To the question of the pathogenesis of endometrial hyperplasia

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 estrogens.
The aim: is to study the structure of pathological endometrial changes that patients with abnormal uterine bleeding (AUB) have and natural combination of various forms of pathological endometrial changes.
Material. The results of histological examination of endometrium collected from 668 patients have been studied.
Results. The structure of pathological changes that occur in case of AUB has been identified. Various endometrial changes outside CEH and AEH pockets against the background of SEH, polyposis, atrophic endometrium have been detected without any regularity; the fact that does not confirm the role of hyperestrogenia in CEH and AEH pathogenesis.
Conclusion. SEH being the result of estrogen and progesterone imbalance is subjected to cyclic progestin hormone therapy to prevent acyclic bleeding. Observation with regular control is acceptable in the absence of AUB after the curettage in case of SEH and CEH without atypia. In case of AEH surgical treatment is required.

1. Кузнецова И.В. Возможности терапии гиперпластических процессов эндометрия. Труд пациент 2010;1:48−52.

2. Чернуха Г.Е. Аденоматозная и железистая гиперплазия эндометрия в репродуктивном возрасте (патогенез, клиника, лечение). Дис. ... д.м.н. М., 1999.

3. Terakawa N., Kigawa J., Taketani Y. et al. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynecol Res 1997; 23(3):223−30.

4. Kurman R., Kaminski P., Norris H. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 1985;56(2):403−12.

5. Lacey J.V., Sherman M.E., Rush B.B. Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia. J Clin Oncol 2010 February 10;28(5):788−92.

6. Lacey J.V. Jr., Ioffe O.B., Ronnett B.M. et al. Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan. Br J Cancer 2008;15;98(1):45−53.

7. Horn L.C., Schnurrbusch U, Bilek K. et al. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14(2):348−53.