Dyshormonal diseases of the uterus and mammary glands

Cycle disorders and dysfunctional bleeding

Normally, the menstrual cycle is regulated by hormones: the proliferation phase is stimulated by estrogens, and the secretion phase by progesterone. Disruption of this sequence leads to dysfunctional uterine bleeding.

Most often, the culprit is ovarian pathology, less frequently — disorders in the central nervous system, pituitary gland, or adrenal glands. Bleeding occurs against the background of:

• Anovulatory cycles (when the follicle does not ovulate and the corpus luteum does not form).
• Insufficiency or persistence of the corpus luteum.
• Endometrial atrophy.

In clinical practice, such disruptions manifest as cycle pathologies (dysmenorrhea), excessive bleeding during menstruation (menorrhagia), or irregular spotting outside the cycle (metrorrhagia). A serious and regular outcome of these disorders is often infertility.

Endometrial hyperplasia and carcinoma

In hyperestrogenism, the endometrium proliferates excessively. The prognostic value of hyperplasia depends on its histological form — the risk of malignancy determines the treatment tactics:

1. Simple hyperplasia: uneven distribution of glands, cystic dilations, and stromal infiltration. Usually regresses spontaneously or after curettage.
2. Complex (adenomatous) hyperplasia: glands become more tortuous with little intervening stroma. The risk of cancer development is about 3%.
3. Simple atypical hyperplasia: branching glands with hyperchromatic nuclei (8% risk).
4. Complex atypical hyperplasia: bizarre-shaped glands merge closely ("back-to-back" pattern). Cells lose polarity, pathological mitoses are visible. Cancer risk is 30%.

Endometrial cancer is one of the most common female tumors (average age — 55 years). It develops either against the background of hyperplasia (classic pathway) or rapidly without preceding endometrial thickening (about 1/3 of cases). In 85% of situations, the tumor is represented by adenocarcinoma. It metastasizes first lymphogenously, and then hematogenously and by implantation. Risk factors include obesity, diabetes, nulliparity, and the use of estrogen-containing medications.

Polyps and uterine leiomyoma

The dyshormonal background also promotes the formation of benign tumors and growths:

• Endometrial polyp: forms from the basal layer via monoclonal mesenchymal proliferation. Macroscopically, these are smooth nodules ranging from microscopic to giant sizes (can occupy the entire uterine cavity). The main diagnostic criterion under the microscope is tortuous thick-walled blood vessels with a wide lumen in the base (stalk) of the polyp.
• Uterine leiomyoma: a benign tumor growing exclusively from smooth muscle tissue. Found in 15–30% of women over 35 years of age and almost always regresses in postmenopause. The clinical picture depends on the location of the nodules: patients complain of pain, meno- and metrorrhagia, as well as constipation and dysuric disorders due to the massive tumor pressing on the intestine and bladder.

Extragenital endometriosis

In this disease, endometrial tissue elements are found outside the uterus.

In 70% of cases, the ovaries are affected, where specific endometriotic cysts form. Hemorrhagic content accumulates inside such formations, which is why they are called "chocolate" cysts. The second most frequent localization is the peritoneum (uterosacral ligaments, pouch of Douglas).

Endometriotic foci respond sensitively to the hormonal background: the same cyclic changes occur in them as in the uterus. Periodic hemorrhages into the tissue cause severe aseptic inflammation. The outcome of such inflammation is a pronounced cicatricial-adhesional process that disrupts pelvic anatomy.

Class and exam questions

What else to study on this topic

• Endometrial stromal tumors (nodule and types of sarcomas)
• Mixed epithelial-mesenchymal tumors (carcinosarcoma and adenosarcoma)
• Histological signs and complications of acute and chronic endometritis
• Forms of salpingitis and routes of infection of the fallopian tubes

Other topics in "Chapter 20. Diseases of the Female Genital Organs and Mammary Glands"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.