Endometrial hypoplasia
The content of the article:
- Causes and risk factors
- Symptoms
- Diagnostics
- Endometrial hypoplasia treatment
- Possible complications and consequences
- Forecast
- Prevention
Endometrial hypoplasia - insufficient proliferation or functional failure of the upper layer of the uterine lining. Thinning of the endometrium and the inability to provide the embryo with sufficient nutrients before the placenta is formed prevent the implantation of a fertilized egg and pregnancy.
Causes and risk factors
Normally, the endometrium in a woman of reproductive age during ovulation reaches a thickness of 12-13 mm. To secure the embryo, the thickness should be at least 7–8 mm. Otherwise, the embryo is located too close to the spiral arteries, remaining unprotected from the toxic effects of oxygen.
The proliferation of the upper mucous layer from which the tissues of the placenta are formed is regulated by the steroid hormones of the ovaries. With hypoplasia, the processes of cell proliferation slow down, as a result of which the upper mucous layer does not reach the required thickness or does not produce the required amount of bioactive and nutrients necessary for the development of the embryo.
The causes of endometrial hypoplasia are usually congenital and acquired diseases and pathological conditions:
- underdevelopment and aplasia of the uterus;
- chronic adnexitis, endometritis and other inflammatory diseases of the female reproductive system;
- disturbances in the nervous regulation of the reproductive cycles in pathologies of the pituitary gland and hypothalamus;
- autoimmune conditions;
- endocrine pathologies: hormonal deficiency, polycystic ovary syndrome, lack or functional inferiority of endometrial cell receptors for steroids, autosensitization to progesterone, etc.;
- insufficient blood flow in the uterine arteries;
- hypercoagulation;
- damage to the basal layer of the endometrium during operations, abortions and diagnostic curettage.
In some cases, hypoplasia of the endometrium is provoked by malnutrition, especially a lack of vitamin D, which is involved in the synthesis of steroid hormones. The situation is aggravated by bad habits and general intoxication of the body.
Symptoms
The main manifestations of endometrial hypoplasia are reproductive dysfunctions - the impossibility of conception during regular sex life without contraceptives or spontaneous miscarriages in the early stages.
With endometrial hypoplasia caused by endocrine pathologies, patients also have scanty or too abundant, painful and irregular menstruation later than menarche, decreased libido and anorgasmia, and a weak severity of secondary sexual characteristics - a narrow pelvis, underdevelopment of the breast and labia, insufficient pubic hair.
Diagnostics
Endometrial hypoplasia is diagnosed by a gynecologist during a vaginal examination. The underdevelopment of the functional layer of the uterus is often accompanied by signs of general underdevelopment of the genitals: narrowing and shortening of the vagina, a decrease in the fornices and the conical shape of the cervix.
To determine the actual thickness of the functional layer of the uterus, a pelvic ultrasound is prescribed. If hypoechoic or hyperechoic zones are detected, the patient is referred for hysteroscopy and hysterosalpinography, and a biopsy of the uterus is performed to assess the morphological state of the endometrium.
A blood test for gonadotropic and thyroid hormones reveals endocrinopathy; if necessary, additional laboratory tests are prescribed to diagnose possible chronic infections. If there is a suspicion of damage to the pituitary gland and hypothalamus, magnetic resonance imaging or computed tomography of the brain and determination of bone age are recommended.
Source: pomedicine.ru
Endometrial hypoplasia treatment
The choice of a therapeutic strategy depends on the cause of the endometrial hypoplasia. If endocrinopathy is detected, hormone replacement therapy is prescribed - combined oral contraceptives, progesterone and estradiol preparations or their analogues; vitamin D deficiency is eliminated through nutritional supplements and vitamin complexes. As a last resort, they resort to the removal of the pathological endometrium and subsequent hormone therapy. In some cases, the growth of the functional layer is stimulated with a hysteroscope.
Source: cistitus.ru
For patients planning a pregnancy, hormone therapy to build up the endometrium is carried out in two programs. In accordance with one of them, a course of estrogens is first prescribed in tablets or in the form of a gel; when the thickness of the functional mucous layer of the uterus reaches 8 mm, progesterone preparations are introduced into the scheme for 5-6 days. In order to prevent miscarriage, courses of estrogen and progesterone continue to alternate for some time after conception or embryo transfer during an in vitro fertilization (IVF) program. With a low efficiency of conservative treatment and preserved ovarian function, IVF and services of a surrogate mother are indicated.
The second program is mainly used for intact ovulation in preparation for IVF. In the first half of the cycle, vitamin therapy (vitamin D and folic acid) is carried out. When the follicle matures, the patient is injected with chorionic gonadotropin or progesterone preparations with ultrasound control of ovulation.
Successful treatment of endometrial hypoplasia, provoked by an immunological shift against a background of chronic infection, is possible only after elimination of the underlying pathology. To correct insufficient hemodynamics in the uterine arteries, anticoagulants and blood flow stimulants are used.
Physiotherapy is additionally used:
- laser therapy;
- UHF;
- diathermy and magnetotherapy;
- applications of ozokerite and paraffin;
- galvanization;
- gynecological massage.
Possible complications and consequences
In the absence of treatment, hypoplasia of the outer mucous layer of the uterus leads to infertility and recurrent miscarriage, and also greatly increases the risk of ectopic pregnancy and obstetric pathology. If, with endometrial hypoplasia, pregnancy still occurs, patients often suffer from toxicosis and other complications, they often have pathological childbirth and weak labor, and in the postpartum period, heavy bleeding.
Forecast
The underdevelopment of the upper mucous layer of the uterus does not pose a threat to life, with regard to reproductive function, the prognosis is cautious. Moderate thinning of the functional layer can be corrected in most cases, but severe endometrial hypoplasia and pregnancy are often incompatible. When infantilism and anomalies in the structure of the uterus are detected, which impede the growth of the functional layer, treatment is ineffective.
Prevention
It is impossible to prevent congenital endometrial hypoplasia, however, the development of acquired forms of pathology can be prevented if acute and chronic diseases of the reproductive system are timely identified and treated, avoiding self-medication. It is important to eat well, give up bad habits and prevent the development of congestion in the small pelvis, paying sufficient attention to physical activity and walking in the fresh air.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
