Drug treatment of endometrial hyperplasia
The treatment strategy depends on endometrial hyperplasiaon many factors: this is the age of the patient, the cause and nature of hyperplasia, clinical manifestations of the disease, the presence of contraindications to a particular method of treatment, tolerance of medicinal products, and more.
It goes without saying that since the main cause of endometrial hyperplasia is hormonal imbalance, the primary treatment of endometrial hyperplasia - hormone.
The action of hormones thatare used to treat endometrial hyperplasia may be local, aimed at suppression and inhibition of endometrial proliferation processes and central suppressing the pituitary release of gonadotropins. The central action is most strongly expressed in the combined estrogen-progestin preparations, local action - in progestogen. The choice of drugs depends on many criteria, in particular, on the age of the patient.
Young girls aged 13 to 20 years,juvenile suffering from bleeding caused by endometrial hyperplasia, most often recommend the introduction of a six-month cyclical combined oral contraceptives: estrogen and progestin.
If, after a six-month course of the patient's conditionnot normal ovulation and can not be restored, then to stabilize the condition of the endometrium and prevent possible bleeding continues receiving estrogens with progestins. Oral contraceptives can be continued until the desired woman planning pregnancy.
Patients of reproductive age, usuallyappoint three courses cyclical receiving estrogen plus progestin, followed by re-biopsy of the endometrium. It is known that even high doses of progestins are generally well tolerated by patients.
However, in patients of childbearing age tactics of treatment of endometrial hyperplasia it depends on whether desirable or undesirable is currently the pregnancy.
Since one of the main symptoms hyperplasiaendometrium is anovulation and consequently infertility, a doctor about endometrial hyperplasia often seek women who are trying, but can not get pregnant.
If a woman wants to get pregnant, the doctor may first of all, to restore ovulation.
If pregnancy until desired, andwoman turned to the gynecologist about the bleeding, you must first identify the causes of anovulation and treatment is cyclic reception of estrogens with progestins.
It should be remembered that even the recoveryovulation and normal menstrual cycle does not relieve a woman from having to go through re-examination, most often - a biopsy of the endometrium, which is carried out in about 3 - 6 months after treatment.
This is due to the fact that endometrial hyperplasia, which is preserved after treatment with progestin drugs increase the risk of endometrial cancer. It occurs in approximately 3% of patients after treatment.
As for the patients during perimenopause and menopause, then it is shown in the main drug treatment, six months after which also performed endometrial biopsy.
If the risk of complications, includingtransition of endometrial hyperplasia in cancer, is high, patients who have no reason to leave the womb, the doctor may recommend a hysterectomy, ie removal of the uterus.
In the appointment of hormone therapy is requiredcompliance with certain conditions and strict accounting of contraindications. Of course, the treatment of endometrial hyperplasia using hormones is not always possible - in the case of contraindications for hormonal therapy as an alternative to surgical treatments applied endometrial hyperplasia.
For surgical treatment of hyperplasiaEndometrial include amputation and hysterectomy. These are shown in particular in relapsed cystic glandular hyperplasia that has developed on the background of endocrine disorders (diabetes, prediabetes, etc.), Obesity, hypertension, liver disease and veins.
Moreover, surgical treatment is preferablywhen precancerous conditions of the endometrium - adenomatosis, adenomatous polyps, especially in the case of a combination with adenomyosis and uterine myoma, pathological processes in the ovaries.
In general it can be said that the conservativeprogestin therapy in the treatment of endometrial hyperplasia is acceptable, especially among girls and young women who want to preserve their reproductive function. Such treatment is carried out under close medical supervision before and after therapy.
For women during menopause definitive treatment is a hysterectomy.
After the treatment of endometrial hyperplasia much attention is paid to the prevention of relapse and the development of endometrial cancer.
Prevention of disease
Prevention is primarily to regular medical examination of the patient, during which carried out a thorough investigation of endometrial tissue.
In addition, patients younger doctor may prescribe preventive hormonal drugs, which significantly reduces the risk of endometrial hyperplasia and cancer.
From the very same patient depends largelytimely treatment to the gynecologist at the first symptoms of the disease - especially in case of uterine bleeding or spotting between periods.