The information provided below about medical diseases is not for advertising purposes. These are articles intended to inform and promote patients. If you think you have one of the diseases listed below, we recommend that you be examined by healthcare professionals who specialize in this field for medical advice and treatment.
Unfortunately, when the inner wall of the uterus, which is responsible for preparing the appropriate environment for the fertilized egg (embryo) to settle into the uterus, grows (thickens) uncontrollably, it can pave the way for irregular bleeding and uterine cancer in women.
In my clinic in Ankara, we can diagnose uterine wall thickening with ultrasound, hysteroscopy or biopsy. After diagnosis, we follow up patients who are suitable for medical treatment with biopsies performed at certain intervals. However, I try to heal my patients who require surgery, especially with closed surgeries, which are the gold standard in the surgical treatment of this disease. In closed surgery, no large incisions are made to the patient. The largest skin incision made on the patient is approximately 1 cm long. This 1 cm skin incision is usually made at the belly level. A camera with advanced technology is placed into the patient’s abdomen through a 1 cm incision made at the belly level. Thanks to this camera, the tissues are projected on the screen in front of the surgeon at high magnification, allowing a very meticulous and precise surgery to be performed. Apart from this incision made at the belly level, skin incisions are made at 2 or 3 different points, half a centimeter long. The surgery is completed with advanced technology surgical instruments placed inside these incisions.
Closed hysterectomy is a patient-friendly surgery. Because this type of surgery; It has many advantages for the patient, such as less pain, less bleeding, better cosmetic results, faster recovery period and shorter hospital stay. The surgery takes approximately 30-40 minutes in experienced hands. Experience and experience are very important in closed surgery technique. For years, I actively worked and managed clinics where closed (laparoscopic) surgery was performed. I tried to be beneficial to my patients by performing thousands of closed surgeries. In addition, I have played and continue to play an active role as an educator in the training of both assistant physicians specializing in obstetrics and gynecology and obstetrics attending post-vocational training courses so that this form of closed hysterectomy can be performed more widely in our country.
If you would like to get more detailed information about Closed Uterus Surgery, you can read my article explaining this surgery .
Below, I will give information about how Uterine Wall Thickening occurs, which women are at risk, whether there are protective measures, and what to do in its treatment and follow-up.
In order to understand how the thickening of the uterine wall (endometrium) occurs, it is necessary to know well the menstrual cycle in women and the function of the inner wall of the uterus (endometrium) in this cycle. That’s why I want to start my article by briefly explaining how women menstruate.
How Do Women Menstruate?
The inner wall of the uterus (endometrium) is a tissue sensitive to hormones. This tissue has the capacity to grow (thicken) by responding to hormones. This growing tissue is excreted from the vagina in women every month, along with menstrual bleeding, when there is no pregnancy.
The average menstrual bleeding lasts 3-5 days in women. After menstrual bleeding ends, that is, after this 3-5 day period, the inner wall of the uterus (endometrium) begins to grow and thicken again by responding to the secreted hormones. It reaches its thickest level approximately 10 days after menstrual bleeding ends. This period is the most suitable period for the fertilized egg (embryo) to settle into the uterus. In cases where pregnancy does not occur, the inner wall of the uterus (endometrium) begins to lose its integrity within the next 10-14 days. During this period, menstrual bleeding begins, and with menstrual bleeding again, the inner wall of the uterus (endometrium) is expelled from the vagina along with blood. This cycle begins in adolescence, when women first menstruate, and continues until menopause, when they stop menstruating.
What is Intrauterine Wall Thickening (Endometrial Hyperplasia)?
Thickening of the intrauterine wall, also known as endometrial hyperplasia, is the abnormal growth of the gland tissues of the uterine wall, that is, the endometrium, and the tissues around them, which we call stroma, and sometimes deviate from their typical appearance. This condition, which is considered a pre-cancerous condition, has 4 types with different risk rates in terms of developing uterine cancer.
Types of Endometrial Hyperplasia
- Simple hyperplasia (least risk group)
- Complex hyperplasia
- Hyperplasia with simple atypia
- Complex hyperplasia with atypia (highest risk group)
What are the Risk Factors for Intrauterine Wall Thickening (Endometrial Hyperplasia)?
Some women are more at risk for intrauterine wall thickening. I have listed these risk factors below.
- Having increased female hormone (estrogen) activity or level.
This occurs either with external medications or with an increase in the level of female hormone (estrogen) produced by the body itself.
- a) An example of an externally taken female hormone is receiving unopposed estrogen therapy. This form of treatment has been almost completely abandoned today due to the risks it poses.
The second example of externally taken female hormone is using medication containing the active ingredient tamoxifen. This drug therapy has been used successfully for years in the treatment of breast cancer and is still used. However, this drug can cause uterine wall thickening and increase the risk of uterine cancer in the post-menopausal period.
- b) The body’s own production of unmet female hormone (estrogen) is also the situation that increases the risk of uterine cancer the most. These situations;
– polycystic ovary disease
– menopausal transition periods
– obesity, diabetes mellitus, estrogen-producing tumors
– never giving birth, infertility, not breastfeeding
– menstruation at an early age, menopause at a late age
– genetic diseases (Lynch syndrome, women with breast cancer with BRCA mutation).
What are the protective factors against uterine wall thickening?
Birth control pills, giving birth, especially giving birth at a later age, breastfeeding, physical activities, diet and being at an appropriate weight are protective factors against uterine wall thickening.
What kind of complaints does uterine wall thickening cause?
Thickening of the uterine wall, that is, endometrial hyperplasia, is the most common complaint of vaginal bleeding in women. This may occur in the form of excessive menstrual bleeding, spotting during the menstrual period, or post-menopausal bleeding. However, it should be known that it usually does not cause any complaints and is detected by ultrasonography performed during gynecological examination. Therefore, women should not skip their annual gynecological examinations, even if they have no complaints.
How is Intrauterine Wall Thickening Diagnosed?
Ultrasonography
Uterine wall thickness is measured in millimeters and intrauterine wall thickening is evaluated.
Biopsy
Intrauterine wall thickening can be diagnosed by taking a biopsy from the uterus and evaluating these cells in the pathology department.
Hysteroscopy
After focal or unsuccessful biopsies, a biopsy can be taken with this method, which allows imaging of the inside of the uterus with the help of a camera.
How is Intrauterine Wall Thickening (Endometrial Hyperplasia) Treated?
The first step of treatment is to take a biopsy from the area where uterine wall thickness is observed. Treatment is tailored according to the pathology report obtained after the biopsy. If endometrial hyperplasia is accompanied by atypia cells and the woman suffering from this condition has completed her fertility, hysterectomy and hysterectomy will be the appropriate approach. If hysterectomy surgery is to be performed, laparoscopic (closed) hysterectomy surgery is the gold standard treatment method. If she has not completed her fertility and wants to have children, it is necessary to follow up very closely with high-dose progesterone treatment and biopsies taken at regular intervals.
If there is only hyperplasia without atypia cells after the biopsy, various progesterone-containing treatments; These are intrauterine hormonal spiral or oral progesterone treatments. Follow-up treatment can be performed with biopsies to evaluate the response to treatment at certain periods. If there is no response to treatment after biopsy, laparoscopic hysterectomy can be performed. If there is a response to treatment, after several clear pathology results in a row, patients can be taken for annual follow-up and hysterectomy surgery may not be necessary.
For more detailed questions, you can contact us using the contact information on my website.
Stay healthy..
Assoc. Dr. H. Onur Topçu
Gynecology & Birth-In Vitro Fertilization and Advanced Gynecological Endoscopy Specialist
PATIENT COMMENTS
Onur teacher was very supportive and encouraging at every stage of the process, from the very beginning to after the surgery. He informed us in the best and most accurate way by explaining all the details of the process completely and clearly. I would like to thank my teacher Onur very much and definitely recommend him to those who are looking for a doctor in this field.
Arz*** A***
