Submitted to: Dr. Ahsan Munawar

By: Naeem Akhtar

13-ARID-1079

What is Endometrium?

The endometrium is the inner mucous

membrane of the mammalian uterus.

Histology

The endometrium consists:1. A single layer of columnar epithelium.2. Stroma (Supporting part).3. A layer of connective tissue(that varies in

thickness according to hormonal influences).4. Simple tubular uterine glands (reach from the

endometrial surface through to the base of the stroma).

Menstrual cycle

Endometrium is built up after the end of menstruation during the first part of the previous menstrual cycle.

Proliferation is induced by estrogen (follicular phase of menstrual cycle), and

Later changes in this layer are done by progesterone.

It is adapted to provide an optimum environment for the implantation and growth of the embryo.

This layer is completely shed during menstruation.

Endometrial hyperplasia

Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.

Endometrial hyperplasia is a non-cancerous condition.

May occur in any part or all of the endometrium

Pathogenesis

Hyperplasia usually develops in the presence of continuous estrogen stimulation unopposed by progesterone.

The female hormones 1.estrogen 2.progesterone

Both of these hormones control the changes in the uterine lining.

Estrogen builds up the uterine lining. Progesterone maintains and controls this

growth. Estrogen without enough progesterone may

cause the lining of the uterus to thicken.

Risks for developing

1. Estrogen replacement therapy -Take estrogen without progesterone to replace the estrogen their body is no longer making and to relieve symptoms of menopause.

2. Polycystic ovary syndrome- women are anovulatory and have unopposed estrogen effect.

3. Estrogen producing tumors (e.g. granulosa cell tumour).

4.Irregular Menstrul Periods-Skip menstrual periods or have no periods at all –continuous unopposed estrogen activity.

5.Overweight 6.Diabetes Mellitus

Types

1. Simple hyperplasia2. Complex hyperplasia3. Atypical simple hyperplasia4. Atypical complex hyperplasia

Symptoms of Endometrial Hyperplasia

Vaginal discharge Abdominal pain Bleeding between menstrual periods Heavy or prolonged menstrual periods

Classification

Like other hyperplastic disorders, endometrial hyperplasia initially represents a physiological response of endometrial tissue to the growth-promoting actions of estrogen.

However, the gland-forming cells of a hyperplastic endometrium may also undergo changes over time which make them to cancerous transformation.

Endometrial hyperplasia (simple or complex) changes in the appearance of individual gland cells.

In one study, 1.6% of patients diagnosed with these abnormalities eventually developed endometrial cancer.

These changes are similar to those seen in true cancer cells, but atypical hyperplasia does not show invasion into the connective tissues, the defining characteristic of cancer.

The previously mentioned study found that 22% of patients with atypical hyperplasia eventually developed cancer.

Endometrial hyperplasia is a significant risk factor for the development or even co-existence of endometrial cancer

So careful monitoring and treatment of women with this disorder is essential.