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What is endometrial hyperplasia?

Endometrial Hyperplasia is a condition that occurs due to the excessive growth of the lining and cells of the endometrium, i.e. the inner lining of the uterus. Two forms of endometrial hyperplasia exist: typical and atypical. In the typical form, the cells of the uterus have not undergone any changes as a result of the endometrial condition. In the atypical form of hyperplasia, the cells have undergone changes that might develop into uterine cancer if left untreated.

This lining, called the endometrium, thickens every month in preparation for pregnancy. If pregnancy does not occur, the lining is shed. This shedding process is called a menstrual period or menstruation. Most women have a normal menstrual period approximately every 28 days. This entire process is controlled by two hormones: estrogen and progesterone. If the hormones are out of balance or not available, then excessive growth of the cells lining the uterus may occur, which results in endometrial hyperplasia.

Endometrial hyperplasia may be generally visible as a single and prevailing mass in the endometrial cavity. It may also diffuse the endometrium. It is a pathologig diagnosis.


What are endometrial hyperplasia causes?

The primary cause of this disease is the lack of balance between the two female hormones, i.e. oestrogen and progesterone. There may be cases when there is too much of oestrogen secretion, without corresponding exposure to progesterone. This is an abnormal condition, known as unopposed oestrogen. Too much oestrogen, and lack of progesterone leads to a situation of overgrowth of cells in the endometrium. This results in excessive thickening of the endometrium.

Apart from this reason, this disease can also be caused due to a number of chronic diseases such as diabetes, ovary syndrome and obesity. Tamofixen can also cause Endometrial Hyperplasia as it has a negative effect on the womb to oestrogen, since it is a breast cancer drug.


What are endometrial hyperplasia symptoms?

You may experience endometrial hyperplasia symptoms daily or just once in a while. At times, any of these symptoms can be severe:
- Acne
- Bleeding or spotting between menstrual periods
- Dryness of the vagina
- Excessive growth of body hair
- Heavy bleeding during your menstrual period (menorrhagia)
- Hot flashes or hot flushes
- Missed menstrual periods
- Mood swings
- Pain during sexual intercourse
- Rapid heart rate (tachycardia)
- Severe fatigue
- Tenderness of the vagina


How is endometrial hyperplasia diagnosed?

This condition can be diagnosed through a number of methods, it may be done by taking a endometrial hyperplasia biopsy or ultrasound. It can also be done through curettage of the uterine cavity so as to obtain endometrial tissue for the histopathologic analysis. This diagnosis can be done by a pathologist who examines a sample of the endometrial tissue that is removed from the endometrial lining by dilation or biopsy. If the hyperplasia is without atypical cells, then it can even be detected by microscopically by an exam.

Transvaginal ultrasound can be performed to find out the level of thickness of the endometrial lining in the women. This type of ultrasound evaluates the endometrial thickness, which finds out whether the patient has endometrial cancer or not.

Endometrial hyperplasia can be easily detected through biopsy. This can be performed in a doctor’s office. The doctor performs a biopsy by inserting a narrow tube into the uterus to extract a sample of the cells. These cells are sent to the laboratory for examination.


How is endometial hyperplasia treated?

Endometrial Hyperplasia can be treated by Hormonal therapy that may include continuous progestin therapy or even hysterectomy. It can be also treated with TCM medicines. It may be treated through the consumption of medicines such as Povera which may be taken directly or through injections. It may be cured by a D&C – dilation and curettage test. They can also be treated in young women through intrauterine devices or birth control pills.

The treatment for endometrial hyperplasia depends on the stage of life in which this condition appears. It also depends on how severe this condition is.  Those who experience this problem at the time of menopause or perimenopause can be given a complete course of hormone replacement therapy.  If nothing else works out, the patient can resort to Hysterectomy. It is a surgical method of removing this condition.

source : http://www.drleetcmclinic.com/Health_Conditions/31.html

1. Infertility
About 50% of endometriosis patients are infertile. Among all women with infertility, 30 to 40 percent of them suffer endometriosis. For women who have both endometriosis and infertility, the infertility is often caused by pelvic adhesions, pelvic fluid, tubal blockage, imcomplete development of follicle, ovulation failure, etc..Even getting pregnant can help restrain and even counter the developing of endometriosis, habitual abortion in some cases is caused by endometriosis.

2. Pain with menses
This symptom can be progressive, and this is a typical sign of endometriosis. Most patients doesn’t suffer any pain with menses but it occurs once endometriosis occurs, and the pain often aggravates with the cycle carries on. The pain can also occur before or after menstrual period on a small group of patients. Some may have extremely severe pain that they cannot even get up and painkillers are needed. In China, however, it is reported that there’re still 21% of patients don’t have any pain even they have endometriosis.

3. Periodical rectal discomfort
Periodical rectal discomfort seldom occur on other gynecological diseases, thus it is one of the major distinction of this condition. Symptoms may include: rectal pain, anal pain, bulge feeling at perineum area, urge for bowel movement, increased times of bowel movement. These symptoms aggravates with the menatrusl cycle carries on as well, and may ease after menstrual period.

4. Irregular menses
Women with endometriosis may have a shorter or longer menstrual cycle, and a heavy flow. Irregular menses is not a typical symptom of endometriosis so it’s not significant when diagnosing this condition.

5. Pain with sex
This symptom occur on some patients whose lesion develops near the vagina, Douglas pouch, or under the uterus.

6. Acute abdominal diseases before or after menses
ABDs often occur on women whose lesion grows in the uterus, and the lesion can break through ovary. Emergency operation is occasionally needed. The surgery may probably be helpful as well as destructive, because possible pelvic adhesion and scar tissue which develops after surgery cause recurrence of ABDs.

7. Periodical lower abdominal discomfort
This is a more common symptom than pain with menses. Endometriosis patients who don’t have any pain with menses may suffer from lower abdominal discomfort. This often occurs on those whose condition is very slight. Some of the endometriosis sufferers doesn’t develop pain with menses but they may experience from lower back pain with menses and bulge feeling of lower abdomen.

8. Periodical pain at local lump
If the lesion develops at any abdominal scar or navel, local lump with pain may occur.

9. Enlarged uterine
Inner endometriosis (adenomyosis) patients often have a enlarged uterus, but seldom larger than 12 weeks pregnancy. If this condition occurs on women with retroposition of uterus, adhesions is often found on them.

10. Periodical bladder irritation
When the lesion grows near or even inside the the muscle of bladder, urgent and frequent need of urination may occur. If it grows in the mucous membrane of urinary bladder, perodical blood in urine and pain with urination may occur.

11. Small hard knottings at Douglas pouch, Douglas' lieaments, or posterior cervical wall
One or more hard knottings can be found at Douglas pouch, Douglas' lieaments, or posterior cervical wall, their sizes are always very small(3-5mm diameter). Patient can feel pain when touch the knotting especially via rectal exam. For women with ovarian cyst, their cysts can grow as big as a fist. Pelvic adhesions is commonly found on this case.

source : http://www.drleetcmclinic.com/Information_Center/Endometriosis/2013/0906/115.html