home Audience 1 Mucus in the endometrium. Other, less common symptoms. Treatment of hyperplasia with traditional methods

Mucus in the endometrium. Other, less common symptoms. Treatment of hyperplasia with traditional methods

The uterine cavity is lined by a mucous membrane - the endometrium (from the word “endo” - inside). This membrane sloughs off monthly, causing menstruation. The endometrium has the following structure: a layer with a constant structure and thickness, consisting of stem cells that are responsible for the restoration of all layers of the endometrium after menstruation - the basal layer. Another layer, constantly changing under the influence of hormones in the female body, is functional. Hormones are produced by the ovaries in different quantities, according to the days of the cycle; around the 19th day, the maximum increase in endometrial thickness occurs from 14 to 19 mm.

This maximum endometrial thickness is considered normal. If the value is higher, this is a warning sign.

Cyclic change in endometrial thickness

Let's take a closer look at how the thickness of the endometrium changes during a woman's menstrual cycle.

As is known, thickening of the endometrium of the uterus is necessary in order to ensure a comfortable location of the fertilized egg inside the uterus.
During the cycle, endometrial growth occurs as follows:

On the 7th day of the cycle the thickness is 5 mm
On the 10th day of the cycle, the thickness is 8 mm
On the 14th day of the cycle, the thickness is 11 mm
On days 15-18 of the cycle, the thickness is 12 mm
On the 19-23rd day of the cycle, the thickness is 14-18 mm (at this time, not only is the endometrium actively growing, but its porosity and friability also increase).

On the 24-27th day of the cycle, the endometrium gradually thins to 10-16 mm, then menstruation occurs. These days, the thickness of the endometrium does not exceed 9 mm. In women who have experienced menopause, the thickness of the epithelial membrane should be no more than 5 mm; its slight increase, even by 2 mm, gives reason to be wary.

Reasons for thickness deviations from the norm

Deviations in the thickness of the endometrium can be either smaller or larger. Both are harmful. When the thickness of the endometrium is below normal, it is called endometrial hypoplasia.

Causes of hypoplasia:

Inflammatory processes in the uterus
Frequent abortions
Insufficient blood supply to the pelvic organs
Infectious diseases
Long-term wearing of an intrauterine device.

Women with hypoplasia are usually doomed to infertility. It is necessary to treat the causes and restore the endometrial layer. Abnormal thickening of the endometrial layer – hypertrophy – is also dangerous.

Causes of increased endometrial thickness

The photo shows a diagram of a woman’s uterus

Hypertrophy is an increase in the volume and mass of the endometrial layers, which is normal from the 1st day of menstruation until the next menstruation. But if there was no menstruation, and the uterus is enlarged, the endometrium continues to grow further, now increasing the number of its cells, which leads to pathology - hyperplasia.

This condition is dangerous because cell growth is uncontrolled, and the consequence can be a malignant formation in the endometrium.

Causes of hypertrophy:

Diabetes
Arterial hypertension
Myoma
Uterine polyps
Hormonal imbalance (many estrogens, little progesterone)
Polycystic ovary syndrome
Endometriosis
Use of incorrectly selected oral contraceptives
Inflammation of the genital organs caused by sexually transmitted infections
Frequent abortions, curettages
Immune disorders
Genetic predisposition (if the mother was sick, the daughter is also more likely to get sick).

Types of endometrial hypertrophy

Glandular hypertrophy is a benign change, the mildest. The probability of developing substandard changes is 2-6%. Gland cells divide and are arranged in groups, with no other cells between them. The straight glands become tortuous and greatly dilated, causing their contents to leak out.

Glandular-cystic hypertrophy - cells grow at the mouth of the gland, blocking the outflow of mucus, the gland looks like a bubble with fluid (cyst), the whole process is regulated by estrogen hormones.

Cystic hypertrophy is similar to glandular cystic hypertrophy, but the inside of the gland retains normal epithelium. It can degenerate into a malignant formation.

Focal hypertrophy – endometrial cells grow unevenly, in patches. They are very sensitive to hormones and divide actively, forming elevations of glands, also similar to cysts. If this happens in a polyp, then it grows very quickly. The lesions can range from a few millimeters to several centimeters, and there is a risk of malignant tumor formation. When growth occurs over the entire surface of the endometrium, it is diffuse hypertrophy.

Atypical hypertrophy is the most dangerous of all types of hypertrophy. Most often, this form leads to cancer. Cells, including those of the basal layer, grow, often mutate and, accordingly, are called atypical cells. The core structure and structure changes in them.

Treatment depends on the type of hypertrophy. For glandular problems, oral hormonal medications are prescribed. In the case of atypical hypertrophy during menopause, surgical intervention to remove the uterus is urgently required.

The treatment of this disease is described in the video:

Symptoms of endometrial hyperplasia

Typically, endometrial hyperplasia is asymptomatic, since the uterine cavity is not particularly sensitive to pain. The woman always has a regular menstrual cycle and feels good. It can only be detected by ultrasound examination.

Significant symptoms may be:

Menstruation with frequent large blood clots
Very painful periods (algomenorrhea), caused by vasospasm and increased pressure inside the uterus.
Discharge of a bloody nature before and after menstruation occurs with polyps. The walls of the blood vessels burst, and the liquid component of the blood escapes through them.
Bloody discharge in the middle of the cycle, it is not strong, usually bothers you after sexual intercourse or exercise.
Delayed menstruation resulting in heavy bleeding. The endometrium grows due to delay, but when the amount of hormones in the blood drops, the greatly enlarged uterus rejects the overgrown mucosa.
Infertility is a very common symptom of hyperplasia; a fertilized egg cannot survive on poor endometrium, since it will not form a good placenta.
Heavy and long periods, more than 7 days, as special enzymes prevent blood from clotting.

If a woman has discovered at least one symptom, then before the disease has gone too far, she should urgently consult a doctor. He will prescribe effective drug treatment.

It is known that long lactation can increase the thickness of the endometrium. But this condition is not pathological. Long-term lactation reduces the risk of developing endometrial cancer by up to 95%, if lactation lasted from 13 to 24 months. The main protective mechanism of lactation against endometrial cancer is to reduce the number of ovulations in a woman’s life.

Diseases of the genital organs in women account for a large proportion of pathologies leading to disability and sometimes death. Not the last place in this structure is occupied by diseases of the endometrium - the inner layer of the uterine cavity. Therefore, it is extremely important to recognize the symptoms of endometritis in time. And also to distinguish the disease from similar conditions and hyperplastic processes, to ensure proper treatment of endometritis.

The endometrium lines the inner surface of the uterus. This layer is capable of monthly renewal under the influence of female sex hormones: its rejection and restoration represents the monthly menstrual cycle. A woman’s ability to become pregnant and bear a child largely depends on the condition of the endometrium.

There are diseases that destroy the harmonious state of the inner mucous layer of the uterus. The most common are endometritis and endometrial hyperplasia. Sometimes they accompany each other and have similar symptoms. It is very important to differentiate them correctly - this is the only way to choose effective treatment.

Endometritis: symptoms...

Endometritis is an inflammatory disease of the mucous membrane of the uterine cavity. A predisposing factor may be traumatic damage to the endometrium after childbirth, abortion, or diagnostic procedures. There is also a risk in having an intrauterine device. But the main cause of acute inflammation of the uterine mucosa is infection. The infectious agent may be specific:

tuberculosis bacillus.

All other flora are nonspecific. The extent of inflammation depends on the degree of involvement of the endometrium: the focus or damage to the entire mucous membrane. According to the process, two forms are distinguished: acute and chronic endometritis.

Spicy

The disease begins abruptly and the temperature rises. A woman may be bothered by pain in the lower abdomen, radiating to the sacrum and groin, and copious discharge with a foul odor. During a gynecological examination, sharp pain is noted in the area of the uterus and on the sides of it. Echo signs of acute endometritis are as follows:

large uterus;
the boundaries between the mucous and muscle layers are erased;
contents inside the uterus with reduced echogenicity;
a fine suspension (pus) may be detected.

When the muscular layer of the uterus is involved in the process, signs of metroendometritis appear: alternating areas of increased and decreased echo density in the myometrium.

Acute inflammation of the uterine mucosa is difficult to miss. Critical in such a situation is timely treatment in compliance with the required dosages of antibiotics and an adequate duration of their use. Otherwise, the risk of complications increases sharply. It is also possible for the disease to become chronic. Important: in the acute stage of endometritis, it is forbidden to resort to diagnostic curettage.

Chronic

Chronic endometritis often occurs as a consequence of untreated acute inflammation of the uterine mucosa. Certain morphological signs are typical for sluggish endometritis:

inflammatory infiltrates;
sclerotic transformations of blood vessels;
atrophy or, conversely, hyperplasia of the mucous layer;
adhesive septa in the uterine cavity - synechiae.

The following symptoms of the disease are determined.

Menstrual irregularities. The modified endometrium becomes less sensitive to the action of female sex hormones. Menstruation can be irregular, painful, long and heavy, or, on the contrary, scanty. Intermenstrual bleeding is often a concern.
Pathological discharge. A woman may be bothered by discharge with an unpleasant odor of varying consistency.
Dyspareunia. Normal sexual life is disrupted by pain during sexual intercourse. Examination by a gynecologist is also painful.
Infertility and miscarriages. Fertilization itself is possible with chronic endometritis, but the processes of implantation and development of the embryo in the early stages are often disrupted, so such women have a history of infertility or recurrent miscarriages.

Echo signs of chronic endometritis are visible on ultrasound in the form of intrauterine adhesions. Often the thickness of the endometrium does not correspond to the day of the menstrual cycle.

The gold standard for diagnosing chronic inflammation of the uterine mucosa, which makes it possible to distinguish it from pathologies resembling endometritis (endometrial hyperplasia), is histological examination. Affected tissue obtained after diagnostic curettage or pipel biopsy is examined under a microscope in order to establish an accurate diagnosis.

... and methods of treatment

The use of treatment methods depends on the form of the disease. In the acute stage of the disease the following are indicated:

hospitalization in the gynecology department- bed rest;
non-drug treatment- cold in the lower abdomen;
antibiotics - depending on the sensitivity of microorganisms;
antispasmodics - to improve the outflow of secretions from the uterus;
infusion therapy- in case of severe intoxication;
drainage of the uterine cavity- with washing with antiseptic solutions.

For chronic endometritis, complex treatment is carried out. No hospitalization required. The exception is surgical removal of synechiae. Treatment includes the following steps:

physiotherapy - improves blood flow in the pelvis;
sanatorium treatment- healing mud, radon baths;
vitamin therapy- complexes for general strengthening of the body;
"Distreptase" - suppositories for getting rid of adhesions in the pelvis;
introduction of drugs into the uterine cavity- hyaluronidase, Novocaine, antibiotics;
correction of hormonal levels- taking oral contraceptives;
surgery- in the presence of synechiae in the uterus.

With timely treatment of inflammatory diseases of the uterine mucosa, the prognosis is favorable. To restore reproductive function, it is possible to use hysteroscopic and laparoscopic examination; some patients are indicated for in vitro fertilization.

Hyperplastic processes of the endometrium: causes and remedies

Endometrial hyperplasia is a process in which pathological growth of the mucous layer of the uterus occurs. There are main groups of reasons.

Hormonal disorders. Increased estrogen levels with decreased progesterone activity. This can be caused by ovulation disorders, hormone-producing ovarian tumors, dysfunction of the pituitary gland, pathology of the adrenal cortex, and uncontrolled use of hormonal drugs.
Exchange-endocrine disorders. Pathology of fat metabolism, diseases of the gastrointestinal tract, dysfunction of the thyroid gland lead to disturbances in the metabolism of sex hormones. Obesity, arterial hypertension, and diabetes mellitus are often combined with hyperplastic processes in the endometrium.
Chronic inflammation. Leads to damage to receptors located deep in the mucous layer. Endometrial receptors cease to perceive hormonal impulses and give an adequate response. In 95% of patients with glandular fibrous polyp, the endometrium is infected or there are signs of chronic inflammation.

Depending on the prevalence of the process, focal (endometrial polyp) and diffuse endometrial hyperplasia are distinguished.

How to suspect pathology

The main symptoms of endometrial hyperplasia are uterine bleeding, mostly irregular and not coinciding with the menstrual cycle. Often women of reproductive age come with infertility problems. Endometrial hyperplasia in menopause may not manifest itself in any way and may be an accidental finding during ultrasound examination.

Despite the paucity of clinical symptoms, endometrial thickening cannot be considered a harmless condition. Glandular endometrial hyperplasia without atypia can develop into cancer in 3% of cases, and atypical hyperplasia in 29%. Adenomatous polyps are classified as precancerous conditions. Endometrial hyperplasia and deterioration of general condition due to bleeding are dangerous.

Diagnostic standards

A screening examination that allows mass coverage of the target group is a transvaginal ultrasound examination. In women of reproductive age, it is worth assessing the correspondence between the thickness of the endometrium and the phase of the menstrual cycle. At the menopause stage, the thickness of the mucous layer should normally not be more than 4-5 mm.

However, echographically it is possible to diagnose only thickening of the endometrium, but it is not possible to differentiate glandular hyperplasia from atypical one. Therefore, a reliable diagnosis is possible only after histological analysis of the affected endometrium. To do this, diagnostic curettage or hysteroscopy with biopsy is performed.

Therapeutic techniques

Therapy for endometrial hyperplasia includes the following main tasks:

stop the bleeding;
restore menstrual function during childbearing years;
achieve endometrial atrophy during menopause;
prevention of relapses of hyperplasia.

Traditionally, after histological examination of the endometrium, hormonal therapy is prescribed. Its purpose is to normalize the regulation of the thickness of the mucous layer of the uterus. It is necessary to take into account the possible infectious component of the disease, so antibacterial therapy is sometimes used.

If the disease recurs, then a woman who has already given birth to a sufficient number of children and is not planning a pregnancy in the future may be offered endometrial resection.

With reliably determined atypical hyperplasia, removal of the uterus is indicated for women in menopause. If surgery is not possible due to severe general somatic pathology, then treatment consists of long-term use of gestagens.

Is it possible to treat endometrial hyperplasia without curettage? Treatment itself is possible, but curettage is often necessary for a correct diagnosis. However, recently hysteroscopy has been increasingly used as a more accurate and informative procedure.

Folk remedies in the fight against endometrial diseases

It should immediately be noted that under no circumstances will folk remedies replace traditional treatment of pathology of the uterine mucosa. At home, without consulting a doctor, any attempts at therapy are deadly. However, traditional medicine recipes can help in rehabilitation after an illness, as well as in preventing relapses.

Nettle decoction. To combat bleeding. Brew one tablespoon of nettle leaves into a glass of boiling water and filter. Drink one tablespoon three times a day.
Solution. 2 ml per quarter glass of water, drink three times a day.
Infusion of currants, rose hips and. Three tablespoons of rose hips and black currants in combination with one and a half tablespoons of chamomile flowers per half liter of boiling water. Drink half a glass six times a day.
Infusion of rose hips, St. John's wort and. You need three teaspoons of rose hips, one tablespoon each of St. John's wort and calendula and a teaspoon of chamomile. Pour 1.5 liters of boiling water. The mixture is left to stand for two hours, filtered and drunk 100 ml six times a day.

The combination of traditional methods of therapy and traditional medicine methods give good results in maintaining the health of the uterine mucosa. However, treatment of endometrial hyperplasia and all types of endometritis is impossible without a radical revision of style and lifestyle. It is necessary to normalize weight, eliminate the possibility of secondary infection, and adjust the hormonal function of the body.

Hyperplastic processes of the endometrium

Hyperplastic processes of the endometrium is one of the pressing problems of gynecology. Their frequency increases significantly during the period of age-related hormonal changes in perimenopause. The complexity of this problem is due to the fact that hyperplasia of the uterine mucosa can be a manifestation of many pathological conditions of the female body.

Etiology and pathogenesis of the endometrium

A balanced hormonal effect through cytoplasmic and nuclear receptors ensures physiological cyclic changes in the uterine mucosa. Changes in a woman's hormonal state as a result of an imbalance in the FSH/LH ratio (absolute or relative LH deficiency) can lead to changes in height.

Proliferative effects are caused not only by classical estrogens (estradiol, estrone, estriol), but also by phenolsteroids, which are formed in the ovaries, adrenal glands, especially in menopause. Disturbances in the metabolism of hormones in the liver and gastrointestinal tract, lipid metabolism, thyroid function, and immunity also contribute to the development of hyperplastic processes.
The patient's history may include evidence of dysfunctional uterine bleeding at various periods of a woman's life, severe stressful situations, which confirms the role of the central nervous system in the mechanism of occurrence of this pathology.

During puberty, the development of endometrial hyperplastic processes is mainly caused by anovulation of the type of follicular atresia, accompanied by prolonged stimulation of the endometrium with low doses of estrogen and a progesterone deficiency state. Sometimes the development of hyperplastic processes can occur with undisturbed hormonal ratios.

Endometrial classification

According to the classification of WHO experts (1975), the following main forms of endometrial hyperplastic processes are distinguished:
I. Glandular hyperplasia (glandular-cystic and polypoid form or).
II. Endometrial polyps (glandular and intracellular fibrosis).
III. Atypical hyperplasia (adenomatosis, adenomatous polyps).

Glandular cystic hyperplasia and endometrial polyps are usually benign tumors. Atypical endometrial hyperplasia is regarded as a precancerous disease and accounts for 6-10% of all hyperplastic processes.

Glandular hyperplasia is characterized by the absence of division of the mucous membrane into the basal and functional layers. The number of glands is increased, they are not evenly distributed, some of them are cystic, the nuclei are elongated with a large amount of chromatin, and a dense network of argyrodile fibers is noted to the side.

Endometrial polyps are oval in shape and have a body and a stalk. Most often, polyps are located in the fundus or in the corner of the body of the uterus. Depending on the number of glandular structures or fibrous tissue, glandular and glandular-fibrous polyps are distinguished. Glandular polyps can originate from the functional or basal layers of the endometrium, most often appear at a young age (up to 40 years) and are accompanied by symptoms of hyperpolymenorrhea. Polyps of the fibrous type (with a predominance of fibrous elements) are found mainly in women after menopause and are manifested mainly by bleeding.

Endometrial precancer is characterized by atypia of epithelial elements, cell polymorphism, nuclear hyperchromatosis, and signs of increased division of cellular elements. Such structural changes appear diffusely in the endometrium either in the form of cells (adenomatosis) or in the form of polyp-like growths (adenomatous polyps). Endometrial precancer should also include glandular cystic hyperplasia and endometrial polyps in post-menopause, recurrent forms of these processes, as well as their combination with neuroendocrine pathology.

Endometrial Clinic

The development of symptoms of the disease often depends on the age of the patient. A characteristic symptom is. In women who maintain their menstrual cycle, bleeding occurs more often of a cyclic nature, less often of an acyclic nature. Sometimes bleeding occurs in the middle of the menstrual cycle. The substrate for bleeding is, as a rule, an area of hyperplastic endometrium with pronounced dystrophic changes and foci of necrosis, sharply dilated blood vessels and thrombosis.

Most often, hyperplastic processes occur in women 40-50 years old. These patients are characterized by a relatively late onset of postmenopause. Many women experience disturbances in lipid and carbohydrate metabolism, protein-forming liver function, and functional activity of the thyroid gland.

During a gynecological examination in the initial stages of the disease, pathological changes in the genital organs may not be detected. As the process progresses, there is a slight increase in the size of the uterus and its more dense consistency. This is subsequently accompanied by cystic enlargement of the ovaries on both sides, and sometimes hormone-dependent ovarian tumors occur, especially in older women.

Diagnosis of the endometrium

In patients with menstrual irregularities in the form of menopause or metrorrhagia, along with an assessment of complaints, anamnesis, examination of systems and organs, gynecological examinations, a number of additional examination methods are carried out. Diagnosis of hyperplastic processes is based on histological examination of the uterine mucosa.

On an outpatient basis, cytological examination of aspirate from the uterine cavity (aspiration is carried out using a Brown syringe) or washings from the uterine cavity is often performed. This method makes it possible to determine the severity of proliferative processes, but there will be no clear idea of their pathomorphological structure. Therefore, cytological examination is recommended as a screening for endometrial pathology and its condition during hormonal therapy. However, it can be used as an alternative to hysteroscopy and resolving biopsy of the mucous membrane of the cervical canal and the mucous membrane of the uterus, which is performed in a hospital with subsequent histological examination. This is one of the most accurate methods for determining endometrial pathology.

In recent years, a special place has been occupied in the diagnosis of intrauterine pathology, which makes it possible to study in detail the condition of the endometrium, conduct a clear topical diagnosis and monitor the results of therapy. Most often, liquid hysteroscopy is used (isotonic sodium chloride solution, 5% glucose solution, distilled water), which allows you to perform a number of intrauterine operations, use electro- and laser surgery. A control hysterographic study makes it possible to assess the quality of the biopsy with targeted isolation of the remains of hyperplastic endometrium or polyps, and to identify concomitant intrauterine pathology (endometriosis, myomatous nodes).

If a combined intrauterine pathology is suspected or it is impossible to perform hysteroscopy, hysterography can also be performed. Water-soluble contrast agents (verografin, urografin, urotrast) are injected into the uterine cavity, followed by radiography. Research is carried out on days 7-8 of the cycle. Hyperplastic endometrium and polyps on hysterograms appear as jagged outlines of the uterus or filling defects.

The introduction of ultrasound into gynecological practice has made it possible to assess the condition of the endometrium by the thickness and structure of the median M-echo. The endometrium has clear contours and greater acoustic density compared to the myometrium; it occupies a mid-position parallel to the external contour of the uterus. During the normal menstrual cycle, the thickness of the endometrium depends on the phase of the cycle and gradually increases from 3-4 mm in phase I to 12-15 mm in phase II of the cycle. Endometrial hyperplasia causes a significant increase in these indicators. Endometrial polyps are visualized as round or oval formations with a clear contour and a thin echo-negative rim against the background of an expanded uterine cavity. In postmenopause, an increase in the median M-echo to 5 mm or more indicates the presence of a hyperplastic process even without clinical manifestations. All this allows echography to be used as a highly informative and accessible screening method for studying the condition of the endometrium.

In order to establish the nature of endometrial pathology, radiometry with 32P is used. Radionuclide research is based on the properties of radionuclides to accumulate in tissues with a high metabolic rate in higher concentrations than in healthy tissues. The accumulation of 32P in the secretory endometrium averages 175%; for hyperplasia and polyps, it is 260%; for precancerous conditions, it reaches 340% or more. This method does not provide a complete picture of the pathomorphological structure of the endometrium, although it allows one to roughly determine the degree of cell proliferation and carry out topical diagnosis of the pathological process. It is widely used in oncology clinics.

Currently, special attention is paid to studying the state of steroid receptors in the endometrium, which helps to clarify the pathogenesis and optimize therapeutic measures. Considering the presence of concomitant pathology and hormonal disorders, in order to clarify the pathogenetic mechanisms of development with hyperplastic processes, it is advisable to study the state and functional activity of the central nervous system, thyroid gland, adrenal glands, ovaries, liver, and gastrointestinal tract.
Carrying out such a comprehensive examination of patients will allow us to determine the nature of changes in the endometrium and carry out rational treatment.

Endometrial treatment

Therapeutic tactics for hyperplastic processes depend on the pathomorphological characteristics of the endometrium, age, etiology and pathogenesis of the disease, concomitant genital and extragenital pathology.

Treatment at different age periods consists of two stages:

- Stop bleeding;

— Prevention of recurrence of the hyperplastic process.

However, this is achieved by different methods. If in the puberty period hormonal hemostasis is used with subsequent prevention of recurrent bleeding with hormonal drugs, then in the reproductive and menopausal periods hemostasis is carried out by fractional diagnostic curettage of the mucous membrane of the uterine cavity. At the same time, in young women, the 2nd stage of treatment involves the elimination of relapses of endometrial hyperplastic processes with the subsequent restoration of the ovulatory menstrual cycle. In the perimenopausal period, the 2nd stage of therapy aims to prevent recurrence of the hyperplastic process with the preservation of a rhythmic menstrual-like reaction or a stable cessation of menstruation. When hyperplastic processes of the endometrium are detected in the menopausal period, preference is given to surgical treatment; in case of severe extragenital pathology, hormonal therapy is carried out.

The method of stopping bleeding in juveniles is determined by the general condition of the patient, the amount of blood loss and anemia.

If the condition is satisfactory, girls use hormonal hemostasis estrogen-gestagen drugs (non-ovlon, rigevidon) starting with 3-5 tablets on the first day, gradually reducing the dose to 1 tablet per day and continuing to take until 21 days. In case of a girl’s serious condition, severe bleeding and posthemorrhagic anemia (Hb less than 70 g/l, hematocrit drop to 20%), it is necessary to perform curettage of the uterine mucosa with preliminary prevention of hymen rupture by local administration of 64 units of lidase with a 0.5% solution of novocaine. At the same time, anti-anemic therapy is carried out: blood and red blood cell transfusions, plasma, normalization of water and electrolyte balance, improvement of rheology, taking iron supplements (ferroplex, actiferin, tardiferon, ferrum-lek and others). For hemostatic purposes, use a 10% solution of calcium gluconate, 10 ml intravenously or intramuscularly, a 5% solution of epsilon-aminocaproic acid, 100 ml intravenously or 0.5-1 g 3 times a day in powder, Vicasol 1% solution, 2 ml intramuscularly. intramuscularly, dicinone 2 ml intramuscularly.

To contract the uterus, use oxytocin, pituitrin, hyfotocin 1 ml 1-2 times a day, nettle decoction, water pepper potion.

To improve the general condition, vitamins are prescribed: B6 1 ml of a 5% solution, B12 200 µg m, folic acid 0.001 g 2-3 times a day, ascorbic acid 5% 5 ml, rutin 0.002 g 3 times a day. Given the immaturity of the hypothalamic structures, endonasal electrophoresis with vitamin B1 and acupuncture are widely used, which improve the functioning of subcortical structures and support the function of the corpus luteum.

The second stage of therapy is to prevent recurrence of bleeding. Most often, hormonal therapy is carried out with estrogen-gestagen drugs (rigevidon, ovidon, femoden) or triphasic contraceptives (triregol, triquilar, triziston) for 21 days. With the current cycle in the second phase, Primolut-nor, Norkolut, Normoten 5-10 mg are prescribed, the course of treatment is 3-6 months. In case of adenomatous changes, which is very rare at this age, use a 12.5% solution of 17-hydroxyprogesterone capronate 500 mg intramuscularly 2 times a week, Depo-Provera 200-400 mg 1 time a week for 6 months. After 3 and 6 months, control histological examination. Dispensary observation is carried out within a year after stable normalization of the menstrual cycle. Prevention of hyperplastic processes in girls includes good nutrition, physical education, outdoor recreation, and normalization of work and rest schedules.

In patients of reproductive age with hyperplastic processes of the endometrium and menstrual irregularities such as menorrhagia or metrorrhagia, treatment begins with fractional diagnostic curettage of the mucous membrane of the uterine cavity. The following management tactics depend on histological examination data. For glandular or glandular-cystic hyperplasia of the endometrium in women 19-40 years old, estrogen-gestagen drugs are prescribed from days 5 to 25 of the cycle for 3-6 months. It is possible to prescribe “pure” gestagens: norkolut, primolut-nor, norlyuzhen 5-10 mg from the 16th to 25th day of the menstrual cycle, 12.5% solution of 17-hydroxyprogesterone capronate 250 mg intramuscularly, depostat 200 mg intramuscularly, depo-provera 200 mg on 14 and 21 days of the menstrual cycle for 3-6 months. For adenomatous changes in the endometrium, 17-OPK is prescribed 200 mg intramuscularly 2 times a week, Depo-Provera or Depostat 200-400 mg intramuscularly 1 time per week.

In recent years, in the treatment of adenomatous endometrial hyperplasia in women aged 40-45 years, drugs with a pronounced antigonadotropic effect, such as danazol and gestrinone, have been widely used. Danazol is prescribed 400-600 mg daily, gestrinone (non-mestran) 2.5 mg 2-3 times a week for 6 months. Their use is especially advisable when hyperplastic processes are combined with small uterine fibroids and internal endometriosis.

To assess the effectiveness of hormonal therapy in women with glandular or glandular-cystic hyperplasia, a control examination is carried out 3 months after the start of treatment, which includes hysteroscopy, echography, and cytological examination of aspirate from the uterine cavity. After 3-6 months, it is necessary to conduct a diagnostic curettage of the uterine mucosa with hysteroscopy. In patients with adenomatous changes, diagnostic curettage is performed 3 and 6 months from the start of treatment.

To form an ovulatory menstrual cycle in the absence of signs of endometrial hyperplasia in young women, ovulation stimulants are used (clomiphene from 50 to 150 mg per day from days 5 to 9 of the cycle for 3-6 months), for hyperprolactinemia, parloder is prescribed at 2.5-7, 5 mg per day continuously. Monitoring the effectiveness of treatment is carried out on the basis of functional diagnostic tests, ultrasound examination of follicle development, and determination of the concentration of estradiol in the blood.

In the premenopausal period, in patients with hyperplastic processes of the endometrium, the first stage of treatment also begins according to diagnosis with hysteroscopic control. The following therapy depends on the results of pathomorphological examination and is aimed at preventing relapse of the disease, in women under 50 years of age, maintaining a menstrual-like reaction, and after that, achieving a stable cessation of menstruation.

The use of estrogen-gestagen drugs such as oral contraceptives in women over 45 years of age is not recommended due to an increased risk of developing cardiovascular pathology (heart attack, thrombosis, embolism, hypercholesterolemia, hyperglycemia), exacerbation of gastrointestinal diseases. Hormonal therapy for glandular hyperplasia and endometrial polyps in this age group is carried out with “pure” gestagens: norkolut, primolut-nor, norluten 10 mg for contraception (from the 5th to the 25th days of the menstrual cycle) or shortened (from the 16th to 25th th days of the menstrual cycle) schemes for 6 months. They also use 17-OPK 250 mg intramuscularly 2 times a week, Depo-Provera or Depostat 200 ml intramuscularly 1 time per week for 6 months. For a sustainable cessation of menstruation, the listed drugs are used continuously.

For adenomatous endometrial hyperplasia in the perimenopausal period, higher doses of drugs are prescribed: 17-OPK 500 ml intramuscularly 2-3 times a week, Depo-Provera or Depostat 400-600 mg intramuscularly once a week. In addition to gestagens, patients of this age use danozol 400-600 mg daily and gestrinone or nemestran 2.5 mg 2-3 times a week continuously for 6 months. These drugs have a pronounced antigonadotropic effect, help suppress ovarian function and, as a result, cause endometrial hypoplasia and atrophy. Women over 50 years of age can be prescribed androgens: methyltestosterone 20 mg daily for 2 months or testenate 100 mg intramuscularly once every two weeks for 2 months. The result of treatment is monitored after 2 and 6 months by cytological examination of aspirate from the uterine cavity, echography, and radionuclide testing. After completing the course of treatment, it is necessary to perform separate curettage of the uterus with hysteroscopy.

The development of relapses of hyperplastic processes in patients in the perimenopausal period, the combination of this pathology with uterine fibroids or internal endometriosis requires surgical treatment: electro- or laser coagulation, cryodestruction of the endometrium, extirpation of the uterus and appendages.

If bloody discharge from the genital tract appears in postmenopause, first of all it is necessary to carry out an additional examination (fractional diagnostic curettage of the uterine mucosa, hysteroscopy, pathomorphological examination) to exclude oncological pathology (uterine cancer, cervical cancer). Since endometrial hyperplastic processes in postmenopause are often caused by hormonally active structures (stromal hyperplasia, thecamatosis, thecagranulosoclitin tumors), this pathology requires active treatment (extirpation of the uterus and appendages). Only in case of severe somatic pathology, hormonal therapy with prolonged parenteral gestagens (17-OPK, Depostat, Depo-Provera) is carried out continuously for 6 months or more with echographic, cytological control and fractional curettage after 3-6 months.

In addition to hormonal therapy, the complex treatment of patients with hyperplastic processes should include drugs that improve the condition of the central nervous system (Cavinton, Nootropil, Cynarizine and Stugeron), the cardiovascular system (Panangin, potassium orotate, Riboxin), and the gastrointestinal tract (Festal , essentiale, corsil, allohol, herbal mixtures, mineral waters), help improve metabolic and endocrine disorders (thyroid hormones, methionine and linetol), hyposensitizing drugs (tavegil, suprastin, diazolin), immunomodulators (thymalin, decaris), sedatives, vitamin therapy. For concomitant general diseases of the female genital organs, anti-inflammatory therapy is carried out.

The endometrium is the inner mucous membrane of the uterine body, which has two layers: functional and basal. The basal layer has a constant thickness and structure. The stem cells included in its composition are responsible for the restoration (regeneration) of the endometrial layers. The functional layer has different dynamics and is sensitive to the concentration of female hormones. Thanks to the changes occurring in the functional layer, menstruation occurs every month. It is she who is an indicator of women's health. If any pathology of the endometrium occurs, disruptions in the menstrual cycle often occur.

Endometrial thickness

To put it figuratively, the endometrium can be compared to a cradle, which at a certain period is ready to receive a fertilized egg. If this does not happen, then rejection of the functional layer occurs, which is revived again after menstruation.

The endometrium, the thickness of which varies, has different indicators according to the days of the cycle:

5-7 days. In the early proliferation phase, the thickness of the endometrium does not exceed 5 mm.
8-10 days. The endometrium thickens to 8 mm.
11-14 days. In the late proliferation phase, the thickness reaches 11 mm.

After this, the secretion phase begins. During this period, if there is no endometrial pathology, the layer becomes looser and thickens.

15-18 days. The thickness reaches 11-12 mm.
19-23 days. Maximum endometrial thickness. The average is 14 mm, but can reach a maximum of 18 mm. The layer becomes more loose, “fluffy”.
24-27 days. The thickness begins to decrease slightly, becoming from 10 to 17 mm.

These are the phases of the endometrium. During menstruation, the thickness of the endometrium decreases, reaching only 0.3-0.9 mm.

If a woman is going through menopause, what should her endometrium look like? The standard layer thickness is 5 mm. The slightest deviation of 1.5 or 2 mm should cause caution. In this case, it is better to see a gynecologist.

What to do if the endometrium is thin?

Very often, thin endometrium is the cause of female infertility. It is quite possible to cure this, you just need to persistently pursue your goal. Treatment can be carried out in several alternative ways: hormonal drugs, herbal decoctions, pseudohormones.

Herbal treatment

Some women do not want to resort to drug treatment for thin endometrium and use folk remedies in this case.

Thin endometrium is well restored with the help of sage. They drink it in the first phase of the cycle. 1 teaspoon should be brewed in 200 g of water and taken throughout the day.

The boron uterus is transformed as a pseudohormone in the woman’s body. In addition, it has an anti-inflammatory effect.

Drops "Tazalok" from the homeopathy series help normalize the menstrual cycle and are a regulator of the synthesis of endogenous gonadotropic hormones.

Increasing thin endometrium with the help of drugs

How to increase thin endometrium, the thickness of which varies during different phases of the cycle? In the first phase of the cycle, doctors prescribe the drug "Proginova", "Femoston", etc. For the second phase of the cycle, "Duphaston" is suitable. This drug promotes the formation of the endometrial structure; it acts like synthetic progesterone.

Before using all these synthetic drugs, you should definitely consult a gynecologist and assess the risk yourself, since they all have some contraindications.

There are cases when thin endometrium is detected after taking oral contraceptives. Quitting them and using Regulon tablets for two months often gives a positive result and helps restore the thin endometrium.

Anatomical certificate

A healthy endometrium is the key to the successful onset and development of pregnancy. Currently, many women are faced with some kind of endometrial disease and, as a result, suffer from infertility. What does the term “endometrial pathology” mean, what consequences does this phenomenon lead to, how to overcome this problem? First things first.

The main function of the endometrium in the female body is the successful, safe implantation of the embryo. For pregnancy to occur, it must attach to the endometrial wall. That is why, with various pathologies of the endometrium, infertility can occur, and successful implantation of the embryo becomes simply impossible. But pathologies are different; there are several endometrial diseases. Which one should be determined by a specialist in each specific case.

Deviations from the norm

Based on the nature of the disease, gynecologists-endocrinologists distinguish two benign disorders. The pathology of the endometrium of the uterus is inflammatory in nature, this includes endometritis. Non-inflammatory - these are hyperplastic processes. These include endometrial polyps, hyperplasia, and endometriosis.

It happens that several pathologies are combined in the female body. What is the reason for this? Primarily by disruption of the endocrine system or genetic predisposition. In many cases, after successful treatment, pregnancy becomes possible.

Endometritis

Inflammatory disease of the mucous membrane (endometrium) of the uterus. What causes the disease? Penetration of various pathogenic microorganisms into the uterine mucosa. There are several basic factors contributing to the disease:

Any infectious processes existing in the body.
Complete sexual intercourse without protection.
Erosion of the uterus.
Examination of the uterus and tubes using hysterosalpinography.
Chronic gynecological diseases.
Unsterile instrument during a gynecological examination.
C-section.
Endometrial scraping.

Typical symptoms of endometritis:

If endometritis is discovered during pregnancy, it requires immediate treatment. The disease can affect the membranes of the embryo and lead to its death.

Hypoplasia - thinning

If on certain days of the cycle the thickness of the endometrium is underestimated, gynecologists diagnose hypoplasia. The cause of the disease is hormonal disorders, poor blood supply, and inflammatory processes. This endometrial pathology can occur as a result of frequent abortions, infectious diseases, or long-term use of an intrauterine device. The main task in curing hypoplasia is thickening the endometrium.

Hyperplasia - thickening

The cause of the disease is most often hormonal imbalances in the body or hereditary factors. With hyperplasia, the layers of the endometrium change their structure.

There are several types of hyperplasia:

Glandular hyperplasia.
Atypical fibrous hyperplasia (precancerous condition).
Glandular cystic hyperplasia.

Glandular endometrium is often found in diseases of the adrenal glands, ovaries, and thyroid gland. Most often, hyperplasia affects women with diabetes mellitus, polyps in the uterus, fibroids, and arterial hypertension.

Why is hyperplasia dangerous? Uncontrolled cell growth, which can lead to dire consequences - endometrial cancer. Hyperplasia is treated with both medication and surgery.

Endometrial polyps

Benign proliferation of endometrial cells. Polyps can be located not only in the uterus itself, but also on its cervix. The reasons for their formation are hormonal disorders, the consequences of surgical interventions, abortions, and genitourinary infections. Polyps most often form in the endometrium. There are several types of polyps:

Ferrous. They are formed in the tissues of the glands and are usually diagnosed at a young age.
Fibrous. Formed in connective tissue. More often observed in older women.
Glandular-fibrous. Consists of both connective and glandular tissue.

You can only get rid of polyps through surgery. This must be done as soon as possible, since the cells can degenerate into malignant ones. Modern equipment allows you to perform operations quickly, efficiently, and painlessly.

Endometriosis

A female disease in which nodes form outside the uterus, similar in structure to the endometrial layer. Nodules may appear on nearby organs. It happens that when uterine tissues are rejected, they are not completely removed with menstruation, penetrate into the tubes and begin to grow there. Endometriosis develops.

The main causes of the disease:

Symptomatic indicators of endometriosis include:

Infertility.
Painful urination and bowel movements.
"Spotting" discharge in the middle of the cycle.
Pain before the onset of menstruation.
Pain during sexual intercourse.

Endometrial removal - ablation

Currently, an increasing percentage of women suffer from various endometrial pathologies. They suffer from long, heavy, painful menstruation, hyperplastic processes, and polyposis. Unfortunately, it is not always possible to achieve effective treatment with hormone therapy or curettage of the uterus. An alternative in this case is ablation, or removal of the endometrium. This is a minimally invasive procedure that destroys or completely removes the lining of the uterus (endometrium).

Indications for the operation:

Massive, repeated, prolonged bleeding. However, the treatment is not effective. The presence of malignant processes in the genital area in women over 35 years of age.
Relapses of hyperplastic processes during premenopause or postmenopause.
The impossibility of hormonal treatment of proliferative processes during the postmenopausal period.

What factors need to be considered when performing ablation?

Impossibility of complete removal of the uterus or refusal of this type of surgical intervention.
Reluctance to preserve reproductive function.
Dimensions of the uterus.

Endometrial biopsy

For diagnostic purposes, small volumes of tissue are taken from the body using special methods. To make a correct diagnosis based on the results of a biopsy, the doctor must comply with a number of necessary conditions during the procedure. Based on the results of scraping examination, the pathologist assesses the functional and morphological state of the endometrium. The results of the study directly depend on how the endometrial biopsy was performed and what material was received. If heavily crushed pieces of tissue are obtained for research, it is difficult, sometimes impossible, for a specialist to restore the structure. When performing curettage, it is very important to try to obtain uncrushed, larger strips of the endometrium.

How is an endometrial biopsy performed?

As a complete diagnostic curettage of the uterine body during dilation of the cervical canal. The procedure begins with the cervical canal, then the uterine cavity is scraped out. In case of bleeding, curettage should be carried out with a small curette, special attention should be paid to the tubal angles of the uterus, where polypous growths often form. If, during the first curettage, crumb-like tissue appears from the cervical canal, the procedure is stopped due to suspicion of carcinoma.
Line scrapings (train technique). The goal is to find out the causes of infertility and monitor the results of hormone therapy. This technique cannot be used for bleeding.
Aspiration biopsy. Suctioning pieces of endometrial mucous tissue. The method is most often used for mass examinations, the goal is to identify cancer cells.

If any endometrial pathology is detected in a woman’s body, treatment must begin immediately. Timely initiation of the treatment process gives the most promising prognosis. Even such a sentence as infertility may not be terrible if you consult a gynecologist in a timely manner, undergo a full examination, and a course of treatment. Watch your health!

The uterus is a unique organ in which the unborn child develops. In order for the conditions to be as comfortable as possible, the mucous membrane lining it, equipped with a network of blood vessels, is renewed every month. Through them, the growing organism receives nutrients and oxygen. The embryo enters the uterus precisely when the thickness of the functional layer of the mucous membrane is maximum, and its structure is most suitable for the implantation and consolidation of the fertilized egg. The fetus develops correctly only in a healthy, complete endometrium.

Content:

The structure of the endometrium and stages of its development

The endometrium is the mucous membrane of the uterus that covers its wall from the inside. Thanks to changes that regularly occur in its structure, a woman has menstruation. This lining is designed to allow the fertilized egg to remain in the uterine cavity and develop normally. After it is implanted into the mucous membrane, the placenta grows, through which the fetus is supplied with blood and nutrients necessary for its growth.

The mucous membrane of the uterus consists of 2 layers: basal (directly adjacent to the muscles) and functional (superficial). The basal layer exists constantly, and the functional layer changes in thickness every day due to the processes of the menstrual cycle. The thickness of the functional layer determines whether the embryo can take hold and how successfully its development will occur.

During a cycle, changes in endometrial thickness normally go through several stages. The following phases of its development are distinguished:

Bleeding (menstruation) is the rejection and removal of the functional layer from the uterus, associated with damage to the blood vessels of the mucosa. This phase is divided into the stages of desquamation (detachment) and regeneration (the beginning of the development of a new layer of basal cells).
Proliferation is the growth of the functional layer due to the growth (proliferation) of tissue. This process occurs in 3 stages (they are called early, middle and late).
Secretion is the phase of development of glands and a network of blood vessels, filling the mucous membrane with secretory fluids. An increase in the thickness of the mucosa occurs due to its swelling. This stage is also divided into early, middle and late stages.

Sizes are affected by hormonal processes occurring during different periods of the cycle. The age of the woman and her physiological state matter. Deviations from the norm may appear in the presence of diseases and injuries in the uterus, or circulatory disorders. Hormonal imbalance leads to pathologies. Normal indicators have a fairly wide range, since for each woman they are individual and depend on the length of the cycle and other characteristics of the body. A value outside the specified limits is considered a violation.

Why and how the uterine mucosa is measured

The measurement is carried out using ultrasound. The study is carried out on different days of the cycle. This makes it possible to establish the cause of menstrual disorders, detect tumors and other neoplasms in the uterus that affect the thickness and density (echogenicity) of the mucosa, as well as its structure.

An important point is to determine these indicators on the days of ovulation during infertility treatment. In order for the fertilized egg to implant in the uterus, the thickness of the functional layer should not be less than 7 mm. Its value in this case is determined approximately on the 23-24th day of the cycle, when it is maximum.

Such a study is carried out when examining women of any age.

Normal thickness of the functional layer on different days of the cycle

During the cycle, the thickness of the mucous membrane changes literally every day, however, there are average thickness indicators that can be used to determine whether the state of a woman’s reproductive health corresponds to the norm.

As can be seen from the table below, with the onset of menstrual bleeding (in the first two days of the cycle), the thickness of the mucous membrane reaches a minimum (about 3 mm), after which its gradual growth begins. At the regeneration stage, a new layer is formed due to the division of basal cells. The thickness normally reaches its maximum value (on average 12 mm) a few days after ovulation. If fertilization has occurred (on the 15-17th day of the cycle), then by this moment (after 21 days) conditions are created in the uterus that are most favorable for implantation of the embryo into its wall.

Table of normal thickness of the uterine mucosa

Dimensions of the functional layer of the mucosa during pregnancy

If fertilization does not occur, then in the last days of the cycle the thickness of the endometrium decreases as it detaches.

If conception has taken place, then normally its thickness remains at the same level in the first days, and then it begins to thicken, and at 4-5 weeks the figure is 20 mm. At this stage of pregnancy, a tiny fertilized egg can already be seen on an ultrasound.

If a woman experiences a delay, even if the pregnancy test gives a negative result, its occurrence can be judged by the increase in the thickness of the mucosa, starting from 14-21 days after implantation of the embryo.

Dimensions of the functional layer during menopause

The onset of menopause is associated with a sharp drop in the level of female sex hormones in the body, which leads to a change in the condition of the mucous membranes, a decrease in the thickness of the endometrium (up to its atrophy), and the disappearance of menstruation. During this period, the thickness of the functional layer normally does not exceed 5 mm. Exceeding the norm indicates the occurrence of pathological processes (formation of cysts, polyps, malignant tumors).

Video: Changes in the condition of the uterine mucosa during the menstrual cycle

Pathologies

During the development of the functional layer, the following disturbances may occur:

excessive uneven growth (hyperplasia) of the endometrium;
insufficient thickening of the mucosa in the 2nd half of the cycle (endometrial hypoplasia);
endometriosis - the growth of the mucous membrane and the entry of its particles into neighboring tissues and organs, which leads to disruption of their functioning;
adenomyosis - germination of the epithelium into the muscular layer of the uterine wall;
disruption of the structure of the mucosa due to the formation of polyps (its growth in individual foci), the formation of cancerous tumors;
abnormal development of the endometrium in the presence of foreign elements in the uterine cavity (contraceptive device, threads left after surgery);
disruption of the structure of the functional layer as a result of the formation of adhesions or scars remaining after curettage of the uterus;
abnormal growth of mucous membrane around particles of the fertilized egg that were not completely removed during abortion.

The main pathologies that usually lead to severe diseases and infertility are endometrial hyperplasia and hypoplasia. The causes of deviations from the norm are most often hormonal imbalance.

Endometrial hyperplasia

If the thickness of the functional layer of the endometrium is too large (up to 26 mm), its density increases, the structure becomes heterogeneous, which complicates the implantation of a fertilized egg and the occurrence of other processes necessary for the normal development of the fetus.

The consequences of hyperplasia are cycle disorders, increased duration and intensity of menstruation, the appearance of intermenstrual bleeding, and anemia. Excessive growth of the endometrium can cause the formation of polyps and endometriosis.

Treatment for hyperplasia is carried out both medically and surgically (by curettage of the uterine cavity). When choosing a technique, the woman’s age, her desire to have children, and the degree of growth of the mucous membrane are taken into account.

Drug therapy (mainly for young women) is carried out using oral contraceptives, as well as drugs with a high content of progesterone. In this way, they achieve a decrease in the concentration of estrogens, which promote endometrial growth. In this case, the thickness of the endometrium is controlled by the days of the cycle.

Endometrial hypoplasia

If the membrane is too thin, then pregnancy does not occur, since, firstly, the fertilized egg cannot attach itself to the wall, and secondly, having no connection with the mother’s circulatory system, the embryo does not receive nutrition, as a result of which it dies after a few days after education. If the thickness of the mucosa is too small, inflammatory and infectious diseases may occur in the uterus, as it becomes less protected from the penetration of microbes.

If such deviations from the norm occur at a young age, this is manifested by a late onset of puberty and weak development of external sexual characteristics. Hypoplasia is often the cause of ectopic pregnancy (embryo implantation in the cervix or abdominal cavity).

Treatment for this pathology is carried out by restoring hormonal levels with the help of drugs containing increased doses of estrogens. To improve blood circulation, small doses of aspirin are prescribed, as well as various physiotherapeutic procedures.