Underlying diseases of the endometrium

Underlying diseases of the endometrium are pathological states characterized by hyperplastic changes in the inner layer of the uterus, which may be due to excessive cell proliferation. These processes can be benign, but in some cases, they progress to precancerous forms, or even to endometrial cancer, if not detected and treated in time. Endometrial hyperplasia and polyps are the most common forms of endometrial disease and require monitoring and treatment.

Causes and Development Mechanisms

Hyperplastic processes are due to a hormonal imbalance, particularly an excess of estrogen associated with a deficiency of progesterone. Estrogen stimulates the growth of endometrial cells, and in the absence of its physiological counterpart, progesterone, excessive tissue proliferation occurs. At puberty, this disorder may be related to anovulatory cycles and the immaturity of regulatory axes. In women of childbearing age, triggering factors may include stress, hyperprolactinemia, chronic starvation, hormonal cysts, and polycystic ovary syndrome. At perimenopause and postmenopause, hyperplasia occurs more often due to increased activity of the adrenal glands and central regulatory disorders.

Clinical Manifestations and Symptoms

The most common symptom of underlying endometrial diseases is uterine bleeding. It can be cyclical but is more often manifested as intermenstrual bleeding with long and heavy periods. The mechanism of bleeding is related to the fact that the hyperplastic endometrium becomes less sensitive to regulatory signals and detaches unevenly, with areas of necrosis, dystrophy, and vascular changes. In the presence of polyps, bleeding is accompanied by stabbing pain or contractions.

Effects on Fertility and Assisted Reproductive Techniques

Underlying endometrial diseases often pose an obstacle to pregnancy, both naturally and through assisted reproductive techniques. In the case of natural conception, hyperplasia is accompanied by hormonal disorders and anovulation, making the process of ovulation and implantation unstable or even impossible. Even if fertilization has occurred, the altered endometrium may not provide the necessary conditions for embryo implantation, thereby increasing the risk of early miscarriage.

In the case of IVF, endometrial hyperplasia and polyps significantly reduce the chances of implantation. This is why, before starting the protocol, normalization of the endometrial condition is performed, either medically or surgically. This is especially important in programs with donor eggs, where the embryo is initially of high quality and the success of the transfer depends primarily on the condition of the endometrium. In the case of double donation (egg and sperm), the requirements for the endometrium are even higher, as the outcome relies on the recipient part of the woman undergoing the transfer. Without adequate preparation of the endometrium, these programs lose their effectiveness.

Diagnosis and Therapeutic Strategy

The diagnostic algorithm in suspected cases of underlying endometrial diseases begins with a thorough examination, collection of medical history, and ultrasound of the pelvic organs. However, a definitive diagnosis can only be made after a diagnostic biopsy of the cervical canal and uterine cavity, followed by histological analysis. Hysteroscopy is considered the modern standard: it allows not only for visualizing the pathology but also for immediately removing polyps or areas of hyperplasia. In the absence of hysteroscopy, hysterosalpingography may be used. A hormonal profile is mandatory to assess the endocrine context.

The choice of treatment depends on the patient's age, reproductive plans, the degree of endometrial modification, and the presence of concomitant diseases. The main treatment objectives are to stop the bleeding, restore hormonal balance, improve the morphofunctional state of the endometrium, and prevent recurrences. Patients with these disorders should be monitored regularly.

You can obtain qualified advice and begin treatment for underlying endometrial diseases at the "Natuvitro" clinic.