ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY

Abstract

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of hypoestrogens. The aim. To justify a differentiated approach to treatment tactics of patients with EH. Material. Pathological changes adjacent to the lesions AEH in 274 patients have been studied. Results. The structure of the endometrium outside the foci of the CEH and the AEH represents a wide spectrum of pathological changes – SEH, proliferative and secretory endometrium, polyps, atrophic endometrium, that's not confirms the role of hyperestrogenic in the pathogenesis of the CEH and AEH. Conclusion. SEH, as a result of imbalance of estrogen and progesterone, is subject to cyclic hormone therapy with progestin for the prevention of acyclic bleeding. In the case of the absence of abnormal uterine bleeding after uterine curettage under SEH and CEH without atypia valid only observation with regular control. At AEH surgical treatment is required.