What is complex endometrial hyperplasia?

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. Let’s discuss what polyplastic hyperplasia of the uterine wall means.

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.

For the treatment of intestinal metaplasia of the uterine wall, the diagnosis must be established first and the cause must be identified. If it is accompanied by polycystic ovary, ovarian tumors, or other endocrine and neurological disorders, targeted treatment should be given. At the same time, patients diagnosed with intestinal metaplasia of the uterine wall should start medication treatment immediately, using medication or surgical treatment. The choice of plan should be determined based on the patient's age, requirements for pregnancy, and health status. For those under 40 years old, the disease tendency is low and drug treatment can be considered first. Young people who are looking forward to having a baby should first use medication treatment, because after medication treatment, about 30% of patients are still likely to become pregnant and give birth to a full-term baby. For women before and after menopause, the potential development of the disease is higher than that of young people, so hysterectomy is often performed immediately.

1. The standard of medication treatment is

Standard medication, long-term examination, regular testing, and timely pregnancy promotion. Medication type: Clomiphene, a blood pressure-induced ovulation drug, is taken once a day from the 5th to the 9th day of the cycle. If necessary, the medication period can be extended by 2 to 3 days. Blood estrogen drugs: They vary according to the degree of endometrial atypia. Mild intestinal metaplasia can be treated with intramuscular injection of corpus luteum copper, starting on the 18th or 20th day of the cycle, and taken for a total of 5 to 7 days. Patients with mild to moderate and moderate to severe intestinal metaplasia should use medroxyprogesterone continuously for a course of 3 months. After each course of treatment, a curettage or removal of uterine wall tissue for histological examination is performed. Depending on the response to the drug, the patient can choose to stop treatment or consider adjusting the dosage of the drug as appropriate. An IUD can also be placed in the uterine cavity.

2. Surgery

Curettage is not only an important diagnostic method, but also one of the treatment methods. Because some diseases can be eliminated through curettage. Patients aged 40 years and above with intestinal metaplasia of the uterine wall who are not pregnant can undergo hysterectomy once diagnosed. However, for patients with hypertension, diabetes, obesity or the elderly who have poor tolerance to surgery, drug treatment can be considered first under strict follow-up testing. Young patients who have failed to respond to medication, whose endometrial hyperplasia continues or worsens or is suspected to have developed into cancer, or whose vaginal bleeding cannot be controlled by curettage and medication, and who relapse after childbirth, can all consider surgical hysterectomy.