Endometrial hyperplasia: pathogenetical aspects, classification and frequency of pathologies among patients of reproductive age (literature review)

Early diagnosis of endometrial hyperplasia is an efficient way to prevent its malignancy. One of the reasons of endometrial pathology is an absolute or relative increase in estradiol amount or lack of progesterone. Endometrial pathology is frequently observed in patients with menstrual irregularities, polycystic ovular syndrome, neuroendocrine syndromes (20 %), in the period of menstruation and reproductive function establishment (4 %). 5 % of cases are asymptomatic. Nowadays the major anamnestic risk factors of endometrial hyperplasia include early menarche, chronic anovulation, and late onset of menopause. Somatic pathologies imply such risk factors as type 2 diabetes, metabolic syndrome, hypertension, obesity, dyslipidemia, liver diseases. Endometrial hyperplastic process may be determined by iparity, infertility and complicated course of pregnancy and childbirth (endometrial cancer risk is increased by 2,8 times). The article describes the role of hormone replacement therapy in endometrial pathology genesis. Common hyperplasia increase up to 27 % and complex hyperplasia increase up to 22 % along with atypical endometrial hyperplasia up to 11,8 % are observed. Normal and hyperplastic endometrial characteristics are given. The factors which are highly prognostically important for malignant process identification are determined. Endometrial pathology classifications recommended by WHO and EIM system are presented. Their benefits and drawbacks are considered. The relation between endometrial hyperplasia type and endometrial receptor phenotype is reported. Estrogen and progesterone receptor types are presented in the article. Their characteristics are given. Receptor dysfunction types are highlighted. The interrelation of estrogen and progesterone receptors is studied. The role of changes in endometrial receptor function is established.