What Is Endometrial Hyperplasia?

Endometrial hyperplasia has a certain tendency to become cancerous, so it is classified as a precancerous lesion. However, according to long-term observation, most of the endometrial hyperplasia is a reversible disease, or maintain a persistent benign state. Only a few cases may develop cancer after longer time intervals. Divided into 3 types according to glandular structure and morphology of glandular epithelial cells: Simple hyperplasia: Endometrial physiological response caused by progesterone-antagonized estrogen long-term stimulation Interstitial and glandular hyperplasia simultaneously without glandular crowding, no glandular epithelial morphology. Compound hyperplasia: The glands in the lesion area are crowded, the interstitial tissue is significantly reduced, and there is no atypia of glandular epithelial cells. Atypical hyperplasia: glandular epithelium is atypical and belongs to the intraepithelial tumor of the endometrium. It can be divided into mild, moderate and severe according to the degree of the lesion.

Basic Information

English name

endometrial hyperplasia

Visiting department

Obstetrics and Gynecology

Multiple groups

Perimenopausal or postmenopausal women

Common causes

Sustained by estrogen, without progestin, etc.

Common symptoms

Irregular bleeding, thin or amenorrhea, infertility

Causes of endometrial hyperplasia

The pathogenesis of endometrial hyperplasia is not very clear, but the following phenomena and facts indicate that long-term estrogen stimulation is the main pathogenesis factor.

Anovulation can occur in adolescent girls, perimenopausal women, or some aspects of the hypothalamic-pituitary-ovarian axis disorders, polycystic ovary syndrome, and so on. The endometrium is affected by estrogen for a long period of time, without progestin, and lacks the transformation of the periodic secretion period, but is in a proliferative state.

In patients receiving postmenopausal estrogen replacement therapy (ERT), 20% of women with endometrial hyperplasia were observed for 1 year with estrogen alone.

Endometrial hyperplasia is also observed in patients with long-term use of tamoxifen (TAM) in postmenopausal advanced breast cancer. Because tamoxifen has a weak estrogen-like effect.

Clinical manifestations of endometrial hyperplasia

Age

Endometrial dysplasia occurs in younger women. It can also be seen in perimenopausal or postmenopausal women.

2. Menstruation

Abnormal menstruation is one of the prominent symptoms of this disease. Often manifested as irregular vaginal bleeding, thin menstruation or amenorrhea for a period of time followed by a long period of large vaginal bleeding.

3. Fertility

Long-term ovulation due to endocrine abnormalities reduces fertility in these patients. The infertility rate of patients under 40 can reach 90%.

Endometrial hyperplasia

Diagnosis depends on endometrial histology. The methods of material selection include: endometrial biopsy, dilatation and curettage, negative pressure aspiration, and hysteroscopy. Because atypical hyperplasia of the endometrium often manifests as scattered or single focal lesions, the entire endometrium may have various degrees of proliferation at the same time. Taking only a few tissue biopsies cannot reflect all changes in the endometrium. For perimenopausal women with atypical hyperplasia of the endometrium after curettage, 30% to 50% of uterine resections are accompanied by highly differentiated adenocarcinoma. Therefore, it is important to obtain a comprehensive endometrial tissue for pathological examination. Compared with simply taking a few pieces of endometrial tissue, the tissue removed by dilatation and curettage is more comprehensive, but some parts may be missed where the curette does not reach, especially the double uterine horns and the bottom of the palace. Negative pressure suction will make the endometrium fall off completely due to the negative pressure suction, and the diagnosis will be more comprehensive and reliable. Hysteroscopy can not only see the endometrial condition from the appearance of the endometrium, but also can perform curettage or negative pressure suction under direct vision, and its examination and diagnosis are more detailed and comprehensive.

Endometrial hyperplasia

For the treatment of endometrial atypical hyperplasia, the diagnosis must first be clarified and the cause identified. If it is accompanied by polycystic ovary, ovarian functional tumors, and other endocrine disorders, targeted treatment should be performed. At the same time, symptomatic treatment was immediately started for those diagnosed with endometrial atypical hyperplasia, and medication or surgery was used. The choice of plan should be determined according to the patient's age, fertility requirements, and physical health. Those younger than 40 years of age have a low cancerous tendency, and drug treatment can be considered first. Those who are young and looking forward to giving birth should try drug therapy first, because about 30% of patients may still conceive and give birth at term after drug therapy. For women before and after menopause, the potential trend of canceration is higher than that of young people, so hysterectomy is often taken directly.

1. Drug treatment principle is

Standardize medication, long-term inspection, regular testing, and timely pregnancy assistance. Types of medication: Ovulation-promoting drug clomiphene, once a day, taken on the 5th to 9th days of the cycle, if necessary, the medication period can be extended for 2 to 3 days. Progestin drugs: It varies according to the degree of atypical endometrium. Mild atypical hyperplasia can be injected intramuscularly with progesterone. The cycle starts on the 18th or 20th day, and the drug is shared for 5-7 days. Patients with moderate and severe atypical hyperplasia continuously use medroxyprogesterone for 3 months as a course of treatment. After completing each course, curettage or endometrial tissue is taken for histological examination. According to the response to the drug, the treatment is stopped. Or increase or decrease the dose of the drug as appropriate. The ring can also be placed in the uterine cavity.

2. Surgical treatment

Curettage is not only an important diagnostic method, but also one of the treatments. Because local lesions may also be removed through the curettage. Patients who are over 40 years old and who have no endometrial hyperplasia without fertility requirements can undergo hysterectomy upon diagnosis. However, for patients with high blood pressure, diabetes, obesity or advanced age and poor tolerance to surgery, it is also possible to consider first trial of drug treatment under strict follow-up testing. Young patients who fail to respond to medication, endometrial hyperplasia or exacerbation, or suspected to have developed cancer, or vaginal bleeding that cannot be controlled by curettage and medication, and postpartum recurrence, can consider surgical removal of the uterus.

Prognosis of endometrial hyperplasia

Cancer rate

The carcinogenesis rate of endometrial simple hyperplasia and complex hyperplasia is very low, ranging from 0 to 7%, and the atypical hyperplasia cancer rate can reach 8 to 45%.

Prognosis

Endometrial hyperplasia is actively treated with ovulation-promoting drugs or progestins. Most endometrial reactions are good and the prognosis is good. During the rigorous follow-up process, if a few people with poor curative effects are found to perform hysterectomy in time, they can still avoid developing into cancer. Even if there is a certain rate of canceration, the interval of cancerization is relatively long. Adhere to long-term regular follow-up, if there is cancer, early detection and surgery, the prognosis is optimistic.