What is irregular endometrial hyperplasia

Girls are born great. They suffer from many gynecological diseases and have to endure pain every month. It is said that mothers are the greatest people in the world, which is not an exaggeration. Today we will talk about irregular endometrial hyperplasia and see how harmful it is to girls. So boys should take good care of girls, and girls should also take good care of themselves. Let's take a look.

Endometrial hyperplasia has a certain tendency to become cancerous, so it is classified as a precancerous lesion. However, based on long-term observations, the vast majority of endometrial hyperplasia is a reversible lesion, or maintains a persistent benign state, and only a few cases may develop into cancer after a long time interval. There are three types of endometrial hyperplasia: simple hyperplasia, complex hyperplasia and atypical hyperplasia. The following discussion will focus on atypical hyperplasia.

Menstrual disorders are one of the prominent symptoms of this disease, which are often manifested as irregular vaginal bleeding, infrequent menstruation, amenorrhea or continuous bleeding after a period of amenorrhea. It is generally called anovulatory functional uterine bleeding. In addition to vaginal bleeding, infertility is also the main symptom of patients with anovulatory dysfunctional uterine bleeding during the reproductive period.

Endometrial hyperplasia has a certain tendency to become cancerous, so it is classified as a precancerous lesion. However, based on long-term observations, the vast majority of endometrial hyperplasia is a reversible lesion or maintains a persistent benign state. Only in a few cases may cancer develop after a longer time interval. There are three types of endometrial hyperplasia: simple hyperplasia, complex hyperplasia and atypical hyperplasia.

1. Treatment

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.

(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 pathological morphology of the endometrium is highly atrophic, and the ultrastructure has obvious degenerative changes.

(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.

3. Monitoring of the condition during drug treatment

During drug treatment, it is important to monitor atypical endometrial hyperplasia during the treatment process.

(1) Monitoring of the condition can guide the medication regimen: Some young patients with atypical endometrial hyperplasia have anovulation or insufficient corpus luteum due to deficiencies or imbalances in certain links in the hypothalamic-pituitary-ovarian axis. This condition often lasts for a long time, and the endometrial glands will show secretory or atrophic changes, decidualization of stromal cells, and squamous metaplasia. Once the endometrium has transformed to normal, progesterone drugs can be discontinued. For infertile patients, ovulation-inducing drugs should be used immediately to increase the chance of conception. If the endometrium does not respond well to the drugs, the drug dosage should be increased and treatment should continue. Ignoring the monitoring of drug responses may lead to over- or under-treatment.

(2) Monitoring of the disease can assist in the differential diagnosis of endometrial atypical hyperplasia and well-differentiated adenocarcinoma: Although endometrial cancer and endometrial atypical hyperplasia have their own characteristics in terms of tissue pathological morphology, it is sometimes difficult to make a correct judgment on the difference between severe atypical hyperplasia and well-differentiated adenocarcinoma based solely on the results of endometrial examination obtained by curettage. The two conditions respond differently to drug treatment and can be used as a reference for differential diagnosis.

(3) Monitoring of the disease can help detect stubborn cases early and pay attention to canceration: Although the canceration rate of atypical endometrial hyperplasia is only about 10% to 15%, we should be more vigilant for stubborn cases that do not heal for a long time and detect and treat them early.

4. Drug efficacy

Lindahl (1990) reported 89 cases of endometrial hyperplasia. After treatment with high-dose progestin, 96.7% of the endometrium returned to normal. The disappearance rate of endometrial atypical hyperplasia and well-differentiated adenocarcinoma treated with drugs is shown in Table 4. The disappearance rate of endometrial lesions after progestin treatment is better for atypical hyperplasia, with a lesion disappearance rate of 70% to 94%. The response of well-differentiated carcinoma is poor, but its lesion disappearance rate can also reach 60% to 75%.

5. Pregnancy after progesterone therapy

(1) Age: The canceration rate of patients with endometrial atypical hyperplasia before or after menopause is quite different, 3% in the former and 25% in the latter, so age is an important high-risk factor for canceration.

According to the above statements, we know some symptoms of endometrial fibroids. We hope that women can pay attention to them in life and always pay attention to changes in their bodies. If gynecological diseases occur, we should see a doctor in time, discover them in time and treat them in time. This is good for us. In daily life, girls should pay attention not to stay up late and drink more water.