PREMALIGNANT ENDOMETRIAL LESION

There is ample evidence that both endometrial hyperplasia and carcinoma are estrogen-dependent. Long-term unopposed estrogen, particularly around the time of menopause, often leads to various types of endometrial hyperplasia.

Risks: A significant number of such cases will develop invasive carcinoma during the period of 2–8 years. It has been estimated that about 25 percent of adenomatous hyperplasia, 50 percent of atypical hyperplasia and 100 percent of carcinoma-insitu will develop endometrial carcinoma, if left untreated.

ETIOLOGY: -

Endometrial hyperplasia develops in women of 40–50 years. Amongst numerous factors, unopposed estrogen appears to be the primary factor. Pre-menopausal persistent anovulation is almost a constant factor. In the postmenopausal women with obesity, peripheral conversion of androgens into estrogen is a risk factor. Long-term estrogen stimulation in condition of polycystic ovarian syndrome or feminizing ovarian tumor may predispose to endometrial Cancer.

DIAGNOSIS

♦ There is no classic symptom of premalignant lesions. But the constant feature is abnormal perimenopausal uterine bleeding and ultimate diagnosis is by uterine curettage and histology Accidental diagnosis is made during investigation of infertility, DUB, PCOS or excised specimen of removed uterus.

♦ Diagnosis by screening procedures extended to ‘at risk’ women is not as effective like that of CIN. Vaginal pool smear, endometrial aspiration (pipelle endometrial sampling), endometrial biopsy(curettage) and vaginal ultrasound are the different methods available for screening.

HISTOLOGY: -

Simple hyperplasia: Endometrium is thick. The glands are dilated and have outpouching and invaginations. They are crowded and have irregular outlines. The stroma is more dense and cellular.

COMPLEX HYPERPLASIA: - Endometrium is thicker. The gland is crowded and arranged back to back with reduced stroma. Most glands have irregular outlines. There are papillary processes and intraluminal bridges within the glands. Epithelialpseudostratification is present.

ATYPICAL HYPERPLASIA: The endometrial glands have cytologic atypia. The gland outlines are of complex hyperplasia in type. The nuclei of the glands show enlargement, irregular size and shape, hyperchromasia and coarse chromatin.

CARCINOMA-IN-SITU: Commonly describes a lesion with severe cytologic as well as architectural abnormalities of the glands.

HOMOEOPATHIC MANAGEMENT OF PREMALIGNANT ENDOMETRIAL LESION: -

Prescribing the most suitable medicines for Endometrial lesions needs a detailed case study and analysis. Homoeopathic medicines help in managing the symptoms as well as dissolving them.

Some of the frequently used medicines are: -

• Calcarea carb
• Medorrhinum
• Belladonna
• Phosphorus
• Sepia
• Thuja
• Teucrium marum varum etc.