, but increases. Endometrial hyperplasia in menopause leads to serious complications.
In young women, endometrial hypoplasia (an abnormal reduction of mucosal thickness) is also considered a pathology. It also leads to infertility. However, during menopause, hypoplasia is a normal physiological process, and cannot be cured.
Types of hyperplasia
The following types of disease exist:
Ferruginous. The thickness of the epithelial layer increases due to the growth and violation of the shape of the glands located in it. Overgrowth occurs in the direction of uterine muscle tissue.
Cystic. Epithelial cells overlap the outlet openings of the glands, which begin to swell, forming cavities (cysts). In this form of the disease, malignant cell degeneration is possible.
Basal. A rare form of hyperplasia associated with germination deep into the uterus of the inner (basal) layer of the epithelial sheath.
Polypous (focal). Outgrowths on the thin stem (polyps) are formed from the cells of the glands. Separate areas of endometrial growth appear at the site of their formation.
Atypical. During menopause, this form is rare, since the processes in the body slow down. Meanwhile, atypical hyperplasia is associated with rapid abnormal changes in the shape and size of endometrial cells, which actively grow into other tissues. This form is most dangerous because it goes into cancer. Hyperplasia of this type is not treated, the uterus is removed.
Causes of endometrial hyperplasia during menopause
The emergence of this pathology contribute to disruption in the work of some body systems. Health problems can appear before the onset of menopause, and aging only exacerbates the consequences.
Hormonal disorders. The main factor affecting the state of the endometrium, is the content of estrogen in the blood. Endometrial hyperplasia occurs when the level of this hormone exceeds the norm. In turn, the content of estrogen is regulated by the second female sex hormone - progesterone, which suppresses the synthesis of excess amount of estrogen. During menopause, there is a decrease in the production of both of these hormones. However, the violation of their ratio in favor of estrogen causes pathological growth of the mucous membrane in the uterus.
Endometrial hyperplasia in menopause may occur, for example, if a woman uses hormone replacement therapy to alleviate the symptoms of menopause. The emergence of the disease contributes to the use of drugs containing only estrogen. Safer are the combined means, which also contains progesterone. They restore the right balance of hormones, preventing the appearance of hyperplasia.
Using hormonal contraception, a woman should consult a doctor about the effect of contraceptive drugs on the body. It is necessary to select the means in accordance with the hormonal background, which must be constantly monitored.
Endocrine diseases. The hormones produced by the thyroid gland, adrenal glands and other organs of the endocrine system also affect the hormones of the body. Violations in the work of these organs can lead to an abnormal increase in the content of estrogen.
Metabolic disorders, obesity. In addition to the ovaries, estrogens are also produced in adipose tissue. In obesity, their level exceeds the level of progesterone, which leads to the appearance of pathologies in the uterus, as well as diseases of the mammary glands, liver and other organs.
Aging body tissue. As a result of aging, the mucous membranes of the genital organs become more susceptible to damage and infection. Age-related weakening of the immune system contributes to the occurrence of inflammatory processes in the uterus and appendages. As a result, cell development can be disrupted, including in the endometrium.
Injuries and surgery on the uterus. During curettage and abortion, the mucous membrane of the uterus is destroyed, which creates the prerequisites for the incorrect formation of cells and the appearance of tumors of a different nature.
Heredity. Some women have a genetic predisposition to the appearance of such diseases.
Addition: The risk of disease is increased in nonpartum women, as well as those with menstruation that appeared at a very young age. Early and late onset of menopause are also provoking factors.
Signs of hyperplasia with menopause
Typical symptoms of this disease are usually absent. In the premenopausal period, when the woman still has monthly periods, in the presence of hyperplasia, the regularity of the cycle is disturbed, bleeding from the genitals appears between the periods. Menstruation can become very painful, profuse and prolonged.
In menopause, if menstruation comes again after a break of 0.5-1 years, this can also be a sign of hyperplasia. In the postmenopausal period, when the appearance of any blood discharge is an abnormality, their renewal clearly indicates the occurrence of endometrial hyperplasia or a malignant tumor in the uterus. During this period, the weakening of the body’s immune defenses and the complications of chronic diseases create an additional risk of hyperplasia becoming cancer.
Note: The likelihood of hyperplastic processes in the uterus is increased in overweight women, as well as those with myoma or mastopathy. With diabetes, liver disease, with hypertension, the risk of the disease is also great.
If there are suspicions that a woman has endometrial hyperplasia, then she is scheduled for an examination by the following methods:
- Transvaginal Ultrasound. Using a special device inserted into the vagina, the thickness of the endometrium is measured. If during menopause, its value is 5-8 mm, then within six months the measurement is repeated 2-3 more times. With a thickness of 8-10 mm prescribed treatment with drugs or scraping, depending on the type of hyperplasia.
- Scraping the uterus. It is performed if the risk of rebirth into cancer is too great. But this procedure is also a diagnostic one. The removed endometrium is sent for histological analysis for the content of cancer cells.
- Biopsy. This method is used only for the diagnosis of diffuse hyperplasia (the process applies to the entire endometrium). In case of focal form, information cannot be obtained, since it is impossible to accurately select a tissue sample. For this purpose, a special tube with a piston (pipel) is used.
- X-ray of the uterus using a contrast solution. This method manages to see polyps in the uterus, changes in the structure of the endometrium, glands.
If the process is not started, atypical cells are not detected, then the endometrium is restored in a medical way. Hormone preparations based on progesterone are used. The treatment lasts about six months. All drugs are taken solely on doctor's prescription. Constant monitoring of the thickness of the endometrium by ultrasound. According to the results adjusted dose of medication.
Warning: After medical treatment, the disease may relapse, so a woman should have an ultrasound every 3-6 months.
Often, such treatment is carried out before the operation. Then it becomes less traumatic, healing is faster. For prophylaxis, hormonal preparations can also be prescribed after surgery.
It is carried out in cases where the disease recurs after medical treatment, polyps or abnormal cells are found in the endometrium. Scraping, various cauterization techniques, or uterus amputation are used.
Scraping (curettage). It is produced to remove mucous membranes with a thickness of more than 10 mm. The operation is performed under local anesthesia, lasts about half an hour.
Cauterization is especially effective if there are individual foci of hyperplasia. Methods such as cryodestruction (burning with cold), laser destruction, diathermocoagulation (using electric current) are used.
Hysterectomy - amputation of the uterus, performed with atypical degeneration of endometrial cells, a large depth of the uterus, and an increased risk of cancer. In some cases, menopausal women remove their ovaries if they are also affected, which often happens during the postmenopausal period.
With the onset of menopause, a woman needs to undergo a gynecological examination 1-2 times a year, with the most information about the state of the endometrium given by ultrasound. It will also allow time to identify and treat inflammatory diseases of the genital organs.
Tip: In old age, women are not recommended to drink beer, as well as excessively carried away with dairy products. They are sources of estrogen. It is useful to eat tomatoes, beets, pineapples, olive oil and other "anti-cancer" products.
With great care should be used hormonal and herbal remedies that increase the level of estrogen in the body. It is necessary to control the diet, not allowing a significant increase in body weight.
Endometrial hyperplasia with menopause
The inevitable changes that are characteristic of menopause, find a response in different parts of the body. One of the features of the new state is a decrease in the activity of immunity. This cause, as well as others, causes the onset and unexpected development of diseases.
Even gynecological ailments, which, it would seem, should give a woman a break from her presence, are able to become more active and threaten to enter a more serious stage. Endometrial hyperplasia in menopause is no exception. She may show up for the first time without showing visible signs, subside or remind herself with a new force.
What does “hyperplasia” mean?
The uterus has inside the mucous coating, called the endometrium. This body consists of several layers, each with its own functions. Endometrium is not the only part of the uterus, with its other divisions, it has clear distinctions. But for many reasons, which are reliably difficult to identify, his cells begin to grow into the muscular layer of the organ.
The thickness of the mucous membrane increases, causing hormonal, endocrine and reproductive disorders. Endometrial hyperplasia with menopause, this is its abnormal distribution deep into the layers of the uterus. It is also called adenomyosis. Depending on which mucosal cells predominate in the abnormal formations, there is more than one type of disease.
Forerunner of adenomyosis is endometrial hypertrophy in menopause. This is the growth of the volume and mass of the layers of the uterine lining. When menstruation still comes, then at the beginning of the period this is normal, since at the end it will decrease, and its upper layer will reject. But in postmenopause, this is an alarming sign, since the thickness of the endometrium is normally kept constant, having certain values. Following the increase in volume, an increase in the number of organ cells may begin.
What is adenomyosis?
Despite the fineness of the endometrium, it consists of various types of cells. Tissues found in the myometrium may be a cluster of one type or several. This, as well as the location of the abnormal growth determines the type of disease. Experts call the following forms of hyperplasia:
- Glandular cystic,
Glandular and cystic disease types
Glandular cystic hyperplasia of the endometrium in menopause appears most often due to the characteristic age-related causes. This is a hormonal failure, its risk during menopause has natural causes. Diabetes mellitus, benign tumors in the mammary glands, obesity, thyroid problems, often seen in women after 45, are favorable for the development of the disease circumstances.
This type of adenomyosis differs in that its basis is glandular tissue, but the growth is complemented by the formation of cysts and nodules in it. The latter may be found, including on the ovaries. Mucosa cells seep into the mouth of the glands, clogging them up and blocking the outflow of their contents. Grow cavity filled with mucus.
Cystic hyperplasia of the endometrium in menopause threatens that benign tumors can degenerate into a tumor. It forms a little differently than glandular, although the changes exist in the same tissue. Cysts in this form of adenomyosis are formed by increasing the size of the glands.
The forms of malaise described above are a uniform penetration of endometrial tissue into the muscle layer of the uterus. But it happens that it reveals pathological areas of limited size. This is focal hyperplasia.
It consists mainly of connective tissue, not glandular. It can also be collected into polyps, having the appearance of rounded formations on the stem with a shiny pink sheath. They are both singular and plural. Polyps are often located in the upper segment of the uterus, near the fallopian tubes. They are permeated by blood vessels, which are sometimes damaged.
Endometrial hyperplasia in postmenopause is more likely to turn into a cancer of this type more often than in the earlier period.
In an abnormally enlarged thickness of the endometrium, a special type of cell sometimes appears, called atypical. This happens more often when glandular tissue prevails over connective tissue. The epithelium is actively divided with the formation of papillae, excessive branching of the glands, other pathologies at the cellular level.
This can be found on the entire surface of the endometrium or in its individual sections. The latter is especially dangerous due to the high risk of transition to a malignant tumor.
Why does hyperplasia occur?
Having understood the threat of the disease, many will want to know why endometrial hyperplasia occurs in menopause or continues to develop. Causes may form long before the onset of menopause. Among the known causes of hyperplasia:
Hormonal imbalance. In menopausal age, an overestimated amount of estrogen can be observed in comparison with progestins. And although all hormones are produced in a smaller volume, their opposition does not end, but can be aggravated by the uncontrolled use of drugs that relieve menopausal syndrome. Most of them are estrogen-containing. Birth control pills can play the same role
- Metabolism failure. With age, it leads to the appearance of excess fat, which has the ability to produce estrogen. As a result, the balance changes again in favor of these substances, progesterone is suppressed. Exchange disorders provoke diabetes, vascular problems, liver problems. And this, too, will cause a thickening of the endometrium during menopause,
- Endocrine malfunction. The adrenal glands, the pancreas and the thyroid gland produce hormones that affect the general background, and therefore the state of the reproductive system. Malfunctions in their work lead to an abnormal amount of estrogen, which means it can cause adenomyosis,
- Age-related changes of the genital mucosa. Shells become thinner, but become more susceptible to any influence. Increases the risk of inflammation, infection. A large number of immune components are formed in the uterine cavity and its tissues, stimulating the reproduction rate of the envelope cells,
- Frequent invasion of the uterus. Because of these, mucosal receptor receptors almost do not respond to the effects of progesterone. And the natural ratio for menopause with estrogen does not help protect the cells of the body from increased division.The less history of abortions, scraping, the better for the health of the mucous membrane in menopausal age,
- Genetic predisposition. Pathology of the endometrium in menopause is more likely to occur among those whose ancestors in the female line were unwell,
- Immune failure. It lies in the fact that the protective components produced by the body perceive the uterine lining as foreign tissue. This forces the latter to produce their own kind.
The presence of fibroids, mastopathy can also spur the appearance of adenomyosis.
Signs of disease
Endometrial hyperplasia in postmenopausal symptoms shows slightly different than in young women with the same diagnosis. This is due to differences in hormonal balance. Adenomyosis is manifested:
- Sudden bleeding that may be a daub or intense. It is impossible to confuse them with menstruation, at the described stage ovarian function finally died out. However, endometrial hyperplasia in menopause without discharge also happens,
- Abdominal pains, pulling character,
- Increased fatigue and irritability,
Some may occasionally have a strong unreasonable thirst (due to jumped sugar in the blood), to grow weight. And sometimes endometrial hyperplasia in menopause does not show symptoms at all, showing up only during a routine examination. That is why it is important to monitor the state of the reproductive organs even when their main functions have already been fulfilled.
When do you need to worry?
Experts identify the diagnosis of "adenomyosis" and establish its appearance. For this purpose, hardware methods have been created, the main of which is ultrasound. It is held annually and in the absence of problems. There is such an indicator as the thickness of the endometrium, in the postmenopausal disease its rate is 4-5 mm, not more. At this stage, it atrophies, because in the mucous membrane no more repeated changes occur. The adherence of some parts of the uterus, the appearance of fluid in the cavity due to the partial narrowing of the canal of its cervix is also permissible.
The endometrial norm in menopause also includes the evaluation of its structure by a specialist. If there are changes in it that do not tangle with age, their character is determined.
The thickness of the endometrium with a menopause of 6-7 mm is a reason for closer observation. A woman will have to do an ultrasound after 3 months and six months later.
Thick endometrium in menopause is referred to as such, ranging from 8 mm. In this case, the indicator leads to scraping and analysis of the material obtained. And if it is 10-15 mm, histological examination will become necessary.
Mucus in the uterus on the ultrasound during menopause should be considered in conjunction with other symptoms. If there is pain and discharge from the blood, it is not just the result of a natural atrophy of the organ, but a sign of inflammation, hypertrophic changes in the membrane.
Getting rid of adenomyosis in menopause
Treatment of endometrial hyperplasia in menopause is determined by the type and prevalence of the pathology, as well as the duration of the course. There are several possibilities of elimination; home methods can be used as additional ones.
The doctor should choose the methods of treatment; amateur activity will lead to an increase in the symptoms and neglect of the disease. It is life threatening, because some types of adenomyosis can transform into cancer.
Even in the absence of symptoms, it will later be necessary to monitor the endometrial state during visits to the doctor.
Medications for adenomyosis
Endometrial hyperplasia in menopause treatment without surgery can only be in the absence of fibrous polyps. Drug therapy is the effect of hormonal drugs to reduce the effect on the uterine lining of estrogen. The following tools are used:
- Megestrol acetate,
- Hydroxyprogesterone caproate,
Postmenopausal hyperplasia is treated with a mandatory reception
- Ursosana, Phosphogliv, Essentiale to restore the liver,
- Heparin, Hepatrombin for preventing blood from clotting.
Progestogens and agonists of gonadotropin-releasing hormones, as well as antigonadotropins, take from 3 to 6 months, constantly monitoring ultrasound of the state of the endometrium.
Sometimes drug therapy is used before surgery to narrow the foci of adenomyosis. Intervention in this case will be the least traumatic.
We recommend reading an article about postmenopausal women. You will learn about the manifestations of this condition, especially the secretions, the extinction of the reproductive function, the need for medication.
When not to do without surgical treatment?
The treatment of postmenopausal endometrial hyperplasia is more often surgical, especially when it recurs, or there are prerequisites for cancer. Atypical cells found in the organ, a direct need to be operated on. Surgery may include:
- In curettage. Menopause curettage is recommended for mucous membranes with a thickness of 10 mm. It is also very informative for diagnostics. The doctor removes the top layer of the mucous with all the growths, doing it under intravenous anesthesia. The operation lasts 20-30 minutes
- In cauterization. This method is appropriate for focal spread. Laser treated areas of adenomyosis. They collapse and are removed later on their own,
- In cryodestruction. The method is similar to cauterization, but here they use not high, but low temperatures. Pathological areas die off and also leave the uterus,
- In hysterectomy. At high risk of developing cancer, that is, complicated types of atypical hyperplasia, the uterus is removed. In late menopause, a similar threat can hang over the ovaries. And because at this age, the operation captures all the appendages of the uterus.
Will popular ways?
Treatment of endometrial hyperplasia in postmenopausal folk remedies should not be taken as a basis. As an addition you can use:
- A mixture of burdock root juice and golden mustache. Take equal proportions and take 1 tbsp. twice a day
- Alcohol tincture of nettle. For 200 g of grass you need 500 ml of liquid. Insist 3 weeks in the dark, drink 1 tsp. in the morning and before bedtime.
The first in the list should be regular examinations by a gynecologist, despite the excellent state of health.
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 performed under general anesthesia, and is at the same time a therapeutic and diagnostic procedure, allowing both to stop excessive 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
- антагонистов гонадотропин-рилизинг-фактора (Бусерелин, Госерелин и другие),
- 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.
Endometrial hyperplasia in menopause: treatment, symptoms, types
Endometrial hyperplasia is a pathological, hormonally dependent change and proliferation of the uterine lining.
Hyperplasia is a proliferative process caused by abnormal reproduction of uterine gland cells and, to a lesser extent, connective tissue cells (stroma) of the endometrium.
It is important to understand that hyperplasia of the uterine lining is not a local problem, but a disruption of the work of the whole organism.
Perimenopausal endometrial hyperplasia affects up to 50% of women. The maximum incidence is in the early postmenopausal period. The development of endometrial cancer in older women in 80% of cases is due to the malignancy of recurrent endometrial hyperplasia of the uterus in menopause. That is why this disease requires timely diagnosis and adequate treatment.
Endometrium: structure, hyperplasia
The direct “culprit” of typical endometrial hyperplasia is a hormonal imbalance: the dominant effect on the uterine lining of estrogen against the background of progesterone deficiency.
Why is endometrium important and what is hyperplasia
The lining of the uterus, which is represented by the endometrium, is necessary to prevent damage and adhesion of the walls of the organ, as well as the retention and nutrition of the fetus during pregnancy. The structure of this part of the uterus is represented by the outer and inner layers, which are also called functional and basal, respectively.
In reproductive age, the functional endometrial layer exfoliates during menstrual bleeding. Following this, a new functional layer is formed from developing basal cells.
In the menopausal period, the endometrium performs only a protective function. Its atrophic changes gradually progress - the total volume decreases, the thickness becomes less.
Note! If earlier before the onset of menstrual bleeding, the thickness of the endometrium layer reached 18 millimeters, then during menopause this value is about 5 mm.
A specialist should be treated for preventive purposes.
Such changes are the norm of female physiology. But in some cases, the thickness of the pavement will increase. This phenomenon is called hyperplasia. Such a condition can lead to a number of complications, so it is important to regularly visit the gynecologist even during the period of menopause in order to early diagnose and assign a rational course of therapeutic correction.
Possible forms of hyperplasia
According to the histological classification, endometrial hyperplasia during menopause can be one of the following types:
- Ferruginous. In this case, an increase in the thickness of the endometrial lining layer occurs due to the proliferation of glandular cells. The growth of the endometrial layer is observed in the direction of the myometrium.
- Cystic. Epithelial cells close the excretory ducts of the glands, with the result that the glands themselves increase in volume with the formation of cystic cavities. This form of pathology can be the starting point of malignancy - malignant transformation.
- Basal. It is a rare form of pathology. Manifested by excessive proliferation of cells of the basal layer of the epithelium.
- Polypous or focal. Outgrowths are formed from glandular cells, at the place of formation of which the endometrium grows.
- Atypical. This form of hyperplasia during menopause is quite rare, however, is the most dangerous. This is due to the high risk of cancer transformation.
Clinical classification (as recommended by WHO):
- Simple without atypia. Increasing the number of stromal and glandular elements without restructuring the mucous layer of the uterus.
- Difficult without atypia. There is a structural reorganization (change of localization, shape and size of the endometrial glands) without activation of mitosis.
- Simple atypical. An increased mitotic activity of the cells without structural changes.
- Difficult atypical. A structural reorganization of cells occurs and their mitotic activity increases.
Based on the clinical classification, a diagnosis is made and treatment strategy is determined.
Etiology of hyperplastic changes during menopause
In menopause, hyperplastic changes in the endometrial layer can be caused by the following factors:
- Fluctuations in hormone levels are a leading factor in the activation of hyperplastic processes. Hyperplasia occurs with a high content of estrogen in the blood. The concentration of these hormones in the blood is controlled by progesterone, which suppresses their synthesis. However, during menopause, the synthesis of both types of hormones decreases. Hyperplasia in menopause is triggered by a violation of the ratio of estrogen and progesterone in favor of the first.
- Uncontrolled hormone replacement therapy. Many remedies for suppressing menopause symptoms are not as safe as they appear at first glance. Even herbal remedies can provoke excessive cell proliferation.
- Pathology of the endocrine system. Disruption of the endocrine system (thyroid, adrenal glands) can cause abnormal growth of endometrial cells due to the stimulating effect of hormones on the level of estrogen in the blood.
- Metabolic disorders. In the case of an excess amount of adipose tissue in the body, an excess of normal levels of estrogen is observed, which leads to hyperplasia. So overweight is a significant risk factor for hyperplastic changes.
- The weakening of immunity, provoking inflammation of the uterus and its appendages, can lead to hyperplastic processes. The development of hyperplasia on the background of chronic endometritis leads and infection with sexually transmitted infections.
- Traumatic injuries of the uterus, including surgery.
- Hereditary predisposition
What are the signs of hyperplasia?
In the presence of hyperplastic changes, any clinical symptoms are usually absent. If there is endometrial hyperplasia in premenopausal (that is, there is still menstrual bleeding), then it can cause fluctuations in the duration of the cycle, it is also possible that bleeding occurs in the interval between menstruation. Soreness during menstruation increases, bleeding is more abundant and prolonged.
Endometrial hyperplasia in menopause without secretions is detected only during preventive examinations. In the menopausal period, indirect confirmation of hyperplastic processes may be the resumption of menstruation after a break of 1 year.
Postmenopausal endometrial hyperplasia can provoke the appearance of pathological secretions with blood impurities. Hyperplastic changes during this period are especially dangerous, since the immune defense is weakened, the risk of exacerbation of chronic pathologies and malignant transformation is great.
At any age, endometrial hyperplasia can lead to uterine bleeding. In premenopause, such a complication often becomes the outcome of a long and abundant menstruation.
Important! The likelihood of hyperplasia is increased in such categories of patients: overweight, with mastopathy, myoma, diabetes, hypertension, liver pathologies in history.
How is endometrial hyperplasia diagnosed
The following methods are included in the range of informative diagnostic methods:
- Transvaginal ultrasound. Allows you to identify the thickness of the endometrial lining. In the case when the thickness is determined from 5 to 8 mm in postmenopausal, for half a year, the study should be repeated 2 or 3 times. If the thickness is determined from 8 to 10 mm or more, correction measures are assigned based on the form of the pathological process and the individual characteristics of the clinical case.
- The main criterion for postmenopausal endometrial hyperplasia is an increase in M-echo of more than 5 mm. In menstruating women in premenopause, the thickness of the M-echo on the 5-7th day of the cycle should not exceed 18 mm.
- Hysteroscopy. Allows you to visually assess the state of the endometrium, to assume the type of hyperplasia, to identify comorbidities.
- Diagnostic curettage. During this procedure, part of the endometrial layer is removed, after which specialists study its histological features. Allows you to determine the type of hyperplasia, to identify precancerous changes.
- Biopsy. This method of diagnosis is appropriate in diffuse forms of pathology. The biomaterial is collected using a pipe - a special tube with a piston.
- X-ray examination of the uterus with the involvement of contrast. The method allows to determine changes in the structure of the endometrial lining of the organ.
If the pathological process is identified in a timely manner, there is no cell atypia, then the most rational administration of medications. The doctor prescribes hormonal drugs:
- Gonadotropin-releasing hormone agonists.
- Progesterone-based drugs.
The duration of treatment is 6 months or more. Medicines should be taken only according to medical appointments.
It is important to regularly monitor the thickness of the endometrial layer using ultrasound to determine the need for dose adjustment.
Monitoring the effectiveness of therapy:
- Endometrial aspiration biopsy.
- Hysteroscopy with separate diagnostic curettage.
The timing of control depends on the form of pathology.
A course of drug therapy is also carried out before surgery to reduce its trauma and accelerate healing. In some cases, hormones are prescribed after surgery.
It is necessary in such cases:
- recurrence of the pathology after drug therapy,
- polyp detection
- detection of cell atypia.
- uterine bleeding,
- combination with adenomyosis, uterine myoma,
- the presence of contraindications for hormone therapy.
Surgical treatment involves the use of one of the following methods:
- Scraping, or curettage. Rationally, if necessary, remove the area of the lining, the thickness of which is more than 10 mm. The intervention is carried out with the use of anesthesia or local anesthesia, its duration is approximately 30 minutes.
- Ablation of the endometrium. It is used in cases of focal hyperplastic changes. Such techniques as cryodestruction, diathermocoagulation, laser destruction are used.
- Hysterectomy, that is, removal of the uterus. It is advisable in the case of cell atypia and a high risk of malignancy, with a significant depth of organ damage, when combined with myoma, adenomyosis.
- Extirpation of the uterus with appendages - shown in postmenopausal recurrent pathology.
Preventive measures to reduce the risk of hyperplasia in the menopausal period
The most important point of prevention is a regular visit to the gynecologist. This allows time to identify the initial changes in the structure of the endometrium and take rational measures for their correction. Monitoring the state of the structure of the uterus and appendages is carried out using ultrasound. In addition, women in menopause is recommended:
- eat right by eating healthy foods - fruits, vegetables, cereals,
- include in the diet tomatoes, pineapples, olive oil and other products that reduce the likelihood of cancer pathologies,
- limit consumption of dairy products (within reasonable limits) and beer drinks, since they are sources of estrogen,
- optimize physical stress on the body - do not overload, relax, go to the swimming pool, practice yoga, do things that will be good for your body and soul,
- before taking any drugs, including herbal remedies, you should consult with a specialist,
- pay attention to the timely treatment of chronic pathologies.
After reading the concept of endometrial hyperplasia, knowing what it is during menopause, one can form an idea of the danger of this condition and the importance of timely prevention. Early diagnosis will allow you to choose the most benign course of treatment, which is important for maintaining the balance of a woman’s health during menopause.
More information about modern ideas about this pathology can be found in the video.
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. С возрастом у большинства женщин появляется проблема лишнего веса.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.
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.
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.