ENDOMETRIAL HYPERPLASIA ( UTERINE INNER WALL THICKNESS)
Definition of Endometrial Hyperplasia
Endometrial hyperplasia, limiting the lining of the uterus endometriumin the uterine lining as a result of excessive proliferation of cells called (endometrial layer)It is a condition that occurs with thickening.
Most of the cases of endometrial hyperplasia occur due to excessive secretion of estrogen hormone and insufficient progesterone hormone, and the proliferation of endometrial cells under the effect of estrogen. It can cause severe, excessive, clotted menstrual bleeding and intermittent bleeding, especially during menstrual periods in women.
In addition, endometrial hyperplasia may occur due to the estrogen hormone-increasing effect of the drug Tamoxifen, which is used in estrogen replacement therapy due to menopause or used in the treatment of breast cancer.
In most of the cases “simple hyperplasia” is encountered. Simple hyperplasia is diffuse thickening of the endometrium, the lining of the uterus. This situation is often reported in pathology reports. ”Cystic Glandular Hyperplasia”It is defined as cancer and has a 1% chance of turning into cancer.
If endometrial hyperplasia is not treated uterine cancer (endometrial cancer)is an important risk factor for
Endometrial Hyperplasia Symptoms
-Excessive menstrual bleeding (menorrhagia)
-Bleeding between menstrual periods
-Acne on face and body
-Iron deficiency anemia due to excessive menstrual bleeding
– Palpitations (tachycardia)
-Tenderness in the vagina
Endometrial Hyperplasia Complications
-Anemia due to excessive menstrual bleeding
Causes of Endometrial Hyperplasia
-Polycystic ovary syndrome
-Estrogen replacement therapy
-Estrogen-secreting tumors (for example, “granulosus cell tumor” that secretes estrogen in the ovaries, etc.)
To reduce the risk of endometrial hyperplasia;
– Menstruation should be regular, appropriate oral contraceptive drugs should be taken if necessary.
– Obesity should be struggled with, care should be taken to maintain the appropriate weight.
-Hormone replacement therapy must be under the control of a doctor
-Diabetes should be under control, insulin resistance should be investigated.
Diagnosis of Endometrial Hyperplasia
-Vaginal ultrasonic examination
– Diagnosis is made by performing endometrial biopsy.
Endometrial Hyperplasia Classification
Endometrial hyperplasia, in response to high levels of estrogen hormone, initially endometrial cells proliferate; this is a physiological hyperplasia. However, as time passes, these hyperplasic endometrial cells transform into cancer cells when treatment and follow-up are not performed. There are many histopathological types of endometrial hyperplasia and these are revealed by pathological examination of endometrial biopsies performed by a gynecologist.
There are two types of endometrial hyperplasia:
1- Hyperplasia without atypical changes in cells
Simple hyperplasia:Conversion to cancer:1%
Complex hyperplasia:Conversion to cancer: 3%
2-Hyperplasia with atypical changes in cells
Simple atypical hyperplasia:Conversion to cancer: 8%
Complex atypical hyperplasia:Conversion to cancer: 29%
As can be seen, atypical changes in cells increase the rate of uterine cancer.
Endometrial Hyperplasia Treatment
1-Medical Treatment:Hormone therapy, continuous or cyclic progesterone therapy
2-Surgical Treatment:Surgical removal of the entire uterus (uterus) (hysterectomy)
An individual approach to the treatment of uterine lining thickening is important. This treatment varies according to the cause of the hyperplasia, the type of hyperplasia, the patient’s age, desire for children and menopausal status.
In young patients, birth control pills and an intrauterine device containing hormones (MIRENA) can be used. In case of thickening of the inner wall of the uterus encountered in the premenopausal period, it can be treated with estrogen + progesterone or synthetic progesterone hormone. Intrauterine device (MIRENA) is a very good option in the treatment of uterine thickening in the premenopausal period, due to its low-dose hormone secretion and extremely low systemic side effects.
Progesterone therapy, which will compensate for the thickening (polyferative) effect of estrogen, is a good option in the treatment of endometrial hyperplasia for young women who do not have menopause yet, whose menstruation continues, and who wish to have children again in the future. Response to the treatment is evaluated by performing a biopsy or a complete curettage 4-6 months after this treatment is given.
Hysterectomy is the best option if you are close to or near menopausal age and have atypical cells.
Since the intrauterine device (MIRENA) is a highly preferred treatment method in the prevention of excessive menstrual bleeding and iron deficiency anemia in case of thickening of the inner wall of the uterus, and in the treatment of thickening of the uterine wall, brief information about MIRENA will be given in this article.
Intrauterine System-MIRENA: An alternative to the treatment of endometrial hyperplasia with the hormone progesterone is the application of an intrauterine system called MIRENA. MIRENA contains 52mg of the progesterone hormone called levonorgestrel. When it is administered into the uterus, it is slowly absorbed from this region within five years, so it releases a very low dose of hormone compared to orally taken progesterone pills, and its side effects are much higher than those taken orally. is less.
MIRENA is applied within the first seven days of menstruation, the system is removed after five years. A new one can be inserted immediately after removal. When MIRENA is inserted, the amount of menstruation is considerably reduced, even 20% menstruation can be cut. Cessation of menses does not mean menopause, the ovaries continue to work. Reduction of menses, prevention of anemia, absence of menstrual pain, thinning of the inner layer of the uterus (removal of the thickness of the uterus wall) and prevention of pregnancy are the biggest advantages of MIRENA.
Kiss. Dr. Kutlugul Yuksel
note: Article Written Date: 28.09.2011