Symptoms of Endometrial Thickening

Endometrial hyperplasia has certain pathological tendencies and is therefore classified as a precancerous lesion. However, based on long-term observations, the vast majority of endometrial hyperplasia is a cross-sectional disease or maintains a persistent benign state. Only in very rare cases may develop into cancer after a long interval of time.

According to the changes in the shape of the glandular duct structure and the presence or absence of glandular epithelial cell atypia, it is divided into three types: simple hyperplasia: a physiological reaction of the uterine wall caused by long-term stimulation of estrogen without progesterone antagonism. The stroma and glandular ducts proliferate simultaneously without glandular duct congestion, and the shape of the glandular epithelium is not atypia. Hematologic complex hyperplasia: The glandular ducts in the affected area are congested, the interstitial space is significantly reduced, and there is no atypia of the glandular epithelial cells. Supplementary intestinal metaplasia: The glandular epithelium has atypical characteristics and belongs to the tumor in the epithelial cells of the uterine wall. According to the degree of metastasis, it is divided into three degrees: mild, moderate and severe.

Causes of endometrial hyperplasia

The pathogenic factors of endometrial hyperplasia are not yet very clear, but the following conditions and facts show that long-term estrogen stimulation is its main pathogenic factor.

Anovulation may occur in adolescent girls, menopausal women, or in cases of imbalance in a certain stage of the hypothalamic-pituitary-uterine-ovarian axis, polycystic ovary syndrome, etc. The uterine wall is continuously affected by estrogen for a long time, has no estrogen resistance, lacks regular metabolic changes, and is in a state of hyperplasia.

In patients receiving postmenopausal estrogen replacement therapy (ERT), it was observed that 20% of women developed endometrial hyperplasia after using estrogen alone for one year.

Endometrial hyperplasia can also be observed in postmenopausal patients with advanced breast cancer who have been treated with tamoxifen (TAM) for a long time. Tamoxifen has a weak estrogen-like effect.

Clinical symptoms of endometrial hyperplasia

1. Age

Intestinal metaplasia of the uterine wall occurs in younger women. This can also be seen in women during menopause or postmenopause.

2. Menstrual status

Irregular menstruation is one of the prominent symptoms of this disease. It is often manifested as non-menstrual bleeding in the vagina, infrequent menstruation, or long-term heavy vaginal bleeding after a period of amenorrhea.

3. Pregnancy status

Long-term anovulation due to endocrine abnormalities reduces the fertility of these patients. The infertility rate for patients under 40 years old can reach 90%.