WOMEN: UTERINE ADENOMYOSIS. ENDOMETRIAL HYPERPLASIA. CANCER OF THE UTERUS
Uterine adenomyosis
Adenomyosis means ‘gland within the muscle’. In this condition fragments of endometrium penetrate and grow between the muscle fibres of the uterine wall. It is really endometriosis of the uterine wall,
and may accompany endometriosis elsewhere in the pelvis. Adenomyosis is most common in women who are over 35 years of age.
Symptoms occur because the endometrium within the muscle undergoes the same changes during the menstrual cycle as that lining the uterine cavity. Periods become heavier and more prolonged, and are often associated with a dull ache and a feeling of pressure in the pelvis. The uterus becomes enlarged and softer, and may be tender.
Treatment of adenomyosis is the same as for endometriosis elsewhere in the pelvis, but unfortunately the response to hormones is not generally as good. In women who want no more children, hysterectomy is usually the best solution.
Endometrial hyperplasia
This is overgrowth of the endometrium resulting from prolonged stimulation by oestrogen without the balancing effect of progesterone. Endometrial hyperplasia occurs in women who don’t ovulate for a long time, and is most common in the years preceding the menopause.
There are two exceptions in which the connection between this condition and failure to ovulate does not apply.
• Young women often don’t ovulate for some months or years after the menarche. Periods may be heavier during this time, but as soon as ovulation begins, progesterone from the corpus luteum corrects the endometrial overgrowth.
• Hormonal contraception stops ovulation, but the progesterone it contains prevents endometrial overgrowth. In fact, the combined Pill or contraceptive progestogens are often used to correct endometrial hyperplasia.
The symptom of endometrial hyperplasia is increasingly heavy and prolonged menstrual bleeding, often quite irregular. Diagnosis is by examination under the microscope of endometrium removed by curettage. D&C often stops the heavy bleeding for a few months, but as long as the ovaries continue to produce oestrogen without ovulation, the condition will recur.
The treatment for endometrial hyperplasia is usually to give progestogens. In young women, taking the contraceptive Pill for several months may correct the condition. Endometrial hyperplasia is a benign condition but if it isn’t controlled, it’s possible that prolonged stimulation by oestrogen could lead to endometrial cancer. For this reason, hysterectomy is often advised for women over the age of 40 who want no more children.
Cancer of the uterus
This usually means cancer of the endometrium (lining of the uterus), which is the second most common pelvic cancer in women (after cervical cancer).
Endometrial cancer is much I treacherous than either ovarian or cervical cancer. It develops slowly and can usually be detected early because it almost causes symptoms of irregular or post menopausal bleeding before it spreads.
The cause of endometrial cancer a clear, but it seems to be connected with oestrogen. It is more common among women over the age of 50 who have been exposed to high levels of oestrogen and lack of progesterone, such as those who’ve had endometrial hyperplasia, polycystic ovarian syndrome, or hormone replacement with oestrogen alone. But not all women with a history of these conditions develop endometrial cancer. It’s suspected that the endometrium of those who do is more sensitive to oestrogen stimulation and overgrowth.
The treatment is primarily removal of the uterus, tubes and ovaries by surgery, and may be curative if there’s been no spread. The ovaries are removed because they might contain minute spots of cancer, and because any oestrogen produced might stimulate tiny groups of cancer that have spread elsewhere. If there’s obvious spread when the cancer is nosed, surgery is usually followed by radiation therapy and sometimes treatment with progestogens.
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