What to do if the endometrium shows hyperplasia

Gynecological diseases are particularly harmful to women, especially uterine diseases. As a female reproductive organ, once a disease occurs in the uterus, it not only affects physical health, but even affects women's fertility. This has a certain impact on women's physical and mental health. Among them, endometrial hyperplasia is the most common gynecological disease. Many women are often worried and afraid. If such symptoms occur, they must be treated in time. Let's understand what to do if endometrial hyperplasia occurs?

What to do if the endometrium shows 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.

We all know that the occurrence of disease is not particularly terrible. If we can better master the treatment methods of the disease, we can recover from the disease well. The above is an introduction to what to do if the endometrium shows hyperplasia. After understanding it, if such symptoms occur, you must go to a regular hospital for examination and treatment in time and receive timely treatment based on your own cause of the disease and physical condition.