What is uterine hypertrophy? Excessive menstruation is a symptom

The most obvious symptom of uterine hypertrophy is that menstruation becomes more frequent and lasts for a long time. It is most common in multiparous women. Failure of the uterus to fully recover after giving birth, ovarian dysfunction, and some gynecological inflammations can all lead to uterine hypertrophy.

1. Common symptoms

The main symptoms are excessive menstrual flow and prolonged duration. There may also be a shortening of the cycle to about 20 days with no significant change in the menstrual flow and duration. Or there may be a prolonged menstrual period but not much menstrual flow.

Most of the patients are multiparous women, and most of them have given birth to three or more children. They have been ill for a long time, and those with heavy bleeding appear anemic. Gynecological examination shows that the uterus is uniformly enlarged, generally the size of 6 weeks gestation, and a few are larger than 8 weeks gestation. The texture is tough, and the bilateral ovaries may be slightly enlarged, with multiple follicular cysts.

The basic pathological changes of this disease are changes in smooth muscle cells and blood vessel walls in the myometrium.

(I) Gross findings: The uterus is uniformly enlarged, with myometrial hypertrophy of 2.5 to 3.2 cm, grayish white or pink in cross section, increased hardness, woven fiber bundles, vascular protrusions in the outer 1/3 of the myometrium, normal or thickened endometrium, and sometimes small leiomyoma (less than 1 cm in diameter) or endometrial polyps can be seen.

(B) Microscopic examination: The images are inconsistent and have the following forms: ① Simple smooth muscle cell hypertrophy, which is the same as the normal uterine myometrium under microscopic observation, without collagen fiber proliferation and no obvious changes in the blood vessel wall; ② Collagen fiber proliferation in the uterine myometrium, forming uterine fibrosis; ③ Changes in the blood vessel wall in the myometrium: The arteries and veins are obviously dilated, and there are clusters of elastic fibers proliferating around the new blood vessels.

2. Causes of uterine hypertrophy

1. Chronic uterine involution in multiparous women (20%):

In multiparous women, elastic fiber tissue in the myometrium proliferates between smooth muscles and around blood vessels. Chronic inflammation and long-term stimulation cause cervical congestion and edema, and hyperplasia of cervical glands and stroma, leading to varying degrees of cervical hypertrophy.

2. Ovarian dysfunction (20%):

Continuous stimulation of estrogen can cause hypertrophy of the uterine muscle layer. Clinically, patients with functional uterine bleeding, especially those with a long course of illness, often have varying degrees of uterine enlargement. Cervical hypertrophy generally does not require treatment. If there is erosion, cervical erosion can be treated.

3. Inflammation (10%):

Chronic adnexitis, pelvic connective tissue inflammation and chronic uterine myositis cause collagen fiber proliferation in the myometrium, resulting in uterine fibrosis.

4. Pelvic congestion (5%):

It causes hyperplasia of uterine connective tissue and may also lead to uterine hypertrophy.

5. Uterine myometrial vascular sclerosis (5%):

Primary uterine vascular disease, etc.