Endometrial hyperplasia is an overgrowth of the mucous layer lining inside the uterus (called endometrium), usually secondary to hyperstimulation by estrogen (a sex hormone found in the female body).
Estrogen stimulates the growth of endometrial cells, a process that is subsequently reversed by the action of progesterone.
Hyperplasia may be due to different causes (exogenous estrogen administration, excessive ovarian production of them …) and can be of different degrees, being the most widely accepted classification, the divide in:
- simple hyperplasia.
- complex hyperplasia.
- simple atypical hyperplasia.
- complex atypical hyperplasia (atypia = abnormal cells).
Atypical hyperplasia is considered a preneoplastic disease (precursor of endometrial cancer), and thus in practice are divided into two groups: those without cellular atypia and that if present, by the differential impact that may exist medium term.
When cells grow and multiply actively called simple hyperplasia, and represent exaggerated forms a persistent proliferative endometrium, which may regress spontaneously or with medical treatment and are at low risk for progression to adenocarcinoma.
If this situation continues, form new cells and glands, forming the so-called complex hyperplasia.
These two entities are normal cells and glands, although increased in number and size.
When cells undergo changes that predispose to malignant degeneration, are called cellular atypia, and we talked about simple or complex atypical hyperplasia or atypical hyperplasia, a process that encompasses the previous two.
According to statistics, every process has a different rate of progress to malignancy progresses simply in less than 1% of cases, the complex, at about 3%, accompanied by atypical simple, up to 8%, and the complex atypical in up to 30%.
Fortunately, most endometrial cancers develop in the course of several years, following detection of endometrial hyperplasia and controlled, can tackle the problem in its early stages, thereby improving prognosis.
Are considered as known risk factors for endometrial cancer include:
- obesity.
- diets rich in animal fats.
- diabetes.
- estrogen replacement treatments.
- polycystic ovary syndrome.
- early menarche (having the period before 12 years of age) and late menopause (which occurs after age 50) because they increase the number of years in which the endometrium is exposed to estrogen.
- not having children (during pregnancy, hormonal balance is tilted toward greater production of progesterone and thus pregnancy reduces the risk of endometrial cancer).
- in some cases it is a hereditary cancer.
Symptoms: usually present as abnormal uterine bleeding, although in some cases may present with minimal symptoms.
The problem is that abnormal uterine bleeding can also occur in fibroids, endometrial polyps …
Available for diagnosis of ultrasound through the vagina, above all, helps us to detect other causes of uterine bleeding as it allows to assess the uterine size and shape and its annexes (ovaries and fallopian tubes).
View the status of the uterine lining (endometrium), and according to their characteristics leads us to suspect a possible endometrial hyperplasia.
Ultrasound has limitations because its sensitivity depends on the sonographer and the experience you have, and it depends on the time of the cycle when it does (should do it after menses), perimenopausal women and in the endometrium may be larger and misleading.
Nor detects whether there is only focal lesions.
Therefore, it is used as a diagnostic method easy to perform, not aggressive and not very annoying, that gives us great information but no definitive diagnosis
If hyperplasia is suspected, take a sample of the endometrium, either by aspiration biopsy by flexible suction cannula (suction curettage) which allows outpatient and avoid the classic instrumental curettage, or a hysteroscopy to visualize cavity and mucosa, and direct biopsy, which increases performance.
Always be performed after the ultrasound and intrauterine manipulation can alter the ultrasound image.
It is imperative that if performed by suction curettage through cannulas, sought in all directions thoroughly, so that no areas remain uncollected because hyperplasia may be focal and therefore, the result is a false negative .
The aspiration has a capacity to detect the problem between 60 and 90% of cases, but if positive, just flawed.
Hysteroscopy, involves threading a thin tube equipped with a lens inside the uterus, which allows to visualize directly the endometrial cavity and direct biopsy to see areas that are most abnormal, of the diagnostic test that gives more performance, but also more complex and has its problems, since depending on the experience of making it can be interpreted the findings differently.
It can be done on an outpatient basis, although some cases require general anesthesia for their implementation.
The diagnosis of endometrial hyperplasia will be done by histological analysis of the samples, but depends on the pathologist’s interpretation, is not uncommon that there are disagreements about whether what you see is atypical endometrial hyperplasia or endometrial cancer true, what requires a review of a sample, obtaining other or a hysterectomy (uterus) when in doubt.
About your treatment will always be individualized, as it will be important to distinguish the type of hyperplasia before which we stand, and if the woman wants to have children or not.
Therefore, this treatment can range from active monitoring, medical treatment or final treatment by removing the uterus.
If a woman wants to have children, treatment usually begins with a progestogen, the injury looking back. We will have to take periodic (approximately every 3 months initially and then every year).
If atypical hyperplasia occurs in postmenopausal, hysterectomy is usually cast, which already can not progress to malignancy, or perform instrumental curettage and then treatment with progestins.
If the process continues, it indicates the hysterectomy, or other alternatives if you do not want to miss the uterus, such as endometrial ablation or laser resection or thermal balloon, microwave …
Tags: Atypical hyperplasia, Cancer, cancer of the uterus, diabetes., Endometrial hyperplasia, Health care, hyperplasia, Hysteroscopy, vagina, women
