Ferruterous giperplaziya of endometrium
Ferruterous giperplaziya of endometrium – the excess growth of ferruterous fabric of endometrium which is characterized by its thickening and increase in volume. The ferruterous giperplaziya of endometrium is shown by plentiful periods, dysfunctional anovulyatorny bleedings, anemia, infertility. For definition of hyper plastic transformation of endometrium ultrasonography, hysteroscopy, Ekho-GSG, an endometrium biopsy, hormonal researches is carried out. Treatment of a ferruterous giperplaziya of endometrium includes a uterus cavity scraping, hormonal therapy, if necessary – a resection or an ablyation of endometrium.
Ferruterous giperplaziya of endometrium
Excessively active proliferative processes in ferruterous tissue of a uterus are the cornerstone of a ferruterous giperplaziya of endometrium. As the main danger of hyper plastic changes of endometrium serves the possibility of their progressing and malignant transformation. Therefore importance of diagnostics and treatment of a ferruterous giperplaziya of endometrium is dictated by relevance of preservation of reproductive potential of the woman and prevention of endometrial cancer. The diagnosis of a ferruterous giperplaziya can be made only by results of a histologic research of samples of endometrium.
Reasons of development of a ferruterous giperplaziya of endometrium
Hyper plastic transformation of endometrium can arise at women of any age with risk factors, but meets during the transition periods connected with hormonal changes in an organism more often (at teenagers and patients of premenopauzalny age).
The background genital processes accompanying development of a ferruterous giperplaziya of endometrium are uterus myoma, a syndrome of polycystous ovaries, endometriosis, endometritises. Development of a ferruterous giperplaziya of endometrium is quite often preceded by gynecologic operations, diagnostic an endometrium scraping, abortions. As risk factors of hyper plastic processes of a uterus serves absence in the anamnesis at the woman of childbirth, refusal of use of hormonal contraception, abortion, a late menopause.
Diabetes, mastopathy, hypertension, obesity, diseases of a thyroid gland, a liver and adrenal glands belong to ekstragenitalny associated diseases. As the leading moment of emergence of a ferruterous giperplaziya of endometrium serve the giperestrogeniye or long influence of estrogen at decrease in constraining progesterone influence.
Classification of a giperplaziya of endometrium
By histologic option allocate several types of a giperplaziya of endometrium: ferruterous, ferruterous and cystous, atipichesky (adenomatosis) and focal (endometrium polyps). The ferruterous giperplaziya of endometrium is characterized by disappearance of division of endometrium into functional and basal layers. The border between miometriy and endometrium is expressed accurately, the increased amount of glands, but their arrangement unevenly is noted, and the form is not identical. At a ferruterous and cystous form of a giperplaziya a part of glands gets the cystous changed look.
For adenomatosis (an atipichesky giperplaziya) restructuring and more intensive proliferation of elements in comparison with a ferruterous giperplaziya of endometrium, polymorphism of kernels, reduction of number of stromalny elements are peculiar. At a local giperplaziya the growth of a ferruterous and integumentary epithelium together with the subject fabrics leading to formation of endometrialny polyps is noted (ferruterous, fibrous, ferruterous and fibrous).
The greatest onkonastorozhennost in gynecology is caused an atipichesky and polipozny giperplaziya which are regarded as a precancer state. The threat of transition of adenomatosis to endometrial cancer makes about 10%. A ferruterous and ferruterous and cystous giperplaziya of endometrium are less inclined to an ozlokachestvleniye. Such probability increases at their recidivous current after a scraping of endometrium and inadequacy of hormonal therapy.
Symptoms of a ferruterous giperplaziya of endometrium
Characteristic symptom of a ferruterous giperplaziya of endometrium is the disorder of menstrual function which is expressed pathological uterine bleedings. Occur among forms of menstrual dysfunction to a menorragiya (the cyclic bleedings exceeding usual monthly on blood loss and duration) and a metrorragiya (acyclic bleedings of various duration and a profuseness).
Bleedings at a ferruterous giperplaziya of endometrium arise after an insignificant delay of periods or during the intermenstrual period. Breakthrough character with allocation of clots is characteristic of the juvenile bleedings arising at a ferruterous giperplaziya of endometrium at teenagers. Long and plentiful bleedings promote development of anemia, weakness, an indisposition, dizziness over time. The Anovulyatorny cycle which is noted at a ferruterous giperplaziya of endometrium is followed by infertility.
Diagnostics of a ferruterous giperplaziya of endometrium
As manifestations of a ferruterous giperplaziya of endometrium are not specific only to this pathology, questions of full and exact diagnostics gain special importance. When studying the anamnesis the gynecologist asks on heredity, features of a current of a menstrual cycle, a condition of genital function, the used methods of contraception, the postponed general and gynecologic diseases.
Except the general gynecologic survey, diagnostics of a ferruterous giperplaziya of endometrium includes transvaginal ultrasonography in the course of which endometrium thickness, existence of polipozny growths is defined. By means of ultrasonography screening the contingent of the women needing histologic confirmation of the diagnosis of a ferruterous giperplaziya of endometrium by means of carrying out an aspiration biopsy of endometrium or a separate diagnostic scraping comes to light.
The diagnostic scraping is carried out on the eve of the expected periods or right after its beginning under control of hysteroscopy. Hysteroscopy provides carrying out an adequate curettage and full removal of pathologically changed endometrium. Scrapes of endometrium are exposed to the histologic research allowing to define type of a giperplaziya and to establish the morphological diagnosis. At a ferruterous giperplaziya of endometrium informational content of diagnostic hysteroscopy makes 94,5% whereas transvaginal ultrasonography - 68,6%.
At a ferruterous giperplaziya of endometrium at the patient the level of progesterone and estrogen, if necessary – hormones of adrenal glands and a thyroid gland are investigated. A supporting diagnostic role is played by a gisterografiya or radio isotope scanning. Differential diagnostics at the bleedings caused by a ferruterous giperplaziya of endometrium is carried out with extra-uterine pregnancy, a trofoblastichesky disease, polyps or an erosion of a neck of a uterus, uterus body cancer, uterus myoma.
Treatment of a ferruterous giperplaziya of endometrium
The procedure of a separate diagnostic scraping of a cavity of a uterus serves as the first stage of treatment of a ferruterous giperplaziya of endometrium. Further taking into account results of histology the scheme of hormonal therapy directed to suppression of further proliferation of endometrium and elimination of a hormonal imbalance is selected.
At a ferruterous form of a giperplaziya of endometrium the COOK (Yarina, Jeanine, Regulon), gestagena (Utrozhestan, Dyufaston) can be appointed to 3-6 months. With success in treatment of a ferruterous giperplaziya of endometrium the gestagensoderzhashchy intrauterine system of Mirren making local medical impact on endometrium is applied. Use of agonists a rileasing-hormone gonadotrophin () effectively at women is more senior than 35 years and the perimenopauzalny period. These medicines cause a temporary reversible condition of an artificial climax and an amenorea.
In parallel with hormonal treatment vitamin therapy, correction of anemia, acupuncture, physical therapy (electrophoresis) is carried out. Control ultrasonography in the course of therapy is carried out in three and six months of treatment; a repeated biopsy of endometrium – upon termination of a course. For stimulation of an ovulyatorny cycle ovulation stimulators are applied further.
In case of a recurrence of a ferruterous giperplaziya of endometrium against the background of hormonal therapy at the patients interested in a child-bearing the ablyation or a resection of endometrium by means of laser and electrosurgical techniques under gisteroskopichesky control can be carried out. At the ferruterous giperplaziya endometrium complicated by endometriosis, uterus myoma and also in the period of a climax removal of a uterus can be method of the choice: nadvlagalishchny amputation, hysterectomy or pan-hysterectomy.
Prevention of a ferruterous giperplaziya of endometrium
After end of a course of treatment of a ferruterous giperplaziya of endometrium the special importance is gained by a question of the prevention of its recurrence and endometrial cancer. It is for this purpose recommended regular surveys of the gynecologist, consultation of the gynecologist-endocrinologist and selection of contraception, vocational training and conducting pregnancy at patients. From the woman, timeliness of its address to the expert and implementation of doctor's instructions, the forecast of a ferruterous giperplaziya of endometrium considerably depends.