ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Wall of the Womb Thickening

Gynecological diseases are one of the most common health problems that concern women of all ages and are very common in society. In particular, menstrual irregularities and undesirable bleeding problems associated with menopause can be a harbinger of some serious disorders as well as negatively affecting the quality of life. One of these disorders is Wall of the womb thickening.

What is Wall of the Womb Thickening?

The uterine tissue consists of three basic layers with different properties and functions. The epithelial tissue that forms the innermost part of the uterine wall and lines the inner cavity of the uterus is called the endometrium. The layer that contains the uterine muscles and is just inside the endometrium is known as the myometrium. The part that forms the outer part of the uterus and separates the internal organs from the uterus is called the perimetrium.

The endometrium is the tissue where very important events such as menstrual cycle and pregnancy occur in terms of women's health. The endometrium layer is sensitive to estrogen and progesterone hormones, which play a critical role in the realization of menstruation and maintenance of pregnancy, and undergoes some changes under the influence of hormones. While the endometrial cells, which are under the influence of estrogen, proliferate and thicken the layer, progesterone functions for the maturation of the tissue and for the storage of certain substances. Following these processes, the endometrial layer shows a cycle of thickening and shedding during the menstrual cycle.

Since the menstrual cycle disappears with menopause, the effect of hormones on the endometrium decreases and tissue regression is observed. However, if the effect of hormones continues during this period for various reasons, the endometrium may continue to thicken uncontrollably and may pave the way for more serious diseases. This condition is called endometrial hyperplasia or Wall of the womb thickening.

How does Wall of the Womb Thickening Develop?

Changes in the endometrium are mainly related to the levels of estrogen and progesterone hormones in the blood. The thickness of the endometrium layer is determined by how much estrogen this tissue is exposed to. Endometrial cells under the influence of estrogen are stimulated and begin to multiply. In healthy women, this effect of estrogen is balanced by the maturation effect of progesterone. With the decrease in the level of progesterone hormone in the blood, menstruation occurs.

In a woman who has entered the menopause, estrogen and progesterone levels decrease and the endometrial layer begins to regress. However, in some diseases that cause an increase in estrogen levels, the endometrial layer is stimulated to thicken again. In cases where the hormone balance changes, such as menopause, the effect of estrogen continues uncontrollably, as the progesterone hormone is insufficient.

As the endometrium layer, which thickens more than usual, is deprived of blood support, it begins to die over time and shedding may occur from the layer. Therefore, women with thickening of the uterine wall may experience breakthrough bleeding. Bleeding due to thickening of the uterine wall does not develop due to the disappearance of the effect of progesterone, as in menstruation, but due to the effect of estrogen more than normal.

If the uncontrolled effect of estrogen continues for a long time and is not treated, changes in the direction of uncontrolled proliferation occur in the endometrial cells and the cells tend to become cancerous. In other words, wall of the womb thickening is an important risk factor for uterine cancer. For this reason, it is very important to suspect wall of the womb thickening and to seek treatment in the early period in cases of abnormal bleeding during menopause.

What Causes Wall of the Womb Thickening?

Situations where the level of estrogen in the blood increases uncontrollably causes thickening of the uterine wall. In this sense, the following conditions are among the causes of wall of the womb thickening:

- Disruption of hormonal balance during menopause: Before the full occurrence of menopause, there is a transitional period called the perimenopausal period. During this period, serious disorders in the hormonal balance can be seen together with irregular menstrual bleeding. The uncontrolled high level of estrogen during this process is a risk factor for wall of the womb thickening.

- Hormone replacement therapy: Some symptoms may occur due to low estrogen levels after menopause. Hormone replacement therapy given to control these symptoms may cause wall of the womb thickening as a side effect.

- Irregular menstrual cycle: Regardless of menopause, women with irregular menstrual cycles may experience wall of the womb thickening due to high estrogen. Again in this context, women who have menstruation at an early age, who go through menopause at a late age, or who are over the age of 35 are at risk.

- Polycystic ovary syndrome: In women whose ovulation mechanism is not fully realized and whose hormone balance is disturbed, wall of the womb thickening may occur with high estrogen.

- Obesity: It has been shown that adipose tissue can convert certain hormones in the blood to estrogen. Women with high fat content have more estrogen than normal, so the risk of wall of the womb thickening increases.

- Some cancers: The wall of the womb thickening, especially in some ovarian cancers that result in abnormal estrogen production. People with a family history of uterine cancer, ovarian cancer or colon cancer are at risk for this.

- Some chronic diseases: Women with diabetes, thyroid disease or gallbladder disease have a high risk of wall of the womb thickening, as hormone balance may be impaired.

What are the Symptoms of Wall of the Womb Thickening?

The wall of the womb thickening alone does not cause any obvious symptoms. However, part of the endometrium, which is exposed to the effect of estrogen, is deprived of blood supply over time due to the thickening effect. As a result, dead cells are shed and bleeding may occur. In this regard, the following symptoms should suggest wall of the womb thickening:

· Vaginal bleeding after menopause

· Menstrual bleeding that lasts longer than usual

· More bleeding than normal

· Menstrual cycle lasting less than 21 days or having breakthrough bleeding

How is Wall of the Womb Thickening Diagnosed?

In the patient presenting with the complaint of irregular or abnormal vaginal bleeding, first of all, a detailed disease history should be taken and a detailed physical examination should be performed. In addition, there are some tests that directly evaluate the wall of the womb thickening. These can be summarized as follows:

Transvaginal Ultrasound

Ultrasound examination on the abdominal skin does not allow detailed evaluation of the endometrial layer. In suitable patients, the ultrasound probe is used to visualize the uterus through the vaginal route with the help of a special cap. With this method, the wall of the womb thickening can be calculated.

Hysteroscopy

Hysteroscopy, which means viewing the inside of the uterus with the help of a camera, is based on sending a camera into the uterus through the vaginal route under surgical conditions. During hysteroscopy, the physician may take biopsies from the areas she deems appropriate or perform some surgical procedures.

Biopsy

A biopsy may be required to distinguish whether the thickening in the endometrium is a malignant tissue or cell proliferation that develops under the influence of hormones. The treatment plan may change depending on the result indicated by the biopsy material taken. The biopsy can be easily taken during hysteroscopy or by curettage.

What is done in the treatment Wall of the Womb Thickening?

In wall of the womb thickening, treatment is usually determined by the result indicated by the biopsy material. Accordingly, simple methods are applied if no malignant cells are found in the endometrium sample, while more advanced methods can be applied if the onset of cancer is detected. In this context, the following methods are involved in the treatment of u wall of the womb thickening:

Follow-up

In simple thickenings seen in certain limits and where no malignant cells are detected, the patient may be advised to follow the symptoms. During follow-up, the symptoms may regress and the thickening may disappear with the improvement of the hormonal balance.

Medications Theraphy

In order to balance the estrogen effect, drug treatments containing progesterone hormone can be applied. Progesterone hormone can be given orally in pill form or it can be administered with an intrauterine device (IUD).

Surgery

Surgical removal of the uterus, called hysterectomy, is the last point of interventional treatment. It is generally applied in patients with abnormal cells as a result of biopsy, when there is no pregnancy plan and desire or when menopause is completed

Medical Second Opinion (MSO) Form
женский
мужчина
✓ Valid