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Endometrial hyperplasia in menopause - reviews of curettage

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Treatment of endometrial hyperplasia after curettage depends on the causes of this condition. Hyperplasia - excessive growth of the inner lining of the uterus. Endometrium is constantly changing under the influence of hormones, the concentration of which is determined by one or another phase of the cycle. The uterus mucosa consists of connective tissue, bilayer epithelium and blood vessels. The outer (functional) layer is responsible for the menstruation.

Endometrial hyperplasia is a common gynecological disease, the number of infected women is growing rapidly from year to year. This is due to the deterioration of the environmental situation, an increase in the life expectancy of women. This affects the reproductive health of the beautiful half of humanity. Most often, endometriosis occurs during the establishment of the menstrual cycle in young girls and premenopause in older women. It is at this time that the most significant hormonal changes occur in the body.

What is the connection between endometrial hyperplasia and female hormones?

Normally, the menstrual cycle consists of 3 phases: the growth of the upper layer, the maturation of the endometrium and its rejection. The countdown of the new cycle begins on the first day of menstruation. At about the 15th day of the cycle, ovulation occurs. If fertilization does not occur, the egg is removed along with the upper layer of the endometrium. All these processes occur under the control of sex hormones. Estrogens are necessary for the formation and maturation of the upper layer of the endometrium, progesterone contributes to the maintenance of pregnancy, if it occurs. In the endometrial maturation phase, programmed cell death occurs, which does not allow the endometrium to grow more than necessary.

Similar processes occur only if a woman has ovulation. In its absence, there is a longer-term effect of estrogen on the lining of the uterus, leading to its excessive growth. The development of endometriosis is caused by an increase in the concentration of estrogen in the blood, which occurs for several reasons. Firstly, there are age-related changes in the amount of female hormones produced, hormonal disruptions, ovarian tumors that produce hormones, polycystic ovary. Hormonal disorders can occur when the contraceptive drugs are not taken correctly, after artificial termination of pregnancy, diagnostic curettage, inflammatory diseases of the internal genital organs.

Complicated pathologies may aggravate the course of the disease: mastopathy, hypertension, diabetes, overweight. According to the prevalence and type of structure, endometrial hyperplasia is divided into: glandular-cystic, focal, glandular-fibrous and adenomatous. Glandular types of hyperplasia are characterized by an increase in the number of glandular cells that form cysts. Glandular and cystic hyperplasia have the same symptoms.

When adenomatous form marked changes in the structure of cells and their accelerated division. Atypical hyperplasia is considered a precancerous condition, so its treatment should begin immediately. The appearance of malignant cells is observed in about 35% of cases. Frequently repeated cases of glandular hyperplasia may be associated with metabolic syndrome, in which the immune system is unable to destroy malignant cells. This disease is characterized by the presence of obesity, diabetes mellitus and the absence of ovulation.

The main symptoms of endometrial hyperplasia

The main symptom of endometriosis are uterine bleeding. In many patients, there are long periods of menstruation, after which abundant menstruation is observed. In some cases, there is no violation of the cycle, menstruation begins on time, but they are longer and more abundant. Against the background of a broken cycle, intermenstrual bleeding often occurs. In some cases, amenorrhea occurs.

Metabolic syndrome often accompanies endometrial hyperplasia. In such cases, such signs as excess weight, male-type hair growth, hoarseness and other symptoms associated with the effect of male hormones are added to the bleeding. Endometrial hyperplasia often leads to infertility, miscarriage, mastopathy. In addition, there may be cramping pain in the abdomen, bleeding after sexual intercourse.

When making a diagnosis, the doctor should know all the features of the woman's menstrual cycle: the duration of the cycle, menstruation, whether there are any delays. Transvaginal ultrasound is performed on the 5-7 day of the cycle. With it, determine the thickness of the endometrium, especially its structure. In pathology, the endometrium has a thickness of more than 8 mm. At a thickness of more than 2 cm, the doctor may suspect the presence of malignant cells. When uterine bleeding ultrasound is performed on any day of the cycle.

Scraping for endometrial hyperplasia is carried out for both diagnostic and therapeutic purposes. A blood test for hormone levels helps to identify metabolic disorders and polycystic ovaries. Mammography is prescribed to identify mastopathy and malignant tumors of the breast.

Ways to treat hyperplasia

The choice of treatment for this pathology depends on the characteristics of the cycle, the structure of the endometrium and the age of the woman. Hormonal drugs are prescribed individually, contraindications to their use are: diabetes, cholelithiasis, thrombophlebitis, alcoholism and smoking. Before the appointment of treatment is necessary to conduct a blood test and monitoring of the immune system. Removal of the endometrium can lead to recurrence of the disease, therefore it is not practiced in the treatment of atypical forms of hyperplasia.

Hysterectomy is indicated with the ineffectiveness of hormone therapy and curettage, precancerous conditions, during menopause.

Treatment of endometrial hyperplasia usually takes place in 2 stages. At 1, the endometrium is scraped under the control of a hysteroscope. When cleaning, the functional part is removed along with all pathological neoplasms. The operation is performed under general anesthesia, the hysteroscope allows you to fully monitor the course of the intervention, making it effective and less traumatic. Cleaning is carried out by means of a curette, in some cases, the use of a mechanism that stops the bleeding is required. The removed contents of the uterine cavity are sent for histological analysis, this is what allows us to determine the nature of the pathological process and the scheme for further treatment.

After curettage, drug treatment is prescribed to prevent the recurrence of the disease. To do this, prescribe hormonal drugs that are taken according to a specific scheme. For the treatment of hyperplasia in young women, combined contraceptives are most often used. It is preferable to use single-phase drugs that have a constant effect on the endometrium, inhibiting its growth. It is necessary to accept them 3-6 months. With proper treatment, glandular hyperplasia usually does not recur.

When treating women older than 40 years, progestogens are used. Reception of drugs begins from the 15th day of the menstrual cycle and continues until the onset of menstruation. The course of treatment lasts six months. With endometrial hyperplasia in the postmenopausal period, treatment is prescribed only after a thorough examination. If tumors are not detected, the doctor prescribes 17-hydroxyprogesterone caproate every 3 days for 8 months. After completion of the course of treatment, diagnostic curettage is performed, the resulting material is sent for histological examination.

Treatment of an atypical form of hyperplasia involves the administration of gonadotropin releasing hormone agonists. Some medications need to be taken once every 30 days, some daily. Six months after the start of treatment, repeated cleaning is carried out.

The patient should undergo an ultrasound scan every month that monitors the pattern of endometrial growth.

Regular medical examinations, blood tests for cholesterol and sugar are also needed.

Features of the diagnosis - endometrial hyperplasia

Endometrial hyperplasia is a disease when the endometrium grows (the inner layer that covers the uterus). At the same time it increases in size and thickens. With a normal monthly cycle, under the action of hormones, the endometrium exfoliates and the reproductive organ is cleared. If a woman has a hormonal failure, this process does not occur.

Scraping (curettage) is a surgical procedure that removes the endometrium. Scraping is considered both therapeutic and diagnostic manipulation, since after the procedure the removed endometrium is examined under a microscope, after which the gynecologist prescribes the correct treatment tactics.

Endometrial hyperplasia is an affliction that occurs in women of the beautiful half of humanity, regardless of age. But, in most cases, such a disease appears in adolescence and menopause, when changes in the level of hormones occur in the body.

According to doctors, endometrial scraping during menopause is the only treatment for this disease.

Reviews of patients about curettage for endometrial hyperplasia

Since the body of each girl is different, today pharmacology and modern medicine have not developed universal means and methods that equally well help women to get rid of the disease.

Despite this, reviews of curettage for endometrial hyperplasia are mostly positive. Many girls claim high efficiency of the procedure.

You can also see reviews that after the cleaning, not only positive changes occurred in the state of the endometrium, but also the well-being improved, the hormonal fund returned to normal, menstruation became regular and less abundant and painful.

But, unfortunately, there are also such patients who doubt the effectiveness of curettage. In such cases, the girls argue their distrust of the procedure by the fact that after the first scraping after a certain time, you have to repeat the manipulations again.

Natalia, 35 years old

“When I was 33 years old, the gynecologist diagnosed endometrial hyperplasia, prescribed a course of hormonal preparations and recommended curettage. The hormones spent on drink, the procedure was done, but after 8 months the endometrium began to grow again. Turning to the gynecologist, she advised to clean again, they say, it happens. So the point is to carry out such a procedure, since then every year again you have to relive it all over again? Maybe doctors should be informed about other methods of treatment with such a diagnosis? ".

Valeria, 57 years old

“When I was 49 years old, my menopause began, my menstruation stopped. But, at 54, bleeding began to trouble me, she turned to a gynecologist. After the examination, the doctor prescribed tests and drink hormones, then scraping, so as not to resort to the removal of the uterus. After the procedure, the body quickly recovered; after a visit to the doctor, no formations and inflammation were found. In addition, well-being improved. Thanks to scraping, not only got rid of the symptoms that accompany endometriosis, but also cured the disease. ”

Daria, 27 years old

“I have had a cycle failure since my menstruation began. But, because of a lack of consciousness, she did not pay enough attention to this, and she missed the opportunity to start timely treatment. A year ago, after getting married, my husband and I began planning a pregnancy, as a result, all attempts ended in disappointment. After consulting with the gynecologist, she advised to clean the uterus. After the procedure, at the age of 26, she was diagnosed with hyperplasia. The gynecologist prescribed a course of antibiotics, then Jeanine. After 6 months, she changed the drug to Duphaston, which was also cut for almost half a year. After such treatment, after 1.5 years my body returned to normal, menstruation became regular and less painful. I really hope that soon there will be replenishment in our family. ”

Causes of endometrial hyperplasia

With the development of any disease there is always a causal link, which entails irreversible pathological changes in the work of human organs and systems. Endometrial hyperplasia is no exception.

The causes of endometrial hyperplasia are as follows:

  • hormonal failure (estrogen excess, premenopausal state),
  • hypertension, adrenal gland diseases, thyroid diseases, diabetes mellitus or other endocrine system pathologies,
  • inflammation of the reproductive system,
  • polycystic ovaries, fibroids or tumors (benign and malignant),
  • genetic predisposition
  • abortions and miscarriages,
  • use of oral contraceptives.
  • obesity, metabolic metabolic disorders in the body.

To avoid endometrial hyperplasia as a result of exacerbation of chronic diseases, it is necessary to regularly visit a gynecologist for examination, to lead a healthy lifestyle.

Symptoms of the disease

The main sign of endometrial hyperplasia is the presence of irregularities in the menstrual cycle. A girl may complain of unusual discharge before or after menstruation, and discharge in large volumes during critical days. Also during this period may be disturbed:

  • soreness in the stomach
  • weakness,
  • temperature rise,
  • indigestion
  • general malaise,
  • headaches, etc.

Sometimes endometrial hyperplasia occurs without symptoms, but a woman cannot become pregnant for a long time. Therefore, if in the absence of complaints and regular sexual life, pregnancy does not occur throughout the year - you should seriously consider and be well examined by highly qualified specialists.

Diagnostic methods

Diagnosing endometrial hyperplasia is not difficult. First you need to collect anamnesis, during which the patient tells all the information about her menstruation: when it started, how many days it lasts, what are the abundances of discharge, what is her state of health during the menstruation, are there any delays, are there any discharges between the months.

The gynecologist also clarifies whether the patient has specific complaints and a predisposition to the development of genetic pathologies.

Be sure to do an ultrasound vaginal sensor. It is carried out in the first phase of menstruation to assess the endometrium in thickness, structure, uniformity. If prolonged bleeding is present, then ultrasound is done regardless of the phase of the cycle. If the layer thickness is 7 mm or more, this indicates hyperplasia, and if 20 mm - about the malignant process.

Informative will also be analysis of the level of hormones, which will determine the failure. In addition mammography is done.

What exactly is removed by scraping, and how does it help

The inner layer of the uterus has two layers - functional and basal layer. The first is responsible for the attachment and development of the child. If the pregnancy has not come, then it is exfoliated and excreted in the form of mucus during menstruation. There are vessels between the layers, and when the first layer (spent) is rejected, they burst and blood is released.

With endometrial hyperplasia, the functional layer is enlarged and, naturally, menstruation becomes excessively abundant. Therefore, with this disease there is a very high risk of opening bleeding.

The danger of endometrial hyperplasia lies in the fact that malignant neoplasms may arise between enlarged cells. Scraping in the diagnosis of endometrial hyperplasia is the removal of all overgrown tissue.

At the same time, during curettage, a layer is removed, in which oncology can progress and the cause of bleeding is eliminated.

Is it possible to do without scraping

It should be noted immediately, sometimes you can avoid curettage of the endometrium.

If a woman before menopause did not have heavy discharge or complaints of well-being during critical days, there are no pathological changes according to ultrasound or computed tomography, the cytological smear from the cervical canal does not have atypical cells, then hormonal agents are prescribed for the treatment.

Thus, a woman can be treated with a drug, but under strict control of the thickness of the functional layer and analyzes of cervical smears.

But, in the period of menopause, scraping is necessary. With its help, blood loss is eliminated and endometrial hyperplasia, oncology and inflammation can be accurately differentiated.

If during the curettage of the endometrium cancer is detected, the disease will be diagnosed at an early stage. This will allow you to immediately assign the correct, and most importantly timely treatment.

Scraping preparation

Since endometrial curettage is a surgical procedure, it requires careful preparation (except when emergency cleaning is performed).

First, you need to remember that the procedure is done on certain days of the menstrual cycle. Во-вторых, нужно пройти обследование у кардиолога, невропатолога, терапевта и сдать полный список необходимых анализов.

К списку обязательных анализов перед выскабливанием эндометрия относятся:

  • complete blood count (finger sampling) and urine,
  • determination of features of blood coagulability (vein pick-up),
  • blood chemistry,
  • test for antibodies to hepatitis, HIV, syphilis (RW analysis),
  • vaginal smear microscopy for purity
  • tank sowing secretions
  • determination of the level of female hormones,
  • electrocardiogram (ECG).

We also need two ultrasound examinations in two different cycles, on which it is fixed that the thickness of the endometrium is more than 1.5 cm. The manipulation is done before the start of the intended menstruation, when the thickness of the functional layer is maximum for removal.

14 days before the intervention, the patient is advised to stop taking medications or dietary supplements, except those prescribed by the attending physician. Before curettage, a thorough cleansing of the body is necessary in order for rehabilitation to proceed faster and more efficiently.

Important! It is mandatory to cancel the use of anticoagulants to avoid heavy bleeding during manipulation. A week before the operation, sexual intercourse is limited, or completely eliminated, especially if contact bleeding is present. Also douching is canceled. 12 hours before the procedure, you should abandon the use of food, and for 6 hours and drink. In the evening, on the eve of the procedure, a cleansing enema is done.

The only case where the scraping is carried out without testing and prior preparation, if the patient is delivered by ambulance with heavy bleeding.

Features of curettage with hyperplasia

Women are always concerned about how this procedure takes place, what the consequences and risks are. Curettage is a surgical procedure that is performed in the operating room. In this case, the patient is in a comfortable position on the gynecological chair.

In most cases, the woman is given anesthesia. This is due to the fact that cleaning is a painful and unpleasant procedure. Anesthesia is not used only after childbirth or miscarriage, because the cervix is ​​already quite dilated.

The gynecologist personally chooses which method he will perform the operation - curettage in the blind or using a hysteroscope (this is a video camera with light, which also has a channel for the supply of sterile air).

Blind scraping

After the anesthesia works, and the patient ceases to feel the internal organs, the gynecologist proceeds with the procedure. But, no cuts are made.

First you need to expand the neck to get more space for surgical procedures. To do this, the dilator is inserted into the vagina, diluted walls and gain access to the cervix.

Then, using special probes with different diameters, they gradually open the neck. When the desired result is achieved, the uterus is checked for bending and length.

Next, with a curette (surgical spoon), a functional layer is scraped along the walls of the organ, special attention is paid to the corners.

After cleansing, the blood vessels that bleed are cauterized, and the removed mucosa is poisoned for histological examination.

Endometrial scraping takes about 30 minutes. Then the patient is taken to the ward, where the anesthesiologist is watching her until she awakens and normalizes her well-being.

Curettage with hysteroscope

In the same way as when blindly scraping, during the procedure, the patient is in a gynecological chair in a medication sleep. The gynecologist installs a dilator, inserts a hysteroscope, and with the help of air gradually expands the uterus to work.

The curette is inserted into another canal of the apparatus, and the state, thickness, relief, and color of the layer being removed are assessed before removal.

After removal, it is placed in a container (one or more) and also sent for histological examination. A special instrument is introduced into the hysteroscope with which the vessels are burned to stop bleeding. The operation is considered over.

Separate scraping

Still there is such a thing as a separate scraping. In other words, it is a diagnostic curettage. It is used by gynecologists in cases when it is necessary to find out the exact cause of pathological changes or complaints (irregular, prolonged periods, blood excretion in menopause, suspicion of infertility).

The procedure is carried out similarly to the above schemes with full preoperative preparation.

Important! Diagnostic curettage is performed only in the hospital! As with any surgical procedure, the procedure has a number of contraindications:

  • recurrence of infectious, bacterial or viral diseases (chlamydia, gonorrhea),
  • acute foci of inflammatory nature in the pelvic organs,
  • exacerbation of chronic heart, kidney or liver disease.

Treatment of endometrial hyperplasia with drugs

After the surgeon’s surgical intervention, the treatment of hyperplasia is necessarily continued at the expense of medications. Hemostatic preparations are prescribed for the first 3-5 days.

The gynecologist advises to undergo a course of antibiotics (5-7 days) in order to avoid the addition of infection. Also, if necessary, prescribe analgesics and anti-inflammatory substances.

Further appointments depend on histological examination. If there is no malignant or pathological change in the material under study, the patient is prescribed standard hormone therapy. But it all depends on some nuances:

  • If the pathology is found in a teenage girl or in a woman under the age of 35, then combined oral contraceptives (COCs) are used, which include estrogen and gestagen.

According to reviews of gynecologists, often prescribed tablets with progesterone. It stops the pathological growth of the functional layer, because it constantly affects it. If hormone therapy is chosen correctly, and the duration of the drug intake is from three to six months, then it is likely that a relapse will not occur.

  • Progestins recommend patients after 35 years of age and before the start of menstruation. They are taken in the second phase of the menstrual cycle or two weeks after scraping. Duphaston and Utrozhestan - the most popular drugs.
  • Women during menopause and in the period of postmenopausal treatment regimen is painted only after a thorough examination, because at this age the disease most often occurs due to ovarian tumors.

It is very good to add physiotherapy to drug treatment - the use of ozone, reflexology, acupuncture, electrophoresis.

But if malignant tumors are confirmed, then an oncologist will appoint further recommendations.

Traditional medicine

Folk remedies for hyperplasia also apply. Herbal medicine takes the first place in traditional medicine. Burdock, nettle, pine forest, plantain handles this disease very well.

Women who have experienced the effect of "grandmother's funds" note that after folk healing improves their health, bleeding becomes less abundant, the menstrual cycle is restored, and pain during menstruation is reduced.

In most cases, use alcohol tinctures, which are prepared at home is very easy. Borovaya uterus is dried and put in a glass jar, where they pour forty-degree alcohol, vodka or brandy 0.5 l. Infusion should be infused for two weeks, stored in a place where there is no light and shake every day.

Take one teaspoon 2-3 times a day with a glass of water. The course of treatment lasts three months. According to reviews, patients note a good effect from douching with decoction from this plant.

Burdock need to prepare in advance. Gather it in late autumn or early spring. To prepare the medicine, it is necessary to squeeze the juice from fresh roots. Take two teaspoons in the morning and evening before meals. The course lasts six months.

Nettle is very well known for its hemostatic properties. For treatment with hyperplasia, you need to boil the decoction: pour two tablespoons of the plant with boiling water (1 cup) and cook for 15 minutes, pouring water to the initial volume. Take ¼ cup broth 3-4 times a day.

In addition, you can use herbs-antagonists of female hormones. These include fireweed, colza and yarutka.

Women who have experienced the means of traditional medicine, speak positively about their effects on the body. But, despite the positive reviews, you should not abandon the traditional methods of treatment, therapy should be carried out comprehensively under the supervision of the attending physician.

Most of the positive feedback can be found about herbal decoction and douching, which uses borovy uterus. Patients claim that the tool is completely safe, highly effective, does not cause side effects.

Hirudotherapy

Positive feedback in the treatment of endometrial hyperplasia with leeches is also found. If you have problems with gynecology, leeches are located in the crotch area, lower back, anus and vagina.

The hirudotherapeutist only puts leeches on the necessary part of the body, and they themselves move to the acupuncture point and “stick” to it. The leeches inject nutrients into the blood of their “victim” and, in general, level the hormones.

But, hirudotherapy is not for everyone. It can not be carried out if:

  • there are malignant tumors,
  • hemophilia is diagnosed,
  • low pressure,
  • the girl is pregnant
  • have an allergy to leeches.

Rehabilitation period

After surgical cleansing, after curettage of the endometrium, the patient feels normal feeling of weakness and drowsiness. It is also considered the norm after such a manipulation pain, as during menstruation, it can last for quite a long time (4-5 days).

Since after the manipulation of the uterus is considered a big wound, the discharge is initially abundant and bloody. Over time, they become sukrovitsy, and then are watery in nature.

Important! If the bleeding lasts more than 11 days, and the volume does not decrease, you should contact your gynecologist for an examination on the chair.

Medical advice! If there are complaints about a pulling pain in the abdomen or lower back, the temperature has risen - you should immediately contact your doctor.

To make recovery more efficient and faster, you need to follow some rules:

  • for two weeks after scraping not having sex,
  • do not use vaginal tampons,
  • do not douching
  • cancel intensive thermal treatments (you can do with a hygienic shower),
  • reduce physical activity and do not lift heavy objects
  • Do not take drugs that thin the blood.

Monthly after cleansing appear at 4-5 week, and can be very scarce and brief. Ultrasound is recommended to take place every month in order to control the thickness of the functional layer, which should not exceed 0.5 cm.

Important! If the delay of the month more than 3 months - you need to contact a gynecologist.

Possible complications

As with any surgical procedure, curettage of the endometrium can lead to complications. During the operation, working with a curette, it is possible to damage the uterus, a rupture by a dilator or a probe is possible. After the intervention can be:

  • bleeding (often this happens if the doctor has performed a poor-quality cleaning),
  • inflammation,
  • infection,
  • accumulation of blood
  • infertility (in violation of the second basal layer).

Anesthesia during the cleaning in almost all cases is general (intravenous). Since the manipulation is not long, such an anesthesia very rarely gives complications. But, while there is no pain, the patient herself breathes and sleeps soundly.

Scraping and pregnancy with endometrial hyperplasia

Pregnancy after curettage is very real. If you do not take drugs with hormones, then pregnancy can occur within 4-5 weeks after the intervention. If the patient observes hormonal therapy, adheres to the recommendations of the doctor, then after stopping, after about 1-2 months of therapy, you can become pregnant.

In order for the pregnancy to come and go well, it is necessary that the inner membrane of the reproductive organ be sufficiently restored. Gynecologists advise to keep from pregnancy for 3-6 months.

Probability of relapse

Unfortunately, the probability of recurrence of endometrial hyperplasia even after curettage is quite high. After scraping, the exact cause of the disease is established, and of course you will have to work on eliminating it.

To do this, you must regularly take medications, observe the appointment of a gynecologist, eat right, play sports - then the risk of relapse will be significantly reduced.

Risks to get sick in menopause

Everyone heard the saying: “hormones are naughty,” and during menopause, they really start to malfunction in our body. The normal functioning of the hormonal sphere keeps in order all the body systems of a woman, not only watching our health, but also our emotions and ability to enjoy.

And when a hormone such as estrogen begins to accumulate unnecessarily in the female body, while progesterone decreases, it can end up in menopause with such a dangerous disease as endometrial hyperplasia. At risk are women with long abundant menopause before menopause, having fibroids, inflammation of the endometrium, or education in the chest.

From the field of anatomy

The uterus is a muscular sac, designed to bear a child, connected to the ovaries, in which the eggs grow before entering this female organ. Inside the uterus is lined with a mucous substance called endometrium. The endometrium is intended to become the first cradle for the life that began, to protect and nourish the fetus.

The basal mucous layer is thicker and more dense, is the basis for the functional layer. In the functional section there are glands that secrete a mucous substance that does not allow the insides of the female organ to stick together. It connects these two layers of a layer of cells in the form of a grid called stroma. Since adolescence, the following processes take place monthly in the inner layer of the uterine mucosa:

  1. Its thickness after the end of the month is only 1 mm.
  2. Prior to ovulation, estrogens act on the mucous membrane, causing it to thicken, its cells grow in size, reaching 0.4 - 0.5 cm.
  3. When ovulation occurs, the egg ready to reproduce leaves the ovary and enters the sperm during intercourse, in its place a temporary corpus luteum grows, progesterone is released into the uterus, forcing the endometrium to increase in thickness and begin to produce a special substance. Moving wavy similarity of cilia growing on the ciliated cells on the inner smooth surface of the functional layer promotes the egg to the place where it attaches and grows. Endometrium grows up to 0.8 cm thick.
  4. In case of failed fertilization, the functional section begins to thin, die off, and its detachment occurs, causing bleeding, with which it erupts from the uterus. This is menstruation.
  5. The basal layer begins to grow internal with the help of stroma, until the next menstruation.

What is endometrial hyperplasia?

When the estrogen level is high, and progesterone is small and cannot cope with female hormones, the mucous membrane begins to grow uncontrollably. The functional layer of the mucous membrane grows inside the basal and does not depart during menstruation. When endometrial hyperplasia has to be made, scraping occurs because both hormonal and endocrine processes are disturbed, and this results in the impossibility of pregnancy.

Typically, this process occurs in the premenopause, although hormonal disruptions also occur in the childbearing age.

This disease often reveals itself late, is asymptomatic, increases, subsides, and again reminds of itself. Endometrial hyperplasia in menopause is not rarely first detected with prolonged shape.

Types of hyperplasia and curettage

Statistics state that this disease is found in every fifth gynecology patient. In recent years, an increasing number of women are falling ill with it. Complications from this disease, including cancer, have also increased.

Consider the types of hyperplasia:

  • glandular hyperplasia - not a malignant form, with her glandular cells multiply, accumulate in groups, and not throughout the mucosa. The shape of the glands changes, they increase, but continue to perform their functions, the scraping is not always carried out, depending on the state of the organ,
  • glandular cystic form - a consequence of an imbalance of sex hormones, which can be a consequence of mastopathy, thyroid disease, diabetes, occurring in women in premenopausal women. The disease is similar to the previous one, but in addition to the expanding cells of the glands, cells grow inside their orifices and do not allow secretion. Similarity bubbles grow up with mucus inside. In addition to the uterus, such cysts can appear in the ovaries. Cleaning is required,
  • cystic adenomyosis: similar in manifestations to the previous form, but unlike it, the glands expand strongly with the normal inner layer of these glands. The appearance of tumors at the site of cell proliferation foci is a frequent consequence of cystic hyperplasia. Scraping is necessary,
  • focal hyperplasia — изменения происходят в соединительной части, в ней вырастают доброкачественные полипы, поражение происходит местами, очагово, чаще в верхнем отделе женского органа. Гиперплазия эндометрия в постменопаузе в данной форме чаще заканчивается раком, чем в молодом возрасте. Scraping work is necessary,
  • atypical hyperplasia differs from others in the appearance of atypical cells in the hypertrophied endometrium, which the immune system cannot influence, and the components of the functional layer begin to mutate. Both internal and basal layer changes. The disease in half of the cases goes into cancer, and you need not just curettage, but removal of the female organ,
  • the rarest type of hyperplasia is basalcharacterized by a thickening of the basal layer of the mucous membrane.

Endometrial hyperplasia in menopause occurs not so much because of the strong growth of estrogen, but because of the duration of the increase in its quantity. At the beginning of menopause, when the cycles of menstruation begin to pass, bypassing ovulation, the initial segment of the cycle increases in time, and the decrease in progesterone does not allow it to cope with its function.

Postmenopausal endometrial hyperplasia appears relatively rarely, because the functional mucous membrane layer dries out and does not grow. Many gynecological problems, such as myomatic manifestations, endometriosis, formations in the chest do not cause adenomyosis, but are indicators of an increased female hormone, and hence the risk of getting hyperplasia.

With early menopause, up to 45 years of age, diagnostic and therapeutic curettage is also prescribed in connection with a possible disease. This leads to the conclusion that before the end of the month it is necessary to have a regular check-up at the gynecologist twice a year, and to carry out an ultrasound examination once a year. Almost always to eliminate the pathology has to carry out the procedure of curettage.

In what case is scraping done?

If a woman has bleeding - this is the main signal of danger, in which you can not pull with a trip to the doctor. Blood in menopause is an abnormal phenomenon, because the ovaries stop working.

The specialist will refer the patient to an ultrasound examination, in order to determine how thick the mucosa of the uterus and the size of the female organ.

Normally, the endometrium reaches a thickness of 0.5 cm, and in postmenopause - 0.4–0.5 cm, with an increase to 0.7 cm, a woman is prescribed a second ultrasound three months later, and after six months. With an increase in the mucous membrane to 0.8 cm in thickness, the patient is sent for curettage, since this symptom is considered already dangerous to health. With a thickness greater than 1 cm, the uterus inside is similarly cleaned, but the uterine cervix and the female organ are scraped separately, and the removed epithelium is examined for pathology.

Inspection takes place with the help of special mirrors. Conduct a biopsy and inspection apparatus hysteroscope, as well as diagnostic cleaning. When menopause occurs, the uterus is normally reduced, the epithelium is modified, dried up, the cervix is ​​narrowed and not elastic.

The structure of the endometrium is also studied, which also changes with menopause. If mucus is found in the uterus, its composition is necessarily examined.

Scraping essence

This is a medical manipulation, which is carried out after the introduction of anesthesia into a vein. The endometrium is scraped from the inside of the uterus with a special tool called a curette, and, naturally, the female organ cavity is injured. This operation is considered therapeutic and diagnostic, due to the fact that the removed endometrium and polyps, if they are present, fall on the laboratory table, where they are examined for accurate diagnosis. Therefore, cleaning is often carried out not only with the exact diagnosis, but also in the case when there is only a suspicion of some ailment.

This suggests thinking: maybe it is not necessary to do this cleaning? Maybe it is possible to do with injections and pills, physiotherapy? But, as we saw above, a disease such as endometrial hyperplasia in menopause, in most cases, is treated promptly: either by scraping, or by laser, or creoapparament, and sometimes it is necessary to remove the entire organ.

Whatever the experienced doctor, but injuries during this operation are unavoidable, it is good that after menopause there is no question about the risk of infertility. After all, cleaning is carried out and women of young age, and with abortion, it is also present. So cleaning itself at a younger age can lead to adenomyosis in menopause, and, ironically, you have to do the same curettage again.

Such a procedure as hysteroscopy helps in solving this problem. With the help of the hysteroscope, the doctor can see the inside of the uterus on the monitor, and diagnostic cleaning will not be necessary, because all the pathologies are evident.

Also, diagnostic curettage can be replaced by an endometrial biopsy, when a thin tube is inserted inside and sucks the tissue for analysis. And there is no need to do the cleaning "just in case." When hysteroscopy has all the conditions to clean the scraping of tissue, without leaving part of the mucous inside, and point to remove polyps or cysts. So terribly lucky are the ladies who live in the area where hospitals are equipped with this new equipment to eliminate female pathologies.

How does a woman get ready for scraping?

Without preparation, the operation is not carried out, unless the woman is bleeding, and it is necessary to intervene immediately. Before scraping, the patient is referred to the district therapist and narrow specialists to learn the contraindications for the procedure. Also conduct analyzes:

  • advanced blood count
  • hepatitis test
  • aids test
  • for sexually transmitted diseases,
  • cardiac electrocardiogram,
  • vaginal smear,
  • It is imperative to perform an ultrasound of the female organ before the operation. Modern devices perfectly show the condition of the endometrium, and there is no need to prescribe a cleaning in order to make a diagnosis.

In case of detected diseases, inflammatory processes and infections are eliminated first.

Endometrial treatment in premenopause

  • Since in the premenopausal ovaries function poorly, the doctor first prescribes hormonal forms that help the appendages work and inhibit the growth of estrogens, and also prevent the tissues from developing into cancerous ones,
  • vitamin preparations A, E and Ca,
  • scraping the affected parts of the endometrium,
  • If symptoms recur, the doctor must remove the entire uterus.

Treatment of endometrial hyperplasia in menopause

  • diagnostic curettage is performed,
  • after analyzing the material from the uterus, the gynecologist chooses a set of hormones necessary for the stagnation of hyperplasia, during the treatment process, observes changes in the mucous membranes and the state of hormonal balance,
  • the anomalies found in the uterus are scraped out using a laser in some places of cell proliferation,
  • in surgery, a combination of hormonal and surgical forms of exposure is carried out, hormones reduce the thickening of the epithelium, and during surgery a smaller area needs to be cleaned,
  • when a disease recurs, an organ is removed, then a course of hormones is again performed.

Treatment of postmenopausal endometrial hyperplasia

  • curettage is the initial stage of treatment
  • the doctor prescribes progestin, which need to take 1 year, hormones to influence the hypothalamus,
  • The treatment is carried out under the control of regular ultrasounds.

If the disease returns, or doctors find atypical formations in women, use the extreme method - removal of female organs.

After scraping

If a woman has undergone this operation, you should not forget about the problem and undergo a gynecologist examination, and in case they are appointed, an ultrasound examination four times a year from the moment of the procedure. Scraping has some health implications: for three to ten days, there may be blood excretion, and this fact should not frighten the patient. This leaves the remaining particles of the endometrium. After six months, the doctor must do a diagnostic cleaning to make sure that the disease has not resumed, and to prescribe to the woman the drugs that the doctor deems necessary during this period.

You need to know that with severe bleeding, the use of hemostatic drugs will not solve the problem, but will only delay it, and you will have to go for scraping. But you can lose precious time, deplete your body from blood loss, as well as get cancer, which results, in most cases, death.

In conclusion, we want to warn you that at a gynecologist appointment you can ask him if you really need curettage, whether it is possible to do with a biopsy or taking medications in your case. This is your health and your life, and undoubted surgical intervention is only necessary for severe bleeding or recurrence of the disease. Be healthy!

Interesting video on this topic:

Endometrial hyperplasia, curettage treatment

Endometrial hyperplasia (thickening of the glandular layer of the uterine epithelium) requires timely and appropriate treatment regardless of the patient's age, stage and form of the disease.

An effective method of removing pathologically changed areas of the mucous membrane is diagnostic curettage.

With it, you can not only get rid of the affected endometrium, but also to conduct a histology of the material taken.

Endometrial scraping is usually performed by a gynecologist under the control of a hysteroscope.

The latter is an optical system that is equipped with a light source and has a special channel for inserting surgical instruments into the uterine cavity.

The use of a hysteroscope in diagnostic curettage allows for a high-quality cleaning of the endometrium with complete removal of pathologically altered areas and polyps, preventing re-growth of the glandular layer.

After surgery, the removed endometrium is sent for histological examination.

According to the results of analyzes, as well as taking into account the form of hyperplasia, the age of the patient, the presence of concomitant diseases and the desire to preserve reproductive function, the gynecologist prescribes treatment.

Maintenance therapy after the operation suppresses the re-growth of the pathologically altered glandular layer and stabilizes the hormones of the woman.

Hormone treatment after curettage

Hormone therapy after curettage surgery includes the appointment of the following drugs:

  1. Oral contraceptives (KOK) is prescribed for at least six months according to an individual regimen for a separate drug.

As a rule, these hormone-based drugs are prescribed to patients under the age of 35 years. Sometimes for hormonal hemostasis in adolescence, the gynecologist also prescribes combined oral contraceptives. The course of administration is 21 days with a gradual decrease in dose. If the bleeding does not stop, then the patient is shown to undergo surgery.

  1. Preparations of the gestagen group prescribed course from 3 to 6 months. This group of hormonal drugs has an obvious advantage - they can be used regardless of the patient's age, form and stage of hyperplasia.

Many patients, in addition to progestins, gynecologists recommend installing a gestagen-containing intrauterine device. The latter has a local regenerating effect on the diseased endometrium.

In the first six months, the established helix can cause bleeding that is not associated with menstruation. Another disadvantage is the term of use (at least 5 years).

That is why the progestin-containing intrauterine device is suitable for patients who are not planning a pregnancy in the near future.

  1. Gonadotropin releasing hormone agonists - The most effective means for regulating the synthesis of sex hormones in the ovaries.

The preparations give a stable positive dynamics in the treatment of any form and stage of endometrial hyperplasia after 35 years, as well as during menopause.

While taking agonists in a woman's body, hypogonadotropic amenorrhea occurs, but after the course is over, ovarian function is fully restored.

The disadvantage of this group of drugs - increased hot flashes and increased sweating during menopause.

Maintenance therapy

After scraping hyperplasia, along with hormonal treatment, the patient is prescribed:

  • antispasmodics, for example, no-silo (with a pronounced pain syndrome) They reduce pain and prevent the accumulation of blood clots in the uterus,
  • antibiotics (to protect the body from various infections in the body),
  • a course of oxytocin injections (to prevent heavy and prolonged bleeding after surgery),
  • vitamin therapy (vitamins of group B, C, iron and other trace elements),
  • sedatives (for example, valerian, motherwort in the form of tablets or tinctures),
  • physiotherapeutic procedures.

For quick recovery after surgery, a woman is shown a complete and balanced diet, adherence to exercise, rest and sleep. Within 2-3 weeks, sex, douching and the use of hygienic tampons are contraindicated.

Six months after the operation, as well as a course of hormonal and supportive treatment, repeated diagnostic curettage is performed. This procedure is necessary for a stable positive result and to prevent the recurrence of the disease.

Treatment of endometrial hyperplasia after curettage should be carefully selected. It is also important that the patient complies with all recommendations regarding lifestyle.

Even the positive dynamics of treatment of hyperplasia after surgery requires regular visits to the gynecologist (2-3 times a year).

A timely appeal to a specialist warns many complications and health problems.

Scraping for endometrial hyperplasia: features of the method

Pathology of the uterine lining, in which there is increased cell growth, occurs in 50% of women.

In the absence of control over the state of the uterus, the disease can lead to negative consequences (anemia, cancer of the uterus).

The doctor selects the method of therapy based on the age, weight of the woman, existing chronic diseases. Scraping for endometrial hyperplasia is one of the treatments.

Indications for scraping with hyperplasia

With endometrial hyperplasia, the upper layer of the epithelium of the uterus expands. There are several types of the disease:

  • cell growth evenly over the entire inner surface of the uterus leads to the development of glandular hyperplasia,
  • uneven growth, with the formation of thickened areas - endometrial cystic hyperplasia.
  • glandular cystic hyperplasia often occurs,
  • the growth of cells of all layers, faster than normal, contributes to the development of an atypical type of disease that can turn into a cancerous form.

Disruption of the normal functioning of cellular processes in the uterus is manifested characteristic signs. Do scraping with the following symptoms:

  • heavy bleeding that does not go away for a long time
  • irregular periods, with a cycle duration of more than 40 days,
  • the inability of a woman to become pregnant for more than six months,
  • spotting blood throughout the cycle
  • pain syndrome, localized in the lower abdomen, which is accompanied by high fever, indigestion, malaise.

Whether it is necessary to do curettage for endometrial hyperplasia, or to apply a different treatment strategy, the doctor determines. For this, a full examination is carried out, laboratory tests are appointed.

Diagnostic curettage of the uterus when endometrial hyperplasia is performed with each method of treatment. Taken biological material is subjected to histological examination, which allows you to determine the type of disease, the risk of developing or existing cancer of the uterus. And after scraping to prescribe an effective course of treatment.

Scraping preparation

Careful preparation of the woman for cleaning is necessary, and avoids complications after surgery. It consists of the following activities:

  • cancellation of all medications for two weeks before the operation.
  • sexual rest a few days before the procedure.
  • Consultation of the therapist and narrowly specialized doctors (neurologist, cardiologist), who give recommendations on whether it is possible to carry out curettage and whether there are any contraindications.
  • holding an ECG.
  • blood donation for general analysis and biochemical composition.
  • testing for sexually transmitted diseases.
  • smear for the presence of dysbiosis, infections.
  • examination of the uterus on ultrasound, which is determined by the thickness of the enlarged endometrium layer.
  • surgery is performed on an empty stomach, and with a cleaned intestine.

Only in the absence of inflammatory and infectious diseases, the uterus is cleaned.

The treatment is carried out at the end of the menstrual cycle, when there is a natural change of the epithelium, the cells of the functional layer are separated more easily, and the load on the woman’s body is less.

Scraping curette, blindly

After the onset of the anesthetic effect, the doctor expands the cervix with a gynecological instrument. Then, using a curette, (a special scraper in the form of a loop on the handle), performs cleaning. The doctor removes a layer of epithelium from all walls of the uterus, paying particular attention to the corners. This may damage healthy areas of the surface, basal layer and muscle tissue of the uterus.

For further investigation, a small sample is placed in a sterile container, and sent to the laboratory.

После процедуры поверхность матки представляет собой открытую рану. При сильном кровотечении осуществляют его остановку, прижигая поврежденных сосудов. Процесс лечения занимает около получаса.

Cleaning with a hysteroscope

A hysteroscope is an optical device, with illumination of the treated surface, and with a gas supply to expand the uterus.

Treatment begins after the loss of tissue sensitivity from the action of anesthesia. Make the expansion of the cervix, enter the hysteroscope, through which air is supplied. The walls of the uterus under the pressure of air moved apart. The doctor under the visual control of the device cleans the curette.

The use of a hysteroscope allows you to assess the condition of the mucous membrane, to control the process of curettage.

The treatment process takes about half an hour. Hysteroscopic curettage is preferable to blind cleaning (curettage), as there is less chance of damage to healthy tissue.

Schemes of operations

Be sure to do diagnostic curettage of the uterus when endometrial hyperplasia, with the placement of the sample in a container for laboratory research.

After scraping

The recovery period is about a month. In this case, endometrial hyperplasia after curettage has the following consequences:

  • bleeding within a few hours after surgery, which turns into minor bleeding. The rapid cessation of discharge should alert the woman, because indicates a spasm of the cervix, and accumulation of blood inside.
  • pain like a spasm during menstruation. It can last for about a week, a course of painkillers is prescribed to relieve pain syndrome. Ibuprofen is effective.
  • weakness, drowsiness and general malaise.

Endometrial hyperplasia after curettage, which has the following symptoms, requires immediate medical attention:

  • temperature rise,
  • the appearance of an unpleasant smell in the discharge,
  • complete cessation of any discharge
  • a sharp deterioration in well-being.

Why and when to scrape

Curettage of the uterus when suspected endometrial hyperplasia is a standard procedure that is performed if there are signs of pathology. Its necessity consists in the following:

  • This is the only way to confirm the diagnosis and establish the type of hyperplasia. This makes it possible to choose the most rational treatment: hormonal therapy or more radical options, including surgery.
  • Scraping helps to refute the presence of a malignant process. Almost always, uterine cancer proceeds exactly the same way as endometrial hyperplasia with its most significant symptom ̶ abundant menstruation. It is possible to establish an accurate diagnosis and detect atypical cells only upon histological examination after curettage.
  • In some cases, scraping is the only effective way to stop uterine bleeding, especially in premenopausal women.

The structure of the endometrium is normal

Scraping is performed with the following indications:

  • in cases of uterine bleeding,
  • if a woman complains of constant heavy periods with clots,
  • if there is a suspicion of hyperplasia and polyps that have arisen after an ultrasound examination on the 3-7th day of the cycle,
  • to control the treatment of hyperplasia.

And here is more about when abdominal surgery is necessary for uterine myoma.

Methodology

Scraping of the uterus can be carried out on an emergency basis or according to plan. In the latter case, a minimum examination is necessary (blood and urine tests, for blood type and Rh factor, ECG, examination by a therapist, swabs on the vaginal flora).

Scraping can be performed in a hospital in the presence of an anesthesiologist, who injects drugs with an anesthetic effect. A woman falls asleep without feeling pain. At this time, the gynecologist conducts scraping with a special set of tools. The degree of action is as follows:

  1. The vagina and cervix are treated with an antiseptic solution.
  2. The cervix is ​​captured by special instruments.
  3. A set of dilators cervical canal slightly increases for the subsequent free passage of tools.
  4. The curettes of different sizes, the doctor scrapes alternately all the walls of the uterus, trying to completely remove the functional layer of the endometrium. This has a peculiar therapeutic effect, and for some time after the procedure, the woman will note that her periods are not so abundant. However, without adequate hormonal treatment, the symptoms will definitely return.

Instead of the usual diagnostic curettage, hysteroscopy is often performed. During the procedure, the doctor places in the uterus a special device ̶ a hysteroscope, which is equipped with a camera that allows you to display the entire picture of what is happening inside the uterus, on the monitor screen. So the doctor can not blindly, as with normal curettage, but under control, detect pathological areas and remove them precisely. This increases the effectiveness of treatment.

Treatment after curettage of endometrial hyperplasia

Immediately after curettage, medical therapy is prescribed, which should prevent complications after the procedure. This includes:

  • Hemostatic agents: Etamzilat, Tranexam, Vikasol,
  • painkillers: “Analgin”, “Ibuprofen”, “Ketorolac” and others,
  • antibiotics for the prevention of infectious complications,
  • if necessary, oxytocin may be administered to improve uterine contractility.

As soon as the result of the histological examination is ready, the doctor prescribes further treatment. In most cases, it includes various hormonal drugs:

  • Oral contraceptives for uncomplicated hyperplasia young girls. They are prescribed using a standard contraceptive regimen on one tablet daily at a fixed time. Often appointed "Midiana", "Dimia", "Jeanine", "Klayra", "Regulon", "Diana" and others.
  • Progestin. Preference is given to this group in the treatment of age-related women, as well as young people who do not need reliable protection (as they do not protect against pregnancy). These include “Duphaston”, “Utrozhestan”, “Norkolut” and others. The Mirena Navy can also be used. It provides both a contraceptive effect and a reservoir that is maintained in the body by a certain level of hormones, sufficient for a therapeutic effect.

With the ineffectiveness of previous drugs can be prescribed stronger, they are also more expensive ̶ gonadotropic hormone agonists. They suppress ovarian function at the level of the pituitary and hypothalamus. These are “Buserelin”, “Diferelin”, “Zoladex” and others.

See in this video about the treatment of endometrial hyperplasia after curettage:

If cleaning failed

Scraping itself is not carried out with a medical purpose, often ̶ with diagnostic. Therefore, to talk about successful and not very successful attempts is not quite right. If, after curettage and subsequent treatment, the hyperplasia recurs, that is, the treatment carried out did not produce results, then other solutions should be considered. For example, perhaps even holding:

  • endometrial ablation: cautery during hysteroscopy of the entire inner surface of the uterus,
  • uterus removal. It is suggested to the patient in the detection of atypical cells in the results of histology, as well as a combination of hyperplasia and other diseases, such as uterine fibroids, adenomyosis, ovarian cysts.

The effects of curettage in endometrial hyperplasia

Scraping is a standard diagnostic procedure, in most cases it runs smoothly and without any complications. Moreover, immediately after its implementation, drugs are prescribed to prevent any undesirable consequences.

Immediately after scraping a woman may feel the following:

  • Pulling pains in the abdomen, which are caused by the contraction of the uterus.
  • Spotting, which, as a rule, gradually decreases and disappears over the course of a week.
  • Immediately after curettage, weakness and dizziness are allowed, which are caused by the anesthesia and the procedure itself.

The following symptoms should alert and cause a visit to a doctor or any medical staff nearby:

  • worse lower abdominal pain
  • progressive weakness up to loss of consciousness,
  • discharge with an unpleasant smell
  • fever,
  • copious discharge.

The most common complications after curettage include perforation of the uterine cavity with a curette (often requires subsequent surgical treatment), delay of clots inside (hematometer), inflammation (endometritis).

And here more about the consequences of hysteroscopy when removing the endometrial polyp.

Scraping is a standard procedure for suspected endometrial hyperplasia. It is carried out in stationary conditions under anesthesia. After the procedure, all the material obtained from the uterus is sent for histological examination, which helps to select the most appropriate treatment in the future. As a rule, the procedure takes place quickly and is not accompanied by complications, but if there are complaints, it is better to additionally consult a doctor.

Indications for the procedure

Scraping is a therapeutic and diagnostic procedure that is prescribed for various gynecological diseases. It is shown in endometrial hyperplasia. During curettage, the doctor removes the functional uterine layer with a hysteroscope or a simple curette, which will fully recover by the next month. Other tissues are not affected.

Curing hyperplasia without curettage is sometimes noted, but such cases are extremely rare. Therefore, gynecologists insist on carrying out this procedure.

For diagnostic purposes, the method is shown in such cases:

  • failure of the menstruation cycle,
  • long and excessively abundant regulations,
  • acyclic spotting,
  • pronounced pain during the critical days,
  • impossibility of conception,
  • suspected oncology.

Scraping treatment is indicated for the following problems:

  • uterine fibroids,
  • endometritis,
  • polyps in the cavity of the reproductive organ and cervix,
  • ectopic pregnancy,
  • fetal death in the womb,
  • postpartum complications
  • spontaneous abortion.

With the development of hyperplasia in the period of menopause, the procedure is performed without fail. This is due to an increased risk of cell degeneration into cancer.

Scraping Technique

Surgery can be performed in several ways: using a hysteroscope or blindly, using a curette. Regardless of which option is chosen, a woman will need to be hospitalized for a short period and then undergo a course of treatment. In the case of re-development of the pathology or mutation of cells into malignant, hysterectomy methods are used and the genital organ is completely removed.

Hysteroscopic

Diagnostic intervention is performed under visual control, which can be achieved through a special device - a hysteroscope. It is a tube equipped with a lighting device, a chamber and channels through which gas or liquid is supplied and a curette is introduced.

At the initial stage, the same actions are performed as with the blind method. First of all, anesthesia is administered and the dilator is inserted. A hysteroscope is placed in the passage, which was formed in this case, and a gas is introduced through its channel, contributing to the expansion of the walls of the genital organ.

A curette is introduced into the second channel and the endometrium is assessed. Part of the uterus while viewed on the monitor in an enlarged form. Then cleaning is performed. The resulting tissue is placed in a container and sent for histological examination.

At the final stage, the vessels that bleed are burned and all the instruments are removed.

Complications after the procedure

Purging of the reproductive organ refers to operations with an increased risk of damage. Bleeding after it is considered a dangerous symptom. Such discharge may indicate the development of the following complications:

  • endometritis,
  • cervical tear,
  • infection penetration
  • perforation of the affected walls,
  • impossibility of conception.

Repeated recurrence of pathology is also not excluded. Therefore, it is extremely important to follow all medical recommendations in the postoperative period, to restore the activity of the ovaries and to normalize the hormonal background.

Occurrence of hyperplasia

Glandular cystic hyperplasia of the endometrium often develops after curettage. This is due to the fact that as a result of its implementation the following changes in the female body can occur, contributing to the occurrence of pathology:

  • hormonal imbalance. There is an excessive concentration of estrogen and an insufficient amount of progesterone,
  • endocrine, cardiovascular and urogenital disorders,
  • inflammatory processes in the genitals,
  • fibroids, polyps in the uterus,
  • polycystic appendages and adenomyosis.

The causes of relapse may also lie in non-compliance with medical recommendations and the lack of effect of hormone therapy.

Scraping for endometrial hyperplasia: features, indications and effects

Women because of the structure of their bodies often face diseases. Pathological processes may have a different character. Some of them are quite difficult to detect. So you do not bite your elbows, you must visit a doctor in a timely manner. The gynecologist will conduct an examination, listen to your complaints and, if necessary, refer you for additional diagnostics.

Approximately half of the representatives of the weaker sex in menopause and after it endometrial hyperplasia is detected. Without curettage of the uterus, the pathology can be defeated only under special conditions. Today's article will tell you about the origin of this disease and present you its types. You will also find out whether it is necessary to do curettage in case of endometrial hyperplasia and what this is fraught with.

What it is?

Not every woman has to endure such manipulation as gynecological curettage. In endometrial hyperplasia, it is often prescribed, but not always. Before you learn about the features of manipulation, you must acquire an idea of ​​the disease itself.

Endometrial hyperplasia develops as a result of the proliferation of the inner surface of the muscular reproductive organ. Each cycle in a woman's body occurs a change in hormonal levels. During menstruation, the endometrium is rejected and goes out with blood. After this comes the time of estrogen.

They contribute to the growth of follicles and the restoration of the mucous layer of the uterus. Further, after ovulation, progesterone contributes to the correct secretion of the endometrium, it prepares the reproductive organ for pregnancy (attachment of the ovum).

If conception does not occur, the progesterone level declines, which causes the next bleeding. Everything is very simple.

But if for some reason a woman has a hormonal failure, then the endometrium is not rejected or not at all exposed to progesterone. Because of this, uncontrolled cell division, their proliferation, begins. It was then that doctors diagnose endometrial hyperplasia.

Types of hyperplasia and features of its correction

There are several varieties of this pathology. Some of them are not so dangerous and may succumb to hormonal correction. Others call for surgery. In some situations, removal of the uterus is indicated. What could be endometrial hyperplasia?

  • Ferruginous. It is considered one of the lightest, often amenable to medical treatment. The mucous surface grows evenly, without forming stromal cells between them.
  • Cystic. This form is similar to the glandular, but with it the surface of the inner shell grows piecewise, forming bubbles that look like cysts. It is treated with hormonal drugs.
  • Focal or diffuse. The mucous surface grows evenly (with diffuse) or piecewise (with focal). On appearing areas, cysts and polyps form. There are cases of the development of such hyperplasia into cancer.
  • Atypical. This form is considered the most dangerous. When it grows mucous occurs not only on the surface of the inner layer. Cells actively divide, penetrating into the basal layer. Scraping for endometrial hyperplasia of this nature is often ineffective. For certain indications have to remove the uterus.

Symptoms of the disease, indicating the need for curettage

The main symptoms of this disease are a variety of failures of the menstrual cycle. A woman may complain of delay, heavy bleeding, daub before and after menstruation.

Also during this period there are symptoms of indisposition: abdominal pain, indigestion, poor health, fever and so on. Often hypertrophy is accompanied by infertility.

In what cases is scraping prescribed? For endometrial hyperplasia, the indications should be as follows:

  • pain in the lower abdomen,
  • prolonged bleeding,
  • cycle time more than 40 days,
  • infertility lasting more than six months
  • bleeding throughout the cycle
  • laboratory confirmation of hyperplasia.

Preparation for manipulation: features

Scraping the uterus with endometrial hyperplasia is performed only after preparation. Previously, the patient should be examined by such doctors as a neurologist, cardiologist, therapist.

Experts give a conclusion that there are no contraindications to manipulation. At the same time, studies such as general and biochemical blood tests, the determination of antibodies to hepatitis, HIV and syphilis are conducted.

Be sure to examine the heart through an ECG.

After that, the patient will have to visit a gynecologist. The doctor prescribes additional examinations, which include ultrasound diagnostics, a smear to determine the purity of the vagina. It is forbidden to manipulate with poor results. If there is an inflammatory process, then it is necessary to eliminate it first.

Carrying out the procedure: the course of action

Scraping of the uterus during endometrial hyperplasia is performed only within the walls of a medical institution. The procedure itself lasts no more than 20 minutes. Manipulation requires intravenous anesthesia.

During curettage, the patient sleeps or is half awake: she does not feel any unpleasant sensations. With the help of dilators, the doctor reveals the cervical canal, falling into the cavity of the reproductive organ.

The curette is removed overgrown layer, which will be further investigated.

In the process of scraping, two positive actions are carried out at once: the doctor cleans the accumulated layer and can further determine its composition and danger (using histology). After cleaning, the patient is under the supervision of medical personnel for another 2-4 hours. If there are no complications, then the woman can go home.

Inflammatory process

If you have endometrial hyperplasia (treatment after curettage was not carried out), then there is a high likelihood of inflammation.

It manifests itself with the following symptoms: abdominal pain, unusual discharge with an unpleasant odor, increased body temperature. In all situations, an urgent correction is shown.

Usually, doctors prescribe a long course of antibiotics for oral, intravenous and vaginal administration.

If the inflammation that has arisen due to curettage is not treated, then the pathology can spread to neighboring organs: the ovaries, fallopian tubes, and so on. All this is fraught with its consequences.

Perforation of the uterus or thinning of the walls of the organ

Treatment of endometrial hyperplasia without curettage is rarely performed. If within a month hormone therapy does not improve, then it is imperative to carry out cleaning. During manipulation, a complication such as perforation of the uterine wall may occur. This pathology requires emergency surgical intervention.

Also, the consequence of manipulation may be the thinning of the walls of the reproductive organ. In the future, this leads to its complication. For example, a uterine rupture may occur during pregnancy. Often, when a thin wall is assigned a planned caesarean section.

Endometrial hyperplasia: curettage. Feedback on the effects of the procedure

What opinion do patients have about this procedure? Many people say that endometrial hyperplasia does not disappear after curettage. After several cycles, the mucous membrane begins to thicken again, forming cysts, polyps.

Indeed, if the patient is not prescribed appropriate therapy, the surgical intervention itself will not relieve her from the illness. Scraping does not eliminate the cause of hyperplasia, but only corrects its effects.

It is therefore important to listen to the prescription and after the operation to comply with the prescribed therapy.

Summarize

From the article you could learn that the treatment of endometrial hyperplasia without curettage is possible, but only in exceptional cases. To realistically assess the patient's condition, it is necessary to perform a biopsy or curettage. Only in this way will it be possible to choose an effective treatment that will save you from the existing problem.

Diagnostic curettage with endometrial hyperplasia: features of the procedure, reviews

Many gynecological pathologies require intervention with the use of special tools. Cleaning is used as a diagnostic method, and as a method of treatment. One of the diseases for which cleansing is indicated is endometrial hyperplasia.

A similar diagnosis is made when the thickness of the endometrial layer exceeds 16 mm. Often, doctors prescribe a diagnostic curettage of the uterus with endometrial hyperplasia.

It is this procedure that allows you to make an accurate diagnosis, take a biomaterial for histology, find the right treatment.

There are several types of pathology, but the most common option is endometrial glandular cystic hyperplasia.

It occurs in women of different ages. For a long time, the disease may be asymptomatic. Suspected deviations can only be irregularities in the menstrual cycle.

The girls notice that the discharge has become abundant, they can appear in the middle of the cycle, often the period of menstruation changes, clots appear. If such signs appear, you should immediately consult a doctor.

He will prescribe tests and various types of examinations, and also clarify whether it is necessary to do curettage for endometrial hyperplasia.

Scraping Features

The uterus is a hollow organ lined with endometrium. This fabric consists of two layers - functional and basic. The first grows and develops, creating a favorable environment for the fertilized egg. If the pregnancy has not occurred, it is rejected and removed from the body along with menstruation. Hyperplasia causes the proliferation of hyperplastic cells of the endometrial functional layer.

The most common cause of pathology is hormonal failure. If the disease is not treated, it will entail serious complications, such as infertility and cancer. To prevent such consequences allows an integrated approach to treatment.

Often, doctors use a proven treatment regimen - a cleansing and a course of hormones. Endometrial hyperplasia after curettage and treatment in most cases passes.

If the therapy did not help or blood tests revealed the presence of atypical cells, a radical method is used in gynecology - hysterectomy (removal of the uterus).

Procedure

Endometrial curettage is performed today in one of two ways - curettage or hysteroscopy. The first option is used less and less, because the operation is performed blindly, and there is a high risk of damage to healthy tissue. The procedure is performed under general anesthesia. It lasts no more than half an hour. Selection after curettage can last for 1-2 weeks.

Hysteroscopy is an innovative method. An optical device and instruments are inserted into the uterine cavity. The camera displays the image on the screen, which allows you to control the entire process.

After scraping hyperplasia with a hysteroscope, the rehabilitation period takes much less time. The final stage of the operation is cauterization of the blood vessels, so the discharge after curettage in this way lasts only 3-7 days.

Regardless of how the uterus is cleaned, before the procedure, the patient will have to pass a series of tests, limit sex, make an enema. You also need to take into account the existing contraindications: it is forbidden to clean in the presence of infections, exacerbation of chronic diseases, pronounced inflammatory processes.

Endometrial Removal Therapy

How to restore the endometrium after curettage the patient will tell the doctor. Woman has a difficult path. The first days after the manipulation you need to drink hemostatic drugs, because the walls of the uterus are completely wounded. Then comes the stage of taking antibacterial drugs designed to prevent complications.

Treatment of endometrial hyperplasia after the curettage procedure, doctors often supplement with enzymes. A set of special enzymes helps to improve immunity, speeds up the healing process, increases the effectiveness of drugs. In parallel, you need to take vitamins and minerals. This is followed by a course of hormones.

Glandular-cystic pathology is treated with estrogen and gestagens. Duration of medication is 3-6 months. In parallel with medical therapy, physiotherapy will be required. It is important to stick to a diet, practice moderate exercise. As an auxiliary measure, recipes of traditional medicine are effective - decoctions and infusions of herbs, douching with perhydrol solution, etc.

Monthly after curettage glandular cystic hyperplasia will go through 28-35 days. If within the specified period of menstruation has not come, consult a gynecologist.

The doctor will conduct an ultrasound scan, determine the size of the uterus, the thickness of the endometrium, determine the cause of the delay, and, if necessary, prescribe a drug that stimulates discharge after curettage. Also, specialist help will be needed if the monthly go longer than usual, have an unpleasant smell, a strange texture.

Restoration of the endometrium after curettage is a long process that requires a responsible approach and strict medical prescriptions.

What is the association of endometrial hyperplasia and female hormones?

Normally, the monthly course consists of 3 phases: the growth of the upper shell, the development of the endometrium and its occupation. The account of the new cycle begins on the initial day of the critical days. Exemplary on the 15th day of the cycle is ovulation. When insemination does not result, the egg is removed at once with the upper lining of the endometrium.

All these processes go under the power of sex hormones. Estrogens are needed for the development and maturation of the upper endometrial membrane, the hormone helps to maintain pregnancy when it begins.

In the phase of maturation of the endometrium, programmed cell death occurs, which does not allow the endometrium to grow more than is necessary.

Similar processes occur only in this case, when a girl has ovulation. When it is lacking, the long-term effect of estrogen on the lining of the uterus is marked, plunging to its excess maturation. An increase in the concentration of estrogen in the blood, which appears for many root causes, leads to the production of endometriosis.

Firstly, these are age-related changes in the number of female hormones produced, hormonal disruptions, ovarian tumors that produce hormones, polycystic ovary.

Hormone breakdown will be able to find out with the wrong method of contraceptives, after an unreal abortion, diagnostic curettage, inflammatory diseases of internal sexual organizations.

Concomitant pathologies will be able to worsen the movement of the disease: mastopathy, hypertension, diabetes mellitus, added weight.

According to the prevalence and type of constitution, endometrial hyperplasia can be divided into: glandular-cystic, focal, glandular-fibrous and adenomatous.

Glandular types of hyperplasia are characterized by an increase in the number of glandular cells producing cysts. Glandular and cystic hyperplasia have equal signs.

When adenomatous figure marked configuration in the texture of cells and their rapid fragmentation. Atypical hyperplasia is considered precancerous capital, because its healing will flow out to proceed immediately.

The appearance of thin cells is marked approximately in 35% of the situation. Often, repeated episodes of glandular hyperplasia may be associated with a metabolic syndrome, in which the immune system cannot kill lean cells.

For this disease is distinguished by the presence of fullness, diabetes mellitus and the absence of ovulation.

The main signs of endometrial hyperplasia

The main property of endometriosis are uterine bleeding. In the majority of patients, long delays of critical days are marked, after which there are abundant menstruations.

In some cases, the cycle breaks are not marked, the menses start on time, although they happen more long and abundant. Against the background of the criminal cycle, intermenstrual bleeding is often found out.

In some cases, amenorrhea begins.

Metabolic eunuchoidism often accompanies endometrial hyperplasia.

In such cases, similar symptoms are added to the bleeding, such as the presence of added weight, body hair growth by a masculine appearance, voice hoarseness and other signs associated with the influence of masculine hormones.

Endometrial hyperplasia often leads to infertility, miscarriage, mastitis. In addition, be able to find out cramping pain in the abdomen, bleeding after a sexual act.

When making a diagnosis, the doctor is obliged to know all the features of the girl's monthly cycle: the duration of the cycle, menstruation, are there any delays. Transvaginal Study cheats for 5-7 days of the cycle.

With his support, the thickness of the endometrium and the peculiarities of its texture are detected. In pathology, the endometrium has a thickness greater than 8 millimeters. With a thickness of more than 2 cm. The doctor will be able to think about the presence of thin cells.

In case of uterine bleeding, the study dies down on another day of the cycle.

Separation in endometrial hyperplasia is slowed down in both research and healing targets. A blood test for hormone content helps to detect metabolic breakdowns and polycystic ovaries. Mammograms are prescribed to identify mastopathy and thin tumors of the snow shackles.

Hyperplasia Treatment Methods

The selection of the method of healing this pathology prays for the unusual cycle, the constitution of the endometrium and the age of the girl.

Hormone substances are prescribed personally, contraindications to their enrollment are: diabetes, cholelithiasis, inflammation, drunkenness and smoking. Before the direction of healing should be a blood test and the power of capital immunity.

The elimination of the endometrium is competent to lead to the secondary origin of the disease, therefore it is not practiced when curing atypical figures of hyperplasia.

Hysterectomy is depicted with the ineffectiveness of hormone therapy and curettage, precancerous conditions, during menopause.

Healing endometrial hyperplasia is commonly studied in 2 steps. At 1, otdraivanie endometrium under the rule of the hysteroscope. When cleaning the multifunctional part is removed at once with all painful tumors.

The operation goes under general anesthesia, the hysteroscope allows absolutely to trace the course of the intervention, making it better and less traumatic. The cleaning is performed by the curette means, in some cases the application of a device stopping the outflow is asked.

The distant content of the uterus is sent for histological analysis, only this allows you to establish the nature of the disease process and the scheme of future healing.

After curettage, medicinal healing assigned to prevent the secondary origin of the disease is prescribed. To do this, determine the hormone substances, which are accepted according to some scheme.

For the treatment of hyperplasia in young girls more often, only combined contraceptives are utilized. It is better to use monophasic substances that have a systematic effect on the endometrium, inhibiting its growth. They need to receive 3-6 months.

With proper cure, glandular hyperplasia usually does not find out again.

When curing girls older than 40 years, progestogens are disposed of. Reception of substances begins from the 15th day of the monthly cycle and lasts until the menstruation has begun. The course of healing continues.

With endometrial hyperplasia in the postmenopausal period, healing is prescribed only after painstaking research. When tumors are not shown, the doctor sets 17-hydroxyprogesterone caproate any 3 days for 8 months.

After completion of the star of healing, diagnostic otdraivanie is slowing, the acquired source is sent for histological study.

Healing atypical to become hyperplasia involves taking gonadotropin releasing hormone agonists. Separate substances need to be received every 30 days, some - every day. Through the after-started healing the cheat is deceiving the secondary cleaning.

The patient is obliged to proceed monthly with the Study on which the temper of maturation of the endometrium is monitored.

Constant examinations of the mammologist, blood tests for the table of contents of cholesterol and the desert are also needed.

endometrial hyperplasia after curettage

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Ask your question Ask your question

Hello! I am 35 years old, I have children, I do not plan to give birth. A few months ago, I was diagnosed with an ultrasound and diagnosed endometrial hyperplasia, after curettage, a diagnosis of endometrial polyp. But my gynecologist abstains from treatment, because I have varicose veins. She says that with this disease, COCIs are contraindicated. How can I be treated? Are there any other options? Thank you in advance.

March 24, 2014

Ostrovorh Elena Ivanovna answers:

In endometrial hyperplasia and endometrial polyp, the drugs of choice in treating these conditions are not COCI, but gestagens. One of the representatives of this group of drugs — Orgametril. Take 1t. once a day from 5 to 25 day of the cycle for 6 months. But every 3 months after menstruation, do an ultrasound scan of the uterus for control. There will be questions, write.

Hello, I'm 47 years old, diagnosed with endometrial hyperplasia. После выскабливания — полиповидные фрагменты эндометрия гиперпластического типа. Врач назначила норколут с 15 по 25 день цикла в течение 3-х мес.

, затем УЗИ, но принимать гормоны что-то не хочется …

Once I tried to take a hormonal contraceptive, although I don’t remember which one, for its intended purpose, it didn’t work, after several days of taking it, severe bleeding began, then such contraception was categorically forbidden. What do you advise?

August 03, 2010

Demisheva Inna Vladimirovna answers:

Such appointments need to be done only with in-person consultation is a serious matter.

Hello! I am 43 years old. In December, the menstrual cycle was diagnosed by the type of metrorrhagia, endometrial polyposis. After hysteroscopy, a diagnosis was made: complex endometrial hyperplasia. After scraping bleeding did not stop completely.

The doctor prescribed injections of oxyprogesterone capronate, 4 ml three times a week - 4 weeks, and then 4 ml - twice a week for 2 weeks. After 10 injections, an allergic reaction appeared and they were canceled. A week later, menstruation began, it is so abundant that it is similar to bleeding and slight pain in the lower abdomen.

Is this normal or not? Advise what to do? Thank you very much in advance.

February 12, 2010

Victoria Vengarenko responds:

Obstetrician gynecologist

All consultant answers

Elena, of course this is not normal, you need to pick up another drug, there are many drugs for the treatment of hyperplasia: 17 OPK, buserilin, zoodex, but these drugs should be prescribed only under the supervision of a doctor.

Hello! I am 54 years old. After menstruation was not 10 months, and then passed scanty and prolonged, endometrial hyperplasia was diagnosed.

After diagnostic curettage, continuous duphaston administration was prescribed for 6 months, so that the menstruations stopped. But against the background of receiving duphaston, they began to come regularly.

Should I continue to receive duphaston, considering my age?

March 01, 2016

Yulia Vasilievna Bosyak answers:

Hello, Alla! After diagnostic curettage, the obtained biomaterial was sent for histological examination? Appointment in continuous mode dufaston you actually caused monthly.

Usually, women at an age like yours are given injections of 17-hydroxyprogesterone capronate.

Continuous reception of duphaston for your age is not rational, perhaps in this case, consider taking HRT after consulting a gynecologist ?!

I am 49 years old, premenopausal, diagnosed with endometrial hyperplasia, doing curettage, normal histology, prescribed oxyprogesterone capronat in a day and omnidren after 25 days, punctured the drugs for three months, the whole period of treatment was very poor, but lasted 10-12 days , there were also side effects of acne and constant irritability, the doctor said that it is quite normal to achieve menopause, after three months of treatment made an ultrasound, diagnosis - fibromatosis of the uterus, endometrial layer 6 mm, doctor advises I could continue the treatment for another three months (I also take anti-epileptic drugs daily). Please, tell me how to proceed?

February 02, 2016

Yushchenko Tatyana Aleksandrovna answers:

Omnadren surprised me in general ... It is not for print. I would choose completely different drugs for the introduction of menopause. The same hormone releasing agonists, which I mentioned above. But I do not see here a reason for the introduction of menopause. Fibromatosis of the uterus with normal scraping requires only observation

Hello. I am 54 years old. P / m is a little over a year. Menopause. On the ultrasound, the endometrium showed 0.65 cm. The doctor put on endometrial hyperplasia. Scraping was done.

The result of the study: in both bioptets, fibrous-muscular tissue with single wiry inclusions (probably from a node? Or a polyp?) H / s for one and a half months on ultrasound, the endometrium is again 0.65 cm with indistinct contours of non-single-stroma. After curettage, no treatment .

The doctor prescribed a repeated scraping. Tell me, is it possible to carry out a repeated scraping after 2 months and what should be prescribed in my case?

January 6, 2015

Dikaya Nadezhda Ivanovna answers:

Faina, good afternoon! You need to re-diagnostic curettage followed by adequate treatment. Treatment: its volume and variant - it depends on the result of histopathological examination of uterine cavity scraping.

I am 28 years old, 1 child. Two months ago, they found endometrial hyperplasia, made a curettage, and appointed 3 months to take duphaston from 16 to 25 DC, as the gynecologist said, to normalize the cycle. One cycle of duphaston propyl, 2 periods passed after scraping, the cycle did not change. Do I have to drink duphaston for 3 months? We are planning 2 children. thank

October 3, 2014

Dikaya Nadezhda Ivanovna answers:

Oksana, good afternoon! According to this scheme, dufaston does not harm, but helps to get pregnant. The presence of a hyperplastic process suggests that there is an insufficient level of progesterone in the 2nd phase of M.C.

In order for you to be able to endure a pregnancy, you need an adequate level of progesterone. Therefore, dufaston is used during pregnancy with the threat of miscarriage or the threat of premature birth.

Treat yourself with respect, undergo a course of treatment, prepare for pregnancy. Good luck to you!

Hello! A year ago, she was doing curettage. Diagnosis: glandular hyperplasia. Currently, ultrasound on the 7th day of the cycle is 6mm endometrium. After curettage, she was not treated. I am 44 years old. After scraping I was not treated. To take hormones, Mirena, etc. I do not want, and everything seems to be normal. What else is the prevention of hyperplasia (sport? grass?). And what procedures in my case can be done in a sanatorium?

February 20, 2013

Korchinskaya Ivanna Ivanovna answers:

The situation must be observed in the dynamics. If you do not want hormone therapy, you can take Tazalok. Spa treatment is indicated, with the exception of thermal procedures.

I am 48 years old. After 3 months of delay, menstruation arrived, which did not stop for 2 weeks, very abundant. I went to the ultrasound: endometrium 1.4 is friable, the length of the uterus is 6.9, anterior-posterior 5.9, myometrium is hmogenic, the right ovary 2.9x1.7 is evenly defined contours with single follicles with a diameter of 0.5, the left is 2.6x1.6 rear arch free.

Dr. C: Hyperplasia of the endometrium. I went to the scraping, I passed the analysis - Dr.: Glandular hyperplasia of the endometrium. After cleansing, the bleeding lasted 14 days. Then it stopped for 14 days, and then monthly came again and it has been going on for 9 days already. I went to the doctor, I was told to drink only Lindinet-20. Does he treat hyperplasia? He has a bunch of contraindications. Advise something.

January 31, 2013

Gritsko responds to Martha Igorevna:

Lindinet-20 is generally not suitable for your situation. If we already appoint COC, then at least Regulon. The best option is the injection of oxyprogesterone capronate for a period of 3 months. On KOKah there is a high probability of recurrence of bleeding, which is what happened in your case.

What is endometrial hyperplasia - causes and symptoms of the disease

Endometrium is the inner lining of the uterus, more precisely, the mucous layer lining the uterus. It creates the necessary conditions for the implantation of the ovum, its normal development.

In other words, the mucous membrane “holds” the fertilized egg inside the uterus, provides it with nutrition, participates in the formation of the placenta.

The endometrium consists of supporting connective tissue (stroma), the uterine glands immersed in it and numerous blood vessels.

All structures of the uterine lining develop and function under the "guidance" of sex hormones. In the first half of the menstrual cycle (in the phase of estrogen influence), the uterine glands and the functional layer of the endometrium grow.

In the second - under the influence of progesterone - this growth stops. The endometrial stroma swells, accumulates beneficial substances. The uterine glands begin to secrete a nourishing secretive secretion. Each month, the endometrium prepares to “take in”, “feed”, and preserve a fertilized egg in the uterus.

If the pregnancy does not occur, the “overripe” functional layer of the endometrium is destroyed and rejected with menstrual blood.

In the next monthly cycle, according to the balanced influence of sex hormones, the uterine mucosa is restored from the basal "germ" plate.

The location of the uterine lining - endometrium

With the "breakdown" of the weighted hormonal effects, more precisely, estrogenia, the uterine glands multiply excessively and the uterine mucosa thickens.

The cause of endometrial hyperplasia is general or local hormonal imbalance: excessive effect of estrogen on the uterine mucosa with insufficient progesterone action.

Dangerous effects of hyperplasia:

  • Uterine hemorrhages leading to anemia
  • Infertility
  • Malignancy
Signs and symptoms of endometrial hyperplasia:
  1. Smearing bloody discharge from the genitals, not associated with menstruation.
  2. Disruption of the menstrual cycle:
    • amenorrhea,
    • hyperpolymenorrhea,
    • irregular menstrual cycle.
Diagnostics
  • Ultrasound - an ultrasound of the uterus reveals signs of endometrial hyperplasia by increasing the size of the M-echo.
  • Hysteroscopy with separate diagnostic curettage of the endometrium - confirms or refutes the ultrasound diagnosis.
  • Histological examination of removed tissues - establishes the final diagnosis.
An accurate diagnosis of endometrial hyperplasia and the determination of its shape (typical benign or atypical precancerous) can only be done by histological examination of tissues obtained by curettage of the uterine liningBack to table of contents

Indications for curettage of uterine mucosa

  1. Suspected endometrial hyperplasia by ultrasound:
    • In reproductive age: the value of the M-echo of the first 7 days of the menstrual cycle is more than 7-8 mm.
    • In postmenopausal: M-echo value of 6 mm or more.
  2. In childbearing age: uterine bleeding, bleeding not related to menstruation.
  3. Postmenopausal: bleeding from genitals of any nature.
  4. Sometimes curettage of the uterus is done to assess the effectiveness of the hormonal treatment of endometrial hyperplasia or other uterine pathology.
The purpose of a separate diagnostic curettage of the mucous membrane of the cervical canal and the body of the uterus is to assess the condition of the mucous in various benign and / or malignant processes in the uterus.

Scraping the walls of the uterus with endometrial hyperplasia is both a diagnostic and therapeutic procedure.

The healing effect of scraping:

  • Removal of unhealthy endometrium with possible pathological formations (glandular polyps, etc.)
  • In some cases: emergency stop uterine bleeding.

Scraping of the uterine lining or “cleaning” in endometrial hyperplasia should be carried out under the control of hysteroscopy. “Blind” (without visual control) curettage in the conditions of modern development of operative gynecology is not justified.

What is hysteroscopy?

Under the visual control of hysteroscopy, many therapeutic surgical procedures are performed, including curettage of the walls of the uterus.

Scraping hysteroscopy is performed:

  • in the hospital
  • in a specialized operating room
  • under general, mostly intravenous anesthesia,
  • without a single incision on the patient's body: the device is a hysteroscope and surgical instruments are inserted into the uterine cavity through the cervical canal.

Hysteroscopy

The optimal timing of hysteroscopy with curettage for endometrial hyperplasia:

  • With the preserved rhythm of menstruation: 3-4 days before the expected menstruation.
  • When oligomenorrhea with metrorrhages: on the first day of the appearance of acyclic bloody discharge.

Contraindications to hysteroscopy with curettage for endometrial hyperplasia:

  • Acute inflammatory process in the genitals.
  • "Bad smear": 3-4 degree of purity of the vagina.
  • Acute general infectious disease.
  • Severe non-gynecological pathology.
Back to table of contents

Preparation for hysteroscopy with endometrial scraping

What tests should be taken:

  • Vaginal smear "on flora": a study of discharge of the vagina on the degree of purity.
  • PAP test: cervical cytology smear.
  • General urine analysis.
  • Determination of blood type and Rh factor.
  • Complete blood count with leukocyte formula.
  • Blood chemistry:
    • total protein
    • creatinine
    • urea,
    • ALT, AST
    • total bilirubin, direct, indirect,
    • PTI
  • Blood markers for hepatitis viruses: HBsAg, Anti-HCV.
  • HIV test.
  • Blood test for syphilis: PB / ORS.
  • Coagulogram.
  • FLO (fluorography).
  • ECG (electrocardiography).
  • Transvaginal ultrasound of the pelvic organs.

  • Therapist cardiologist.
  • Anesthesiologist (tell your doctor about cases of allergies to drugs).
  • If necessary: ​​examination by other specialists.

Personal hygiene before the prescribed operation:

  • In the morning (on the day of the operation), take a hygienic shower, brush your teeth, wash, thoroughly shave the genital area.

Meals on the day of surgery:

  • Sutra not to drink, not to eat (4-6 hours before anesthesia can not eat food and any liquid).
  • If you are constantly using any medication, inform your anesthesiologist in advance. In the morning, the permitted tablets must be swallowed, washed down with a sip of water.

Immediately before the operation (if necessary):

  • Free the mouth: remove dentures, piercings.
  • Remove contact lenses, hearing aid.
  • Remove jewelry.
Back to table of contents

How is endometrial scraping done?

Anesthesia:
Intravenous anesthesia is preferred.

Duration of operation:
The total time of the entire procedure: approximately 20 minutes.

After registration in the hospital and the necessary training, the health worker invites the patient to the operating room.

The woman is placed on the gynecological chair for intrauterine operations.

Disinfection of the external genital organs and vagina with iodine-containing agent. Urine is retracted by a catheter. Blood pressure is measured, pulse counting is performed.

Anesthesia is given (short-term general intravenous anesthesia).

Uterine curette - a surgical instrument for scraping the endometrium

The vagina is dilated gynecological "mirror". The cervix is ​​fixed with special tools. The cervical canal is gradually “opened” by Gegar’s dilators. Then the uterine curette No. 1-2 undergoes curettage (scraping) of the surface of the cervical canal.

Scraping the cervical canal

The resulting scraping of the cervical mucosa is placed in a separate bottle of formalin.

Then, using a hysteroscope device, a review diagnostic hysteroscopy is carried out.

Hysteroscopy. Endometrial hyperplasia: thickened endometrium in the form of folds

After a visual assessment of the mucous membranes of the uterus. Curette No. 4 is introduced into the uterine cavity and curettage of the uterine wall is performed: sequential gentle scraping of the functional layer of the endometrium from all internal surfaces of the uterus and the area of ​​the uterine corners.

Endometrial scraping

The thoroughness of the removal of the endometrium is assessed by hysteroscopy.

All tissue collected from the walls of the uterus is placed in the second bottle with preservative.

After curettage and control hysteroscopy is completed, the endoscopic device and surgical instruments are removed. The vagina is cleaned with a dry cotton swab from blood and tissue residues. The cervix is ​​treated with tincture of iodine. Vaginal "mirrors" removed.

An ice pack is placed on the patient’s lower abdomen. If necessary (in the case of a reduced uterine tone), an injection of oxytocin, which reduces the uterus, is given.

Both containers with endocervical and endometrial specimens are labeled and sent to the histology laboratory.

Postoperative period

After the end of the operation, the patient is under medical supervision in the hospital ward for 2 hours. Then, after assessing the general condition and receiving individual recommendations of the attending surgeon, she can be sent home.

Scraping the uterus - the norm of the postoperative period

  • Pains: discomfort of a pulling character in the abdomen during the first hours after the operation. Minor pain reminds menstrual pain.
  • Discharge: bloody, non-intensive, spotting blood vessels - can be observed within 5-10 days after surgery.
  • Body temperature: in the first three days after surgery, an evening increase in body temperature to 37.3 degrees is considered normal.
  • Antibacterial therapy: antibiotics, anti-inflammatory, painkillers after curettage of the uterus are prescribed by a doctor according to individual indications.
  • Menstruation after surgery: occurs after 28-31 days (in due time) or with a short (weekly) delay.
When to immediately see a doctor
  • Body temperature rose above 38 degrees.
  • Abundant uterine bleeding has opened.
  • There were severe pain in the lower abdomen and / or discharge with an unpleasant smell.
Guard mode after scraping
  • Driving: it is prohibited to drive any vehicle after applying anesthesia - within 24 hours.
  • Physical activity: limit the lifting of weights more than 3 kg - for 1 month.
  • Sex life is prohibited for 2-3 weeks.
  • Do not use hygienic tampons, douche, go to the sauna, bath, swimming pool - for 1 month.
  • Replace the bath with a hygienic shower - for 2 weeks.
With good histology results, pregnancy after separate diagnostic curettage is allowed after 2-3 months.Back to table of contents

Endometrial curettage - effects

Correctly carried out diagnostic curettage of the uterine cavity with endometrial hyperplasia does not bear any negative consequences.

This small operation does not affect the fertility of a woman, and in some cases improves the reproductive prognosis.

But, like any operation, curettage and hysteroscopy for endometrial hyperplasia in rare cases does not exclude complications.

Possible complications of curettage of the uterus:

  • Infectious-inflammatory processes of the endometrium, cervix.
  • Exacerbation of chronic inflammatory diseases of the genital area.
  • Mechanical trauma of the cervix, perforation of the uterus.
  • Uterine bleeding.
  • Hematometer
  • Surgical complications associated with anesthesia, etc.
  • The formation of intrauterine adhesions.

If the patient complies with all the recommendations of the attending physician, adequate preoperative preparation and appropriate qualifications of medical personnel, the risk of adverse effects of diagnostic curettage of the uterus is negligible.

How to restore the endometrium after curettage

As a rule, the mucous uterus after the "cleaning" is restored independently, without difficulty.

If the endometrium does not grow after curettage, or is not compensated enough, to effectively stimulate its repair, apply:

  • Conjugated estrogens: Hormplex, Premarin, Estrofeminal - according to an individual scheme.
  • Monophasic COC: Logest, Mersilon, Lindinet-20, Microgenon, Rigevidon, etc. - 21 days.
Back to table of contents

Glandular cystic hyperplasia of the endometrium - treatment after curettage

There is no uniform algorithm for management of patients younger than 48 years of age with typical glandular-cystic hyperplasia.

In some cases, after curettage, a dynamic observation with ultrasound control is conducted, because endometrial curettage itself is a medical procedure.
In others, hormone therapy with monophasic COCs or progestogens is prescribed.

International recommendations for the treatment of endometrial glandular cystic hyperplasia after curettage. Read in detail: Endometrial glandular cystic hyperplasia.

The tactics of treatment of hyperplasia in the period of perimenopause is aimed at achieving a stable cessation of menstruation with the help of A-GnRH preparations or injection progestogens (Depo-Provera).

Older women suffering from obesity, hypertension, diabetes, glandular-cystic hyperplasia of the endometrium (after curettage and histological confirmation) are treated promptly.

Hysteroscopy

The best time to perform the procedure is the end of the menstrual cycle - 3-4 days before the start of bleeding. At 3-4 degrees of purity of the vagina, inflammatory processes of the pelvic organs, acute infectious or severe non-gynecological pathology do not make hysteroscopy.

The operation involves the introduction to the woman of short-term general anesthesia, which takes place within 30-45 minutes after curettage. During the manipulation, the vagina is expanded with a Cusco gynecological speculum, and the cervix is ​​fixed with special instruments.

To open the cervical canal, Gegar extenders are used, and small curettes are used for scraping mucous membrane. If separate curettage is prescribed, the resulting biomaterial from cervix is ​​laid out in a bottle with formalin, sealed, labeled and sent to the laboratory separately from the mucous membranes of the uterus.

Then a hysteroscope is injected into the woman and a review diagnostic hysteroscopy is performed. Having finished a visual inspection of the endometrium, begin the stepwise removal of the functional layer under the supervision of a video camera.

  • control of the thickness of the removed layer,
  • eliminates inadvertent damage to the uterus,
  • short postoperative period,
  • minimal amount of complications.

After the procedure, the woman is transferred to the ward to monitor her condition and recover from anesthesia. With good circumstances, after 5-6 hours, she can leave the hospital.

Rehabilitation

In order not to need re-curettage with endometrial hyperplasia, a woman should follow the following recommendations for 14-18 days:

  • eliminate sex and use of tampons,
  • avoid excessive physical exertion
  • refuse to take blood-thinning drugs (aspirin, heparin),
  • exclude thermal procedures (bath, sauna).

In the normal course of the postoperative period, women experience weak, pulling pains in the lower abdomen, light spotting (5-7 days), a slight temperature rise to 37.2 ° C (1-2 days) in the first 2-3 days.

An urgent appeal for medical help is necessary if:

  • there was a fever (temperature above 38 ° C),
  • increased pain in the lower abdomen, became cramping, giving to the groin or lower back,
  • the discharge has got an unpleasant putrid odor or has changed its color,
  • discharge stopped abruptly for 2-3 days.

Scraping, without complications, requires a subsequent ultrasound diagnosis 10-14 days after the procedure.

Tactics of treatment after curettage depends on the type of hyperplasia, the general state of health of the patient, her age and the desire to subsequently have children. Treatment after curettage of the uterus when endometrial hyperplasia is determined based on the results of histological examination.

Often a woman needs hormonal drugs that restore a normal ovarian-menstrual cycle. These include:

  • antiestrogenic agents (Proveron),
  • progestin (Duphaston, Utrozhestan),
  • estrogen-progestin contraceptives (Divina, Janine),
  • gonadotropin inhibitors (Zoladex, Nemestran).

The course of therapy leaves from 3 to 6 months. The effectiveness of selected drugs is controlled by ultrasound or pipel biopsy. Additionally, women are prescribed fortifying agents, immunomodulators, vitamin-mineral complexes.

Answering the question of whether scraping is necessary for endometrial hyperplasia, it can be noted that some gynecologists first try to restore the hormonal background with the help of medicines. Only with the ineffectiveness of their actions resorted to scraping. However, it has been proven by practice that complex therapy (drugs + curettage) allows a woman to recover faster and restore her reproductive abilities.

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