Currently, it is believed that hyperplasia of the inner layer of the uterine wall (endometrium) is not a local process, but one of the manifestations of general endocrine metabolic disorders in a woman’s body. Such ideas also suggest completely new approaches to the treatment of precancerous diseases and endometrial cancer.
What is atypical endometrial hyperplasia
This term is practically not used in our country. But it approximately corresponds to adenomatous endometrial hypertrophy with atypia. This is the name of the proliferation of the mucous membrane of the uterus, when externally altered glands predominate in the tissue, in which atypical cells are found. Atypical cells are cells that have changed their properties and acquired a form that is not typical for the cells of the tissue from which they developed. This is the first sign of the transformation of endometrial hyperplasia into endometrial cancer (adenocarcinoma).
The disease begins with a violation of the hormonal maintenance of the menstrual cycle. This is caused by malfunctions in the system of the cerebral cortex – the hypothalamus (the part of the brain responsible for the endocrine system) – the pituitary gland (the main endocrine gland that regulates the activity of the other glands) – the ovaries.
Such an imbalance occurs due to complex metabolic and endocrine disorders in a woman’s body, the mechanism of which is currently not fully understood. What matters is whether a woman has obesity, diabetes mellitus, thyroid disease, and so on.
All this causes an increase in the secretion of female sex hormones estrogens (they provide hormonal support for the first half of the menstrual cycle) and a decrease or complete absence of the female sex hormone progesterone, which is necessary in the second half of the menstrual cycle.
Estrogens contribute to the proliferation (proliferation) of the endometrium, and progesterone suppresses proliferation and “starts” the secretion phase, which finally prepares the uterine mucosa for the forthcoming pregnancy. If pregnancy does not occur, hormonal support falls and the mucous membrane is rejected. But this is normal.
With endometrial hypertrophy, there is no secretion phase, and the mucous membrane continues to grow, and when estrogen becomes too small, it is rejected, most often gradually, in sections, which leads to profuse prolonged menstrual bleeding. Some parts of the mucous membrane are rejected during the intermenstrual period, which also causes bleeding.
In addition, ovulation does not occur without the second half of the menstrual cycle, which means that pregnancy is impossible.
Over time, the mucous membrane changes its properties, altered glands (adenomatosis) appear in it, and then incorrect (atypical) cells appear in these glands – a sign of a precancerous condition.
How is atypical endometrial hyperplasia treated:
The main thing is the timely detection of this disease or the initial stages of cancer, when atypical cells have just appeared in the basal layer of the endometrium. Therefore, all menstrual irregularities should be examined immediately. For this, women are firstly performed an ultrasound examination of the uterus, and then, if changes have been detected, endoscopic (hysteroscopy) and RFE.
Hysteroscopy can be diagnostic and therapeutic. Most often, diagnostic hysteroscopy, when the doctor examines the endometrium enlarged by optical equipment with an eye, turns into a therapeutic one, that is, the endometrium is removed. But this is not always done. In childbearing age, today they are trying to use mainly hormonal therapy: suppressing the secretion of estrogens with the help of drugs with antiestrogenic properties, progestogens (synthetic analogs of progesterone) or analogs of the hypothalamic risling hormones (they suppress the secretion of pituitary hormones).
If the reproductive function is not required to be preserved, then the ablation of the mucous membrane of the uterine cavity is carried out – its complete destruction in various ways together with the basal layer, after which the endometrium is no longer restored. Subsequent hormonal correction is also carried out.
For the prevention of endometrial cancer, any irregularities in the woman’s menstrual cycle should be promptly identified and treated.