What is endometrial hyperplasia?

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Before opening the issue of endometrial hyperplasia, I suggest considering what the endometrium is?

The endometrium is the inner layer of the uterine cavity, which contains the largest number of receptors for female sex hormones (estrogen and progesterone). During the first phase of the menstrual cycle, the growth of the endometrium occurs due to an increase in the number of cells (in other words, we call it proliferation). Then, as in the second phase, there is expansion of the glands and accumulation of secretion (secretion).

A normal proliferative endometrium contains glands that are evenly spaced and have a 1:1 ratio of glands to stroma. It is to the endometrium that the embryo attaches and ensures its nutrition. Each menstrual cycle, if pregnancy has not occurred, the endometrium changes during menstruation and grows again under the influence of female sex hormones. At the end of the reproductive period in the female body (sex hormones stop being produced, there is a shortage of them) and the endometrium stops growing and recovering normally.

What happens to the endometrium during hyperplasia?

Endometrial hyperplasia is a condition of excessive growth and thickening of the lining of the uterus, usually in response to excess estrogen and insufficient progesterone.

What are the types of endometrial hyperplasia?

Simple (benign) endometrial hyperplasia: cell growths are detected, but without disruption of normal endometrial tissue.
Atypical hyperplasia of the endometrium: cellular changes is observed, as well as differences in the structure of the endometrium, so it is considered a precancerous lesion.

What are the causes of endometrial hyperplasia?

Endometrial hyperplasia is more often observed in women with endocrine disorders:

Chronic anovulation (absence of ovulation), for example, in women with polycystic ovary syndrome (PCOS)
In case of excess weight, especially if adipose tissue is deposited on the waist (visceral type), which are risk factors. At the same time, there is an excessive formation of aromatase (an enzyme), which metabolizes androgens (male sex hormones) into estrone, and therefore causes high levels of estrogens. It is known that visceral obesity increases the risk of endometrial cancer by 6 times
When the function of the thyroid gland is disturbed. This important endocrine organ produces thyroxine (free T4), which regulates the activity of sex hormones, constantly transferring them to a safe, inactive state. If the function of the thyroid gland is disturbed, sex hormones begin to excessively affect the endometrium and stimulate their excessive division and growth
When the level of male sex hormones (hyperandrogenism) increases, because this hormone is anabolic and causes hormone-dependent cells to divide excessively. Androgens often suppress the production of progesterone in the female body. Taking sports supplements also stimulates the excessive formation of androgens in the female bod
Liver dysfunction and gall bladder disease (after hepatitis, cholelithiasis). Here the cause is a deviation of the ability of the liver and bile to remove the excess of sex hormones from the female body and regulate their activity
A type of diet with excessive use of carbohydrates and sweets (causes an increase in the formation of insulin in the pancreas, which turns into insulin-like growth factor, which stimulates the growth of the endometrium)
Consumption of meat and products grown with the use of anabolic hormones stimulates their excessive influence on hormone-sensitive cells and, first of all, the endometrium. An excessive amount of animal fats also has a negative effect on the endometrium
Intervention and impact on the endometrium during termination of pregnancy is a traumatic factor that can often provoke the beginning of incorrect cell divisions
The chronic inflammatory process of the endometrium due to constant cell irritation can lead to its improper growth
Taking high doses of glucocorticosteroids affects the endometrium and provokes its chaotic growth (often the development of polyps). Therefore, all women who take this group of drugs for the treatment of autoimmune diseases (bronchial asthma, rheumatoid arthritis, lupus) should be under the observation of a gynecologist-endocrinologist
When the breakdown of vitamin B 9 in the body is disturbed (mutations of the MTHFR 677 gene), homocysteine accumulates, and in women, the tendency to disrupt the division of epithelial cells (the mucous layer of the uterus and cervix) increases significantly, and the risk of polyps formation increases
An increase in the level of prolactin (PRL) in the blood disrupts the hormonal balance in relation to the endometrium, often the reason for the increase in PRL in the body is chronic long-term stress or taking sedative drugs (antidepressants, sleeping pills)
Taking the drug tamoxifen in women for the treatment of formations in the mammary glands significantly affects the development of endometrial hyperplasia, so they should undergo regular ultrasound control of the endometrium once every 3-6 months
When smoking in women, the probability of disruption of cell division at the level of the endometrium increases over time
Having a genetic disorder (such as Lynch syndrome) that increases the risk of endometrial cancer is also a risk factor.

It is important to remember that endometrial hyperplasia is often combined with other endocrine neoplasms (uterine fibroids, endometriosis, mastopathy) because their development is based on hormonal disorders.

How to diagnose and prevent endometrial hyperplasia?

Most often, endometrial hyperplasia is asymptomatic and is detected during pelvic ultrasound. Sometimes women may complain of heavy or prolonged menstruation, bleeding, spotting, which lead to a decrease in the level of hemoglobin and ferritin in the blood, there may be a feeling of heaviness in the lower abdomen. At the onset of menopause, even minor bleeding should alert and become a reason to consult a gynecologist-endocrinologist.

The following methods are used to diagnose endometrial hyperplasia:

Ultrasound of the pelvic organs (the examination is carried out in the second phase of the menstrual cycle on day 18-25, while the thickness of the endometrium is assessed, which should not exceed 16 mm, it is preferable to conduct an ultrasound in the first phase of the menstrual cycle (on day 6-12) for exclusion of endometrial polyps
Endometrial aspiration or biopsy. It is carried out in the second phase of the cycle, while a special catheter is inserted into the uterine cavity to collect the contents, then the obtained material is sent for histological examination, which allows us to establish the type of hyperplasia and determine the tactics of treatment
Hysteroscopy is the use of an optical system under the control of vision on a monitor, with this method the doctor can assess the structure of the endometrium, and make a targeted biopsy of the changed areas, remove polyps or focal growths.

Further tactics of treatment and observation will depend on the histological conclusion. Women with endometrial hyperplasia should avoid thermal procedures (staying in the active sun, saunas, hot baths, abdominal massage and wrapping).

What is the prevention of endometrial hyperplasia?

My first recommendation would be:

Have an annual check-up with a gynecologist-endocrinologist, which includes ultrasound of the pelvic organs, cytological examination and hormonal screening. After all, it is important that the condition of the uterus, endometrium, cervix and mammary glands depends on the proper hormonal balance in the female body
Observation by a specialist with modern approaches to endocrinology, genetics, immunology, nutrition, the possibility of a comprehensive approach and understanding the impact of taking certain drugs on the state of your body
Do not tolerate if any changes or deviations appear in your body
Lead a healthy, active lifestyle in order to prevent excess weight (above we discussed the role excess weight plays in the development of endometrial hyperplasia)
Іntroduce into your daily habit a diet rich in vegetables, fruits, proteins, unsaturated fatty acids, and fiber;·Timely detection and treatment of inflammatory diseases of the pelvic organs
Be careful if there is a genetic predisposition in the family and discuss the issue of prevention with your doctor.

Keep safe!!!

What is endometrial hyperplasia?