Endometrial Hyperplasia In Women Research Articles

A Comprehensive Approach: Correlating Ultrasound Imaging with Endometrial Histopathological Analysis in Perimenopausal Women with Heavy MenstrualBleeding.

Abnormal uterine bleeding (AUB) is a common troublesome symptom in the perimenopausal age group. The most common type of AUB in this age group is heavy menstrual bleeding. There is a risk of endometrial carcinoma and atypical endometrial hyperplasia in women with AUB in the age group of 40-50 years. Hence early evaluation is of paramount importance in managing women with perimenopausal heavy menstrual bleeding. The current study was undertaken to study the correlation between ultrasound findings and various benign and malignant endometrial histologies in perimenopausal women with heavy menstrual bleeding. Women aged 40-55 years presenting with heavy menstrual bleeding at the gynaecology outpatient department at Sree Balaji Medical College and Hospital, Chennai, India, were included in the study. Patients on anti-platelet and anti-coagulation therapy and patients already on hormonal treatment for heavy menstrual bleeding were excluded from the study. The demographic factors, symptom profiles, ultrasound findings, and histopathological reports were tabulated and analysed. Of the 147 women included in the study, 75 (51%) were aged 45-50 years and 107 (73%) had two or more pregnancies. Fibroid was the common non-endometrial cause of heavy menstrual bleeding in 52 (35%) cases. The proliferative pattern was the most common non-pathological histology identified in 46 (31%) cases. Endometrial hyperplasia without atypia was the most common pathological histology observed in the study population. Endometrial thickness of more than 8 mm was strongly associated with premalignant or malignant endometrial lesions. Our study has attempted to identify the correlation between ultrasound evaluation of perimenopausal women with heavy menstrual bleeding and endometrial pathology. Ultrasound, being cost-effective and widely available, is proven to be a tool for first-line investigation of perimenopausal women with heavy menstrual bleeding that guides further evaluation and management.

Prediction of the progression of endometrial hyperplasia in women of premenopausal and menopausal age based on an analysis of clinical and anamnestic indicators using multiparametric neural network clustering

Prediction of the progression of endometrial hyperplasia in women of premenopausal and menopausal age based on an analysis of clinical and anamnestic indicators using multiparametric neural network clustering

Molecular mechanisms of resistance of endometrial hyperplasia to progestogen therapy based on the study of the expression of estrogen and progesterone receptors and paracrine cellular markers of cellular interaction

The problem of resistance of non atypical endometrial hyperplasia (NEH) to traditionally accepted, pathogenetically sound therapy with different types of progestins is currently an unsolved problem. In about 17-20% of cases there is a recurrence or even progression of atypical forms of endometrial hyperplasia (AEH), which required the use of surgical treatments. The aim of the study was to investigate the results of hormone therapy with different types of progestins for the treatment of endometrial hyperplasia in women with different types of expression of estrogen and progesterone receptors in combination with the expression of intercellular adhesion molecules E-cadherin and β-catenin to determine the cause of hormonal resistance, formation of groups of women with progestogen-sensitive endometrial hyperplasia (EH) non atypical type NEH (+), which can use progestogens for treatment, and progestogen-resistant forms of endometrial hyperplasia with non atypical NEH (-), which should be offered alternative therapy. The study was performed on the morphological material of the endometrium obtained by diagnostic biopsy in women with abnormal uterine bleeding who were diagnosed with NEH by histological examination. For immunohistochemical study, 80 endometrial samples were taken from women with abnormal uterine bleeding (AUВ) and in the same women after treatment of endometrial hyperplasia without atypia in 3 and 6 months of therapy. The control group (CG) consisted of a group of 20 women who were followed-up without treatment tactics. All women were divided into 3 groups in which different types of progestins were used for treatment: group I – continuous intake of 100 mg of micronized progesterone per os twice a day for 6 months, group II – 20 mg of dihydrogesterone per os twice a day for 6 months, group III – in which LNG-IUD was used. The state of proliferation and differentiation in the studied tissues was assessed by the expression of their key molecular participants – estrogen receptors (ERα) and progesterone (PGR), transmembrane glycoproteins of E-cadherin and β-catenin. ERα and PGR expression were determined by immu­nohistochemistry and calculated by the semi-quantitative H-index method. Evaluation of the expression of E-cadherin and β-catenin was performed by determining the percentage of IHH-positive cells to these antigens depending on the degree of their color. The criterion for the effectiveness of NEH treatment was considered to be a biopsy in 3 and 6 months of treatment in the absence of pathological changes in the endometrium. The results showed that after the use of progestogens in group I there was a change in the endometrium to the secretory type in 45% of cases, in group II with dydrogesterone therapy – in 55% there was a reduction of EH to normal histological picture. The intrauterine system with levonorgestrel (LNG-IUD) showed the greatest efficiency, with the use of which in 75% of cases normalization of the endometrial structure was observed. In the control group in 32% of cases the structure of the endometrium normalized. After 6 months of treatment with gestagens, both oral forms (micronized progesterone, dydrogesterone) and the use of LNG-IUDs showed a positive effect from their use; the therapeutic form of gestagens for therapy is not significant in reducing excessive endometrial proliferation. In the control group of patients who did not receive therapy or discontinued therapy for various reasons, it was shown that 47% of patients had spontaneous regression of EH. The overall percentage of no effect from treatment was 20% in groups I, II and III. Determination of ERα expression in all groups showed a pronounced expression in glands and stroma, which did not differ significantly in the group with NEH (+) and in NEH (-). Analysis of PGR expression of NEH in endometrium (-) showed that in glandular cells (50.82±0.73) and in the stroma (47.34±0.82) it was lower than in the endometrium of women with NEH (+) (gland 187±3.1; stroma 166.4±2.3; p<0.05), as well as in the unchanged endometrium in the proliferative phase (glands 193.2±8.5; stroma 178.7±6.3; p<0.05) and the secretory phase (glands 140.2±4.4; stroma 116.6±3.1; p<0.05). A study of E-cadherin expression in women with EH (-) showed that in 86.4% of cases the expression was absent and in 13.6% it decreased. In NEH (+) women, 49.2% of E-cadherin expression was weak, in 34.4% – moderate, and in 16.4% – negative, indicating an association between PGR and E-cadherin expression. In women with NEH (-) there was marked cytoplasmic expression of β-catenin up to 80%, which can be interpreted as potentially threatening the progression of NEH in atypical forms and relapses. Thus, the study of molecular mechanisms of resistance of endometrial hyperplasia to progestogen therapy will help to develop a differential approach to its diagnosis and treatment.

THE INFLUENCE OF AN INFECTIOUS AGENT ON THE DEVELOPMENT OF HYPERPLASTIC PROCESSES OF THE ENDOMETRY IN THE EARLY REPRODUCTIVE AGE

The problem of hyperplastic processes of the endometrium (HPE) in women of reproductive age is a potential cause of reduced fertility and the risk of developing oncological pathology, which has been steadily increasing in recent years, attracting the increased attention of clinicians.
 The aim: to analyze the role of an infectious agent in the development of hyperplastic processes of the uterine mucosa in women of early reproductive age for the formation of risk groups for the occurrence of endometrial hyperplasia and polyps.
 Materials and Methods: 90 patients in early reproductive age were examined, who were divided into groups: the main group included patients with histologically verified atypical hyperplastic pathology of the endometrium (polyps of the uterine body and atypical hyperplasia of the endometrium) (n = 60). The control group consisted of 30 healthy volunteer patients of the same age category. The patients of the main group underwent a diagnostic hysteroscopy with endometrial biopsy, material was collected from women of the control group with prior consent using Peipel-biopsy with subsequent examination of the material. Bacteriological analysis of the material from the uterine cavity included the study of aerobic and anaerobic flora using a set of selective differential diagnostic nutrient media.
 Results and Discussion: Data on the role of microbial and viral factors in the development of atypical endometrial hyperplasia in women of early reproductive age are given. The structure of microbial insemination of the uterine cavity in such women has been established. Cytomegalovirus antigens in hyperplastic endometrium were found in 38.3 % of cases. The obtained data make it necessary to carry out high-quality infectious screening for the formation of risk groups regarding the occurrence of hyperplastic changes of the uterine mucosa.
 Conclusions: In patients of early reproductive age with atypical hyperplasia of the endometrium, the persistence of bacterial agents in the uterine cavity in insignificant concentration was noted in all examined, viral - in 38.3 %, which reflects the significant etiological role of bacterial and viral infection, which participates in the implementation of the inflammatory process and formation of hyperplastic pathology. Pathogenetic features of bacterial-viral infection of the genital tract of patients with hyperplastic endometrial pathology determine the need for high-quality infectious screening with the formation of risk groups and subsequent etiopathogenetic treatment.

Comparative aspects of treatment of endometrial hyperplasia in women of reproductive age with overweight

The aim. Minimization of the frequency of recurrence of endometrial hyperplasia (EH) in women of reproductive age with overweight (OW) depending on the tactics of treatment.
 Materials and methods. 90 women of reproductive age with endometrial hyperplasia and OW were selected. They, in turn, were divided into three groups: group 1 – 30 women who took a gonadotropin-releasing hormone agonist (GnRH agonist), namely at a dose of 3.75 mg intramuscularly once every 28 days; group 2 – 30 women who used progestin (norethisterone) at a dose of 10 mg per day from day 16 to 25 of the cycle, group 3 – 30 women who took combined oral contraception (COC) (30 mcg ethinyl estradiol and 150 mcg desogestrel) in a cyclic mode 21/7.
 Evaluation of the effectiveness of therapy included a clinical picture of the disease 6 months after the start of treatment, assessment of the variability of the average values of endometrial thickness and uterine size on ultrasound (US) of the pelvis 6 months after treatment. Also analyzed the effectiveness of therapy based on the results of morphological examination of the endometrium in a biopsy of the uterine mucosa, performed 6 months after the start of treatment. In addition, a general analysis of the frequency of EH recurrence was performed 6–24 months after treatment.
 Results. The results showed that in the group in which women were prescribed GnRH agonist, there was a significantly higher effectiveness of treatment, in particular the absence of uterine bleeding and menstrual disorders (MD). At the same time, in the other norethisterone group, 53.3 % (16) of women had intermenstrual uterine bleeding. In patients in the group in which women received COC, uterine bleeding was observed in 30.0 % (i.e. 9) of patients (p <0.05).
 Immediately after treatment, the average values of endometrial thickness in patients of group 1, according to ultrasound, was 3.59±0.47 mm, which was significantly less than in women of groups 2 and 3 – 6.81±0.59 mm (p<0.001) and 7.58±0.69 mm (p<0.001).
 In addition, patients in group 1 at 3, 6, 12, 24 months after the end of hormone therapy were registered significantly lower average values of endometrial thickness, compared with patients receiving norethisterone and estrogen-progestogen drugs.
 Conclusions. In a comparative evaluation of the effectiveness of treatment of endometrial hyperplastic processes in overweight women, it was found that the recurrence rate after 6–24 months occurs in 6.7 % (i.e. 2) of patients after GnRH agonist therapy, in 33.3 % (i.e. in 10) patients receiving norethisterone (p<0.001), and in 50 % (i.e. 15) of women treated with COC (p<0.001).

Fertility-Sparing Treatment for Atypical Endometrial Hyperplasia and Endometrial Cancer: A Cochrane Systematic Review Protocol.

Endometrial cancer is the fifth most common cancer in women and atypical endometrial hyperplasia is a precancerous lesion. Obesity is an important risk factor for endometrioid endometrial adenocarcinoma and endometrial hyperplasia. Progesterone is recommended as first-line treatment in endometrial cancer or atypical endometrial hyperplasia in women who wish to preserve fertility, but optimal treatment schedules have not been defined. Metformin or bariatric surgery may also be useful in these women. The effectiveness and safety of fertility-preserving treatments being used for women with atypical endometrial hyperplasia and stageIA grade1 endometrial cancer is unclear. Therefore, the systematic review aims to determine this point. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life. This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy. The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia. Prospero 2019 number CRD42019145991.

Histomorphological Patterns of Endometrial Hyperplasia

Background and Aims Endometrial hyperplasia is a pathological condition characterized by an increase in the endometrial gland to stromal ratio when compared to the normal proliferative endometrium. It is the precursor of endometrial carcinomamdashthe most common malignancy of female genital tract. The increased risk of endometrial hyperplasia is found to be more evident in women with abnormal uterine bleeding. Hence we decided to study the histopathological pattern of endometrial hyperplasia in women of different age groups.Methods All the endometrial biopsies with microscopic diagnosis of endometrial hyperplasia over a period of 1 year were retrieved from histopathology records. Information related to age and clinical diagnosis was noted from the accompanying laboratory request forms. Histological typing of endometrial hyperplasia was done depending on the new criteria used in the World Health Organization WHO classification.Results The present study included 40 cases n 40 of endometrial hyperplasia diagnosed by histopathological examination on endometrial biopsies. Age of the patients ranged from 21-70 years. About half of the patients 45 presented with abnormal uterine bleeding and were in the 5th decade of life. Non-atypical endometrial hyperplasia n 34 cases 85 was the most common histological type of endometrial hyperplasia.Conclusions Histopathological examination of endometrium is used for the diagnosis of abnormal uterine bleeding. Endometrial biopsy and curettage are the important sampling methods to detect endometrial hyperplasia. Hence vigilant screening of the endometrial samples plays an important role in the diagnosis and further management.

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.

DIAGNOSTIC ACCURACY OF SALINE HYSTEROSONOGRAPHY IN DETECTING ENDOMETRIAL HYPERPLASIA IN PATIENTS WITH POST MENOPAUSAL BLEEDING

BACKGROUND & OBJECTIVE: Saline hysterosonography is a simple and cost-effective method with high sensitivity to detect uterine abnormalities causing postmenopausal bleeding. The objective of this study was to evaluate the diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia in women with postmenopausal bleeding by taking histopathology as a gold standard.
 METHODOLOGY: A hundred and twenty (120) cases were enrolled from the outpatient and inpatient department of obstetrics and gynecology. Proper history and relevant examination of the patient was done. Then preparations were made for the procedure. The patient was counseled and the technique explained to her. Then Foley catheter no 12 was passed in cervix and sonography was done while instilling normal saline through a cervical catheter and scan pictures were frozen and results were given by expert gynecologist of Allied Hospital, Faisalabad. Histopathology specimen was sent to the pathology lab.
 RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia was recorded as 96.15%,91,49%,75.76%,98.85%, and 92.5% respectively.
 CONCLUSION: Saline hysterosonography has high sensitivity to detect uterine hyperplasia. It can be used as a cost effective alternative to hysteroscopy in many units in Pakistan.

Clinical-immunohistochemical characteristics of atypical endometrial hyperplasia in women of reproductive age.

The article presents the analysis of clinical-morphological and immunohistochemical features of endometrial hyperplasia. 60 patients of reproductive age with non-atypical endometrial hyperplasia (EH) were examined. The following morphological distribution of its different types was established: glandular – 56.6%, glandular-cystic – 40.0%, stromal and cystic-atrophic forms – 1.7%, respectively. When carrying out immunohistochemical studies, the expression of CD-138, a modern reliable marker of the presence of an inflammatory process in endometrial tissue was determined. In the group with non-atypical glandular EH, signs of the inflammatory process in the endometrium were verified in 7 (20.59%) patients. In the group with signs of glandular-cystic change of EH – in 11 (45,83%) patients, as well as in the only patient with non-atypical stromal EH (100,0%). In almost one-third of patients with different morphological types of EH in 19 (31.7%) of 60 the presence of structural-morphological signs of chronic endometritis was revealed, which was manifested by signs of lymphoplasmacytic infiltration, indicating the presence of chronic inflammatory process. These data indicate the possible pathogenetic role of inflammation as one of the trigger factors for the hyperplastic transformation of endometrial structures, which allows to confirm the role of infectious factors in the occurrence of these processes in almost one third of patients with non-atypical ЕН. Thus, the conducted studies indicate that the development of EН is a process based on both the infectious factor and hormonal metabolic disorders, which dictates different personalized approaches to therapeutic tactics.

Патогенетические механизмы развития гиперплазии эндометрия в репродуктивном возрасте

Objective. To analyze pathogenetic mechanisms underlying the development of endometrial hyperplasia in women of reproductive age. Patients and methods. We have examined 143 women of reproductive age with endometrial hyperplasia (EH). Study participants were divided into three groups: Group I included EH patients without atypia; Group II included patients with atypical hyperplasia of the endometrium; Group III (control group) comprised 56 women with abnormal uterine bleeding, in whom we excluded adenomyosis, uterine fibroids, endometrial hyperplasia, endometrial cancer, and iatrogenic causes of uterine bleeding. Genomic DNA was isolated using phenol-chloroform extraction. Real-time polymerase chain reaction (RT-PCR) was used to detect microRNA-210, -18a, -221, and -222. The detection of tumor pyruvate kinase M2 was performed using the ScheBo® Tumor M2-PK kit designed for quantitative assessment of this metabolic cancer marker in plasma and endometrial tissue samples. Results. Significant risk factors triggering the pathogenetic mechanism of EH development in reproductive age include extragenital disorders (obesity, thyroid diseases, diseases of the urinary system, hypertension) and gynecological diseases (pelvic inflammatory diseases, adenomyosis, benign breast dysplasia, uterine fibroids). Alterations affecting estrogen receptors lead to changes in microRNA messengers, which, in turn, affect target genes and cause changes in the adaptive abilities of the cell. Expression of pyruvate kinase M2 in this chain confirms proapoptotic changes in the cell and the risk of its atypia. Conclusion. The pathogenesis of EH is based on the following factors: polymorphism of the ERS1 and PRG genes, increased expression of miRNA-210, -18a, and -222, decreased expression of miRNA-221, and overexpression of pyruvate kinase M2. Key words: endometrial hyperplasia, miRNA, pyruvate kinase M2, progesterone receptors, estrogen receptors

Комбинированное применение агонистов гонадотропин-рилизинг-гормона и внутриматочной левоноргестрел-рилизинг-системы в лечении атипической гиперплазии эндометрия у женщин репродуктивного возраста

Комбинированное применение агонистов гонадотропин-рилизинг-гормона и внутриматочной левоноргестрел-рилизинг-системы в лечении атипической гиперплазии эндометрия у женщин репродуктивного возраста

Endometrial hyperplasia in women with external genital endometriosis and uterine myoma

Endometrial hyperplasia in women with external genital endometriosis and uterine myoma

Clinical features of polycystic ovary syndrome phenotypes in women with normogonadotropic anovulation in reproductive age

Hypothesis/aims of study. Polycystic ovary syndrome (PCOS) is a common disease, the frequency of which ranges from 8 to 13% in women of reproductive age. PCOS is a complex polygenic endocrine disorder with reproductive, metabolic, and psychological features. Currently, four PCOS phenotypes are identified that are associated with metabolic disorders, insulin resistance, impaired glucose tolerance (IGT), diabetes mellitus, and an increase in the number of risk factors for cardiovascular diseases. The aim of this study was to investigate the clinical features of PCOS phenotypes in women with normogonadotropic anovulation in reproductive age.
 Study design, materials, and methods. The study included 60 women of reproductive age from 24 to 37 years (mean age 28 ± 4 years) with PCOS and normogogonadotropic, normoprolactinemic anovulation. We studied the levels of anti-mullerian, follicle-stimulating, luteinizing hormone, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The serum progesterone level was studied by ELISA using test systems manufactured by Alkor Bio Ltd. (Russia) on days 20–23 of the menstrual cycle for three consecutive cycles. The average level of progesterone in the blood on days 20–23 of the menstrual cycle was 3.1 ± 1.5 nM. Echographic methods for diagnosing polycystic ovaries were used. All women included in the study underwent hysteroscopy on days 18–22 of the menstrual cycle, followed by a histological and immunohistochemical study of the endometrium.
 Results. In women with anovulatory PCOS phenotypes, phenotype A (classical) was detected in 32 (53.3%) women; phenotype B (anovulatory) in 18 (30%) women; phenotype D (non-androgenic) in 10 (16.7%) women with. In 32 (53.3%) patients, changes in carbohydrate metabolism (IGT) were found. Clinical and biochemical manifestations of androgen-dependent dermopathy (acne, oily seborrhea, and hirsutism) were significantly (p < 0.05) more often observed in PCOS patients with phenotypes A (84.4%) and B (88.9%) than in women with phenotype D (30%). In the majority (93.8%) of patients with IGT, the androgenic-anovulatory PCOS phenotypes were detected: phenotype A in 20 (62.5%) women and phenotype B in 10 (31.3%) women. Phenotype D (non-androgenic) was present only in two women with PCOS and IGT. As a result of complex histological and immunohistochemical studies of endometrial biopsy specimens, chronic endometritis was detected in 44 (73.3%) examined women with PCOS and simple glandular endometrial hyperplasia was diagnosed in 13 (21.7%) PCOS patients. The incidence of chronic endometritis and simple glandular endometrial hyperplasia in women with normogonadotropic anovulation and PCOS directly depended (r = 0.35; p < 0.05) on disorders of carbohydrate metabolism and was detected more often in patients with PCOS and IGT.
 Conclusion. The differential approach to the examination of patients with various PCOS phenotypes allows personalizing the therapy of this disease and determining the complex of preventive measures to improve the quality of life of women of reproductive age.

Diabetes Mellitus Is Associated with Occult Cancer in Endometrial Hyperplasia.

In the management of women diagnosed with endometrial hyperplasia (EH), it is crucial to determine the risk of coexistent cancer. Diabetes mellitus has been recently suggested as a significant risk factor. However, results in this regard are conflicting. Our aim wasto assess the association between diabetes mellitus and coexistent cancer in women diagnosed with endometrial hyperplasia. A systematic review and meta-analysis was performed by searching electronic databases from their inception to October 2018 for studies assessing the presence of coexistent cancer after a preoperative diagnosis of endometrial hyperplasia in women stratified for diabetes mellitus. Odds ratio was calculated with 95% confidence interval; a p value <0.05 was considered significant. Twelve retrospective studies with 1579 EH were included. Diabetes mellitus showed significant association with the presence of cancer coexistent with endometrial hyperplasia (OR = 1.96; 95% CI, 1.07-3.60; p = 0.03). Heterogeneity among studies was moderate (I2= 55%). Funnel plot showed asymmetric distribution of OR values, with the large and accurate studies showing results stronger than small and less accurate one; this finding should exclude a publication bias. In women diagnosed with endometrial hyperplasia, diabetes mellitus is a risk factor for coexistent cancer, and thus may be included in a predictive algorithm for the risk stratification. In women conservatively treated, glycemic control may be required to prevent the risk of progression. Further studies are necessary to confirm the clinical significance of diabetes mellitus in this field.

Diagnostics and Treatment of Hyperplastic Endometrial Processes in Women in the Menopausal Transition

His article discusses the problems of diagnosis of diffuse hyperplastic processes of the endometrium in women in the menopausal transition. Endometrial hyperplasia is a heterogeneous set of pathological processes, ranging from benign proliferation to monoclonal tissue proliferation. During the study, the most optimal criteria for the diagnosis of endometrial hyperplasia in women during the transition to menopause based on the use of a modern diagnostic complex (immunohistochemical and endoscopic technologies) were selected and formed. Endometrium is a hormone–sensitive, cyclically renewed tissue that reacts to the slightest changes in the hormonal status. In this connection, an attempt was made to analyze the prospects and feasibility of using immunohistochemical technologies in gynecological practice. The authors found that the study and analysis of the hormone — receptor status in individuals with endometrial hyperplasia in gynecological practice, consists of two points, first, the hormone-receptor status in endometrial hyperplasia is individual, and the degree of expression of highly productive or low-productive receptor complexes speaks the mechanism of development of receptor desynchronosis, and secondly, the hormone-receptor status determines the sensitivity of endometrial hyperplasia to hormonal therapy.

Influence of obesity on the development of endometrial hyperplasia in women of all ages

Recent scientific studies show that fat tissue is not a passive metabolism depot, as previously thought, but manifests itself as an active endocrine organ. Pathological processes occurring in adipose tissue with its hypertrophy during weight gain are considered links in carcinogenesis in more than 20% of malignant tumors, including endometrial and breast cancer.The aim of the research was to study the effect of excess weight (BMI &gt;30) on the development of endometrial hyperplasia in women of reproductive age and in menopause.The medical histories of 62 patients from 2016 to 2018 with diagnoses of endometrial hyperplasia without atypia and endometrial hyperplasia with atypia were reviewed in a retrospective study according to pathological histology after hysteroscopy. Depending on the reproductive status and body mass index, four groups of patients were formed.Obtained data showed that in women with obesity, the percentage of atypical hyperplasia (65.9%) was significantly higher than in women with normal body weight (28.6%). In young women with overweight, the percentage of atypical hyperplasia was 57.9%, while for BMI &lt;30 – 16.7%. In women of menopausal age with a BMI &gt;30 percent of atypical hyperplasia, 68.2%, while with a BMI &lt;30 – 33.3%. In women of menopausal age with a BMI &gt;30 percent of atypical hyperplasia is 64.9%, while in young women with a BMI &gt;30 – 48%.The results of the study show that atypical hyperplasia of the endometrium is more often detected in the presence of excessive body weight, and the risk of its development among obese women of menopausal age is comparatively higher than in obese young women. Since the probability of progression of endometrial cancer is increased 45 times within 1 year if the diagnosis of endometrial hyperplasia is confirmed histologically, weight correction is a method of preventing the development of atypical changes in the endometrium at any age.

Risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age

According to many researchers, hyperplastic endometrial processes are not precancerous diseases. However, recurrent endometrial hyperplastic processes, as well as their combination with genital and extragenital pathologies, significantly increase the risk of malignant transformation of the endometrium. Late reproductive and premenopausal age is associated with an increase in the frequency of endometrial hyperplastic processes, extragenital pathology and operative interventions on the internal genitalia. The limited possibilities of conservative treatment in connection with concomitant diseases and the tendency of an increase in the recurring hyperplastic processes of the uterus make the problem of studying various aspects of hyperplastic endometrial processes in women of this age period extremely urgent.The purpose of research: to identify risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age.Materials and methods. We studied the clinical and medical history and long-term results of treatment of 276 women aged 35–54 years with endometrial hyperplastic processes. All patients underwent diagnostic and therapeutic hysteroscopic procedures were carried out. In 88 (31.9%) women for 1.5 years after treatment were observed relapses of the disease. These patients accounted for Рц group, the remaining 188 women included in the group K. Data processing was performed using variation statistics method, Mann-Whitney ranking test, χ2-test and Fisher’s exact test.Results and conclusions. It should be noted the high rate of recurrence of endometrial hyperplastic processes in women of late reproductive and premenopausal age and lack of nosological specificity of recurrent endometrial hyperplastic processes. At the same time, recurrence of endometrial hyperplastic processes significantly increased the risks against the backdrop of giperpolimenorei, endometrioid disease, especially, adenomyosis and ovarian cysts. The greatest chances of recurrence were associated with the presence of patients extragenital diseases: gastrointestinal disorders, iron deficiency anemia, thyroid and breast cancer, vegetative-vascular dystonia. Within the framework of all investigated factors, the chances of recurrence of endometrial hyperplastic processes are most significant increased at the vegetative-vascular dystonia, and the pathology of the lacteal and thyroid gland.

Стан маткового кровотоку при гіперплазії ендометрія у жінок у репродуктивний період

The objective: to assess the state of uterine blood flow in endometrial hyperplasia in women of reproductive period. Patients and methods. 130 patients (n=100 – the main group; n=30 – control group) aged 18-49 years with endometrial hyperplasia were examined. All the women underwent 2D transvaginal echography and color Doppler mapping. The angle-independent indices (pulsatility index, resistivity index, diastolic/systolic ratio) of blood flow were determined in the uterine, arcuate, radial, basal and spiral arteries. Results. There was no significant difference in the indices of blood flow of the right uterine artery, arcuate, radial, basal arteries among patients and control group. Among women with endometrial hyperplasia pulsatility index of the left uterine artery amounted to – 2.11, resistivity index – 0.88, and the diastolic/systolic ratio – 5.45, in women of the control group – 2.34, 1.01 and 7.50, respectively. Only among patients with endometrial hyperplastic process was registered blood flow in the spiral arteries. Conclusion. The use of color Doppler mapping is appropriate, because registration of intraendometrial blood flow allows an endometrial hyperplastic process to be diagnosed with a high degree of confidence. Key words: endometrial hyperplasia, reproductive period, color Doppler mapping, intraendometrial blood flow, pulsatility index, resistivity index, diastolic/systolic ratio.

The Role of Endometrial Volume in the Prediction of Endometrial Hyperplasia

Objective:To assess the accuracy of 3D Trans vaginal sonar (TVS) in the diagnosis of endometrial hyperplasia in women with premenopausal uterine bleeding. Methods:Seventy-five women with premenopausal bleeding were recruited from outpatient gynecology clinic in Ain Shams University Maternity Hospital. The study was conducted from May (2014) till January (2015). The endometrial volume obtained by 3D TVS and results of the histopathological examination of the endometrial tissue were evaluated to assess the cut off value of endometrial volume for diagnosis of endometrial hyperplasia and carcinoma. Results:In the current study, the histopathological results showed 15 cases with atrophic endometrium (20%), 7 cases with disordered proliferative endometrium (9.33%), 7 cases with hyper plastic polyp (9.33%), 14 cases with endometrial hyperplasia without atypia (18.67%), 3 cases with complex endometrial hyperplasia without atypia (4%), 3 cases with hyperplasia with atypia (4%) and 26 cases with adenocarcinoma (34.67%). The median endometrial volume of benign endometrium was 9.6 with interquartile ratio (7.1-12.5) while the median endometrial volume of endometrial hyperplasia was 11.4 with interquartile ratio (7.4-14.7) and the median endometrial volume of endometrial carcinoma was 17.26 with interquartile ratio (14.9-24.1). The difference was highly statistically significant using Kruskal-Wallis test. Conclusion:Endometrial hyperplasia is the commonest observed endometrial abnormality in premenopausal patients with abnormal uterine bleeding. Even though histopathological examination of the endometrium is the gold standard for diagnosis or exclusion of endometrial pathology, 3D TVS is reasonably accurate, helpful & non-invasive tool for assessing the endometrium.