Treatment of adenocystic hyperplasia

Menstrual irregularity is a common disease among women. If not treated in time, it may affect women's fertility, so it has a certain impact on women's physical and mental health. However, there are many reasons for irregular menstruation. Adenoid cystic hyperplasia is the most direct cause of irregular menstruation. In order to make women's physiological cycle more regular, we must also treat it in time. Let's learn about the treatment of adenoid cystic hyperplasia.

Treatment of adenocystic hyperplasia

1. Treatment principles

The treatment of atypical endometrial hyperplasia must first make a clear diagnosis and find out the cause of the atypical hyperplasia, whether there is polycystic ovary, functional ovarian tumors or other endocrine dysfunction, etc. Those with any of the above conditions should receive targeted treatment. At the same time, symptomatic treatment can be started for atypical endometrial hyperplasia, using drug therapy or surgical treatment. The choice of these two treatment options should be based on age, type of endometrial hyperplasia, requirements for fertility, etc.

(1) Different ages have different considerations:

① Young women who are eager to have children should avoid overdiagnosis and overtreatment. It is not uncommon for endometrial hyperplasia to be overdiagnosed as adenocarcinoma and even overtreated. It would be a great mistake to remove the uterus without a clear diagnosis. In clinical practice, there are many examples of such mistakes. If the pathologist is unaware that the patient has fertility requirements and the clinician does not emphasize it, misdiagnosis and mistreatment may be inevitable. Therefore, for the diagnosis of endometrial biopsy in young infertile women, if any doubts are found, multiple experts should be consulted to clarify the differential diagnosis of endometrial hyperplasia or endometrial adenocarcinoma to the greatest extent possible.

② Perimenopausal or postmenopausal women should be alert to the possibility of atypical endometrial hyperplasia and cancer coexisting. They should consider hysterectomy and be careful not to be overly conservative. Do not perform only endometrial resection without ruling out the possibility of cancer, which may cause adverse consequences. When the uterus is removed due to atypical endometrial hyperplasia, the removed uterus should be examined on the operating table to see if there is coexistent cancer, and pay attention to whether there is cancer infiltration into the muscle layer and choose the appropriate surgical scope.

(2) Different types of intimal hyperplasia have different treatment principles:

① Simple and complex endometrial hyperplasia:

A. Young patients: Most of them suffer from anovulatory functional uterine bleeding. The basal body temperature should be measured. If it is confirmed to be monophasic anovulation, ovulation induction treatment can be used.

B. Reproductive period: Generally, one curettage can control bleeding. If bleeding still occurs after curettage, hysteroscopy and B-ultrasound should be performed to rule out submucosal myoma or other organic lesions. Patients with polycystic ovary syndrome who may be infertile during the reproductive period and have clinical manifestations of anovulation should be treated according to polycystic ovary syndrome.

C. Menopausal transition period: It is often anovulatory functional uterine bleeding. If menstruation is infrequent and the amount of blood is heavy or the bleeding time is long after curettage and hemostasis, progesterone treatment should be given every two months, and follow-up observation should be conducted after 3 cycles in total.

D. Late menopause: The patient should be asked whether to use estrogen replacement therapy alone. After curettage, the replacement therapy can be suspended or progestin can be added.

②Atypical endometrial hyperplasia:

A. Menopausal transition or postmenopause: Hysterectomy. Since age is the main risk factor for malignant transformation of endometrial hyperplasia, hysterectomy is appropriate for patients in this age group.

B. Young people or those who want to have children: drug treatment. Atypical hyperplasia is a potentially malignant precancerous lesion. If not treated, 20% will develop into cancer. However, cancer is rare in young patients. Moreover, drug treatment is effective for young and reproductive patients, so drug treatment can be chosen to preserve fertility.

2. Medication

(1) Ovulation-inducing drugs: Ovulation-inducing drugs include clomiphene and chorionic gonadotropin, which are generally used for patients with mild atypical endometrial hyperplasia. The dosage of clomiphene is 50-100 mg, once a day, taken on the 5th to 9th day of the cycle. If necessary, the medication period can be extended by 2-3 days.

(2) Progestogen drugs: Progestogen drugs can inhibit endometrial hyperplasia caused by estrogen. Its mechanism of action is:

① Inhibit ovulation and the secretion of pituitary gonadotropin through the hypothalamus and pituitary gland, causing the serum E2 level to drop to the equivalent of the early follicular stage.

②Reduce the level of estrogen nuclear receptors in the endometrium.

③Inhibit endometrial DNA synthesis.

④ Increase the activity of estradiol dehydrogenase and isocitrate dehydrogenase, thereby increasing the conversion of estradiol to less active estrogens such as estrone.

Commonly used progestins include progesterone, hydroxyprogesterone caproate, medroxyprogesterone (progesterone acetate) and medroxyprogesterone acetate. The method of use and dosage vary according to the degree of endometrial atypical hyperplasia. For mild atypical hyperplasia, 30 mg of progesterone can be injected intramuscularly, starting on the 18th or 20th day of the cycle, and used together for 5 to 7 days to transform the endometrium into the secretory phase. After that, the hyperplastic endometrium will fall off during the complete withdrawal of bleeding and menstruation. For moderate or severe atypical hyperplasia, cyclical medication is not adopted, but continuous application is used. The hormone dosage reported by various authors is inconsistent. The small dose of medroxyprogesterone (progesterone acetate) is only 10 to 30 mg/d, and the large dose is 200 to 800 mg/d, medroxyprogesterone acetate is 40 to 160 mg/d, and hydroxyprogesterone caproate is 125 mg/every other day. Continuous medication must be insisted on. Intermittent interval medication will greatly affect the effect.

(3) Danazol is a derivative of ethynyl-testosterone and a commonly used drug for the treatment of endometriosis. It has a strong anti-proliferative effect on the endometrium. Treatment with a dose of 200 mg/d for 3 months has a significant effect on endometrial hyperplasia.

(4) Cottonpol is an effective drug used in my country to treat endometrial hyperplastic functional uterine bleeding and endometriosis. Its mechanism of action is to inhibit the ovaries and it also has a specific inhibitory effect on the endometrium. After treatment, the endometrial pathological morphology is highly atrophic and the ultrastructure has obvious degenerative changes. Peking Union Medical College Hospital has observed preliminary results in the treatment of atypical endometrial hyperplasia with cottonypol. There was one case of atypical hyperplasia. After using cottonypol, the atypical endometrial hyperplasia improved, but it still recurred. After 8 months of treatment with cottonypol, the endometrium atrophied and the patient soon became pregnant and gave birth to a boy.

(5) GnRH agonists first cause a sharp increase in blood gonadotropin levels, followed by a depletion of the gonadotropin reserve in the pituitary gland, thereby inhibiting the pituitary gland and reducing estradiol levels to postmenopausal levels. Therefore, they can also be used for atypical endometrial hyperplasia.

All of the above medicines have a course of treatment of three months. After each course of treatment, the uterus is scraped or the endometrium is taken for histological examination. Depending on the response to the medicine, the treatment is either stopped or the dosage of the medicine is increased or decreased as appropriate. The treatment period varies, ranging from 3 months, 6 months, 9 months, to 12 months, with an average of 9 months. The difference is related to the severity of the underlying cause of the disease. The dosage and duration of the medicine can be guided by the results of regular endometrial biopsy.

The above is an introduction to the treatment methods of glandular cystic hyperplasia. After understanding it, we know that the causes of such diseases are also diverse. In order to prevent such diseases from occurring, we must maintain good living habits in our daily lives. Especially women must have a regular schedule and pay attention to maintaining good eating habits.