Endometrial hyperplasia is a proliferation of the lining of the uterus. It is often accompanied by the formation of polyps. Hyperplasia with atypia is considered a precancerous condition requiring surgical removal of the uterus. Hyperplasia without atypia is more common. In this form of the disease, the development of a malignant tumor can be prevented with the help of conservative treatments. Doctors in Germany use modern, sparing and safe treatment methods for endometrial hyperplasia, the effectiveness of which is close to 100%.
Content
- Diagnostics
- Conservative treatment
- Surgical treatment
The main treatment method is a hormonal intrauterine device implantation. Instead, oral gestagen therapy can sometimes be used. In the presence of atypia, based on the results of a histological examination of the uterine mucosa, a hysterectomy may be required. In Germany, it is performed using a minimally invasive laparoscopic procedure.
You can undergo treatment in one of these hospitals: University Hospital Rechts der Isar Munich, University Hospital Tuebingen, University Hospital Carl Gustav Carus Dresden.
If you want to undergo the treatment of endometrial hyperplasia in Germany, please contact Booking Health. The specialists of our company will select a specialized clinic and a doctor for you, recommend a treatment method, help you get a visa and arrange a flight, take care of medical insurance, and provide interpreting services. Also, a personal medical coordinator will always be in touch with you.
Diagnostics
The first diagnostic method is pelvic ultrasound. The doctor assesses the condition of the uterus, including the endometrium, myometrium and the ovaries. Ultrasound scanning is conducted on the 5th-7th day of the menstrual cycle, which should be considered when planning a trip to Germany for diagnostics. The Booking Health specialists will help you book a medical care program precisely on the dates when the examination of the uterus will be the most informative.
Suppose on the 5th-7th day of the cycle, the thickness of the endometrium reaches 7-8 mm or more in a heterogeneous structure with the presence of echogenic inclusions. In that case, this indicates a high probability of endometrial hyperplasia. Nevertheless, a final diagnosis cannot be made based on the ultrasound examination results. It is a diagnostic screening method.
If doctors doubt the presence of endometrial hyperplasia or cancer, a diffusion-weighted MRI of the pelvis may be performed. This procedure allows German doctors to detect the early signs of invasion of the endometrium into the myometrium, that is, the uterine mucosa into the deeper muscle layer of the organ.
Separate scraping of the cervical canal and the uterine cavity is the main method of confirming the diagnosis. Doctors obtain mucosal tissues and send them for histological examination. As a result, the diagnosis is established: endometrial hyperplasia with atypia (precancerous changes) or without atypia.
Doctors in Germany perform curettage under the guidance of hysteroscopy but not "blindly", which reduces the risk of complications to a minimum. During the procedure, doctors can not only obtain biomaterial for examination but also perform therapeutic manipulations: remove polyps or myoma nodes protruding into the uterine cavity.
Conservative treatment
Previously, the primary treatment for endometrial hyperplasia was the surgical removal of the uterus. In some countries with poorly developed medicine, this surgical intervention is still preferred by gynecologists. The treatment is carried out according to the principle "no uterus – no problems". In Germany, this tactic has long been abandoned. However, in today's practice removing the organ in the case of endometrial hyperplasia is infrequent. Such an operation is resorted to only in the presence of atypia (a precancerous condition).
Intrauterine system (coil) is implanted for several years and releases hormones – gestagens. The effectiveness of the system for endometrial hyperplasia without atypia reaches 100%. At the same time, there is practically no systemic effect on the body: hormones work mainly in the uterus. The frequency of side effects is minimal. German specialists will implant the coil carefully and safely to avoid its displacement and discomfort.
Oral gestagen therapy has a similar mechanism of action but with many disadvantages. The patient has to take pills regularly for years. The effectiveness of the treatment is 3 times lower than the spiral, and the frequency of side effects is higher due to the systemic effects of hormones. Depending on the woman's age, gestagens are used continuously or cyclically. For the treatment of endometrial hyperplasia in Germany, oral progestogen (pills) therapy is not considered the first-line treatment and is prescribed only for those who refuse intrauterine device implantation.
Gonadotropin-releasing hormone (GnRH) agonists are used in case of a combination of endometrial hyperplasia with endometriosis or uterine myoma.
Regardless of which treatment method is used, the therapy should be long-term and continuous. Coils are usually implanted for 5 years and then changed. If a woman wants to have a baby, then the spiral can be removed earlier. After the cessation of therapy, the risk of recurrence of endometrial hyperplasia within 2 years is 40%.
Surgical treatment
If a woman has signs of atypia, the probability that a cancerous tumor has already begun to grow in the uterus is about 50%. Therefore, the main treatment method for the disease is hysterectomy – removal of the uterus and its appendages. In women under 40, it is possible to preserve the ovaries in order to preserve the production of sex hormones.
An exception is possible for women who want to have a baby. They receive conservative therapy. However, to exclude cancer, endometrial curettage with a histological examination is required once every 3 months.
Doctors in Germany perform hysterectomy using a laparoscopic approach: the uterus is removed through several short incisions. As a result, the invasiveness of the operation and the risk of complications are reduced, the rehabilitation period is reduced and the aesthetic results are improved, since there are no large scars on the abdomen.
To undergo treatment in one of the clinics in Germany, you are welcome to use the Booking Health service. Here you can find out what is the price for treatment, compare prices in different medical centers and make an appointment for treatment at the best price. The Booking Health specialists will help you select the best clinic where doctors achieve the best results in treating endometrial hyperplasia, and arrange a trip to Germany.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
Verywell Health
Medscape
Science Direct
