Endometrial thickening

　　Reason 1: Endogenous estrogen

　　(1) Anovulation: Anovulation can occur in adolescent girls, perimenopausal women, disorders in the hypothalamic-pituitary-ovarian axis, polycystic ovary syndrome, and other conditions, leading to long-term continuous estrogenic action on the endometrium without progesterone counteraction, lacking the transformation of the secretory phase, and remaining in a proliferative state. In patients under 40 years old with atypical endometrial hyperplasia, 80% of the endometrium other than focal atypical hyperplasia lacks the secretory phase; 70% of the basal body temperature measurements show a unimodal pattern. Therefore, the majority of patients do not ovulate.

　　(2) Obesity: In obese women, androstenedione secreted by the adrenal glands is converted into estrone by the aromatase action within the adipose tissue; the more fat tissue, the stronger the conversion ability, the higher the level of estrone in plasma, thus causing a persistent estrogen effect.

　　(3) Endocrine functional tumors: Endocrine functional tumors are rare tumors, but in the research statistics, they account for 7.5% of endocrine functional tumors. Pituitary adenoma with abnormal gonadotrophic function, and granulosa cell tumor of the ovary are also tumors that continuously secrete estrogen.

　　Reason two: Exogenous estrogen

　　(1) Estrogen replacement therapy (ERT): During the perimenopausal period or postmenopausal period, due to estrogen deficiency, there are menopausal syndrome, and there may also be osteoporosis, abnormal lipid metabolism, cardiovascular changes, and even changes in brain cell activity, etc. Therefore, ERT has been widely used and has achieved good results. However, ERT alone with estrogen can stimulate endometrial hyperplasia. After a year of estrogen alone, 20% of women may have endometrial hyperplasia (Woodruff 1994), and the application of ERT is often continuous for years, even lifelong. If progesterone is not used simultaneously, there may be serious endometrial hyperplasia, and even endometrial cancer may occur.

　　(2) The application of Tamoxifen: Tamoxifen (TAM) has an anti-estrogenic effect and is therefore used in postmenopausal advanced breast cancer patients. Under low estrogen conditions, TAM also has a weak estrogen-like effect, so long-term use of TAM can also cause endometrial hyperplasia.

　　Treatment of atypical endometrial hyperplasia, the first step is to make a clear diagnosis, find out the cause of atypical hyperplasia, whether there are polycystic ovaries, ovarian functional tumors, or other endocrine disorders, etc. Those with any of the above conditions should receive targeted treatment. At the same time, symptomatic treatment can be started for atypical endometrial hyperplasia, using medication or surgery. The choice of these two treatment plans should be different according to age, type of endometrial hyperplasia, and requirements for fertility, etc.

　　Obesity:

　　In obese women, androstenedione secreted by the adrenal glands is converted into estrone by the aromatase action within the adipose tissue; the more fat tissue, the stronger the conversion ability, the higher the level of estrone in plasma, thus causing a persistent estrogen effect.

　　Endocrine functional tumors:

　　Endocrine functional tumors are rare tumors, accounting for 7.5% of endocrine functional tumors. Pituitary adenoma with abnormal gonadotrophic function, and granulosa cell tumor of the ovary are also tumors that continuously secrete estrogen.

　　Anovulation:

　　In adolescent girls, perimenopausal women, dysregulation of the hypothalamus-pituitary-ovary axis, polycystic ovary syndrome, and other conditions, there may be anovulatory phenomena, causing the endometrium to be persistently affected by estrogen for a long time without the antagonistic effect of progesterone, lacking the transformation of the cyclic secretory phase, and remaining in a proliferative state for a long time. In a hospital with 41 cases of atypical endometrial hyperplasia in patients under 40 years old, the endometrium in most patients has no secretory phase, except for focal atypical hyperplasia, and more than 80% of the other endometrium has no secretory phase; the results of basal body temperature determination in 70% are uniphasic. Therefore, most patients have no ovulation.

　　The most common clinical symptom of endometrial hyperplasia is irregular vaginal bleeding (66.5%), characterized by irregular menstrual cycle, varying duration of menstruation, varying amount of menstrual blood, and even massive bleeding. Sometimes there is a few weeks or months of amenorrhea, followed by vaginal bleeding, with a usually large amount of blood. It can also start with irregular vaginal bleeding, with little blood and persistent, or start with periodic bleeding similar to normal menstruation. During the bleeding period, there is generally no abdominal pain or other discomfort. A large amount of bleeding or a long duration often leads to anemia, and massive bleeding can lead to shock.

　　1) Strengthen prenatal care: Regular checks during pregnancy to timely detect various complications during pregnancy for timely treatment. During pregnancy, strengthen the intake of nutrition and vitamins. Pay attention to prenatal hygiene, bathe and change clothes frequently. After 8 months of pregnancy, as the cervix gradually relaxes, do not take a bathtub, and do not have sexual intercourse to avoid infection.

　　2) Promote new methods of midwifery: Strict aseptic operation during the process of delivery, avoid unnecessary rectal and vaginal examinations, handle the labor process properly, do not allow the labor process to be too long, ensure the rest and nutrition of the pregnant woman. After the placenta is delivered, check carefully, and remove any residual tissue in time to reduce postpartum hemorrhage. Apply antibiotics in a timely manner to those with premature rupture of membranes.

　　3) Do not abort on one's own: Some women, in order not to let others know they are pregnant, take medicine at will or seek medical help privately, which is very dangerous. Often, not only is the induced abortion not successful, but also mild infections, severe organ damage, and can lead to sepsis, tetanus, and even death. Therefore, this dangerous method should absolutely not be adopted.

　　4) Pay attention to puerperal hygiene: Keep the perineum clean, bathe frequently, and change underwear. During this period, avoid sexual activity and bathtub for at least one month.

　　5) Pay attention to menstrual hygiene: Sanitize menstrual pads. Avoid sexual activity and bathtub during the menstrual period. Try not to have gynecological examinations during the menstrual period.

　　1. Laboratory examination: Routine blood test, platelet count, and bleeding and coagulation time to determine the degree of anemia and the presence of blood diseases.

　　2. Basal body temperature measurement

　　(1) Incomplete atrophy of the corpus luteum: Basal body temperature shows a biphasic pattern, but the temperature decline is delayed or gradually decreases.

　　(2) Anovulatory functional uterine bleeding: Basal body temperature shows a uniphasic pattern

　　(3) Incomplete luteal function: Basal body temperature shows a biphasic pattern, but rises slowly, and the luteal phase is shorter.

　　3. Vaginal exfoliated cell smear examination: Can understand whether ovulation has occurred and the condition of the corpus luteum.

　　4. Thyroid, adrenal, and liver function tests: to exclude abnormal uterine bleeding caused by these diseases.

　　5. Hormone Testing: Can understand whether there is ovulation and corpus luteum condition.

　　Endometrial hyperplasia can lead to menstrual irregularity, and the cause is often related to excessive secretion of estrogen by the ovaries and a lack of progesterone. Severe cases may lead to infertility, therefore, patients with endometritis should pay more attention to their diet.

　　Dietary for endometrial hyperplasia:

　　1. Eat more tonifying and vitalizing foods to help Qi flow and blood, relieve pain, especially for those with Qi and blood deficiency.

　　2. Make beans, grains, and tubers the main food.

　　3. Appropriately drink alcohol to warm the yang and promote pulse, dispel cold, and relieve pain.

　　4. Also eat fennel, Sichuan pepper, mustard, and black pepper, which are also warm and promote circulation.

　　Dietary taboos for endometrial hyperplasia:

　　1. Fatty and greasy foods, as these foods are prone to blood stasis, it is better to eat less, and light and slippery foods are more suitable.

　　2. Cold and cool foods, especially pay attention to not eating hot soups and vegetables, and cold foods before and after menstruation.

　　3. Avoid eating raw fruits before and after menstruation.

　　1. Fertility Preservation Surgery

　　The scope of the operation is to resect or cauterize the endometrial hyperplastic foci as cleanly as possible, but to preserve the uterus and both sides, one side, or at least part of the ovaries, which is suitable for young patients with fertility requirements.

　　2. Ovarian Function Preservation Surgery

　　The operation involves the resection of the lesions in the pelvis and the uterus to prevent the retrograde implantation and spread of endometrial tissue to the abdominal cavity through the fallopian tubes. However, at least one ovary or part of the ovary should be preserved to maintain the ovarian function of the patient after the operation. This operation is suitable for severe patients under 45 years old with no fertility requirements, and medication should be added after the operation.

　　3. Complete Treatment Surgery

　　The operation involves the resection of all endometrial hyperplastic foci in the uterus, bilateral adnexa (uterine tubes, ovaries, etc.), and the pelvis, which is suitable for severe patients near menopause over 45 years old. Generally, no medication is needed after the operation.