Kungenzeka ukuthi wambona udokotela wakho ngegazi elingavamile lokuphuma kwegazi njengofana
- Kunzima kunegazi elivamile lokuphuma esikhathini
- Ukukhipha igazi phakathi kwezinkathi zakho
- Ukuphuma kwe-post-menopausal
Uma unakho, kungenzeka ukuthi unikezwe ukuxilongwa kwe-endometrial hyperplasia.
Sibutsetelo
I-hyperplasia ye-Endometrial iyinhlangano engavamile yesibalo sesisu sakho noma i- endometrium .
I-endometrium yakho yakha futhi ibeka inyanga ngayinye ngokuphendula izinguquko zakho ezivamile ze-hormone yama-hormone.
Kuyinto engxenyeni enkulu yokugeleza kwakho kokuya esikhathini. Kuyinto evamile ukuba uhlaka lwesisu lwakho lube lukhudlwana noma lunwebe kakhulu phakathi nengxenye yokuqala yomjikelezo wakho wokuya esikhathini
Kodwa, uma kukhona ukungalingani ekugqugquzelweni kwe-hormonal ye-endometrium ukungajwayelekile kungenzeka. Lokhu kushintshe okungavamile ukuqina okungavamile kwe-endometrium futhi kubizwa ngokuthi i-endometrial hyperplasia.
Ama-ovari akho avame ukhiqiza i-estrogen ne-progesterone ekuphenduleni ama-hormone akhuthazayo avela ebuchosheni. Lolu shintsho oluhlelekile nolulungiselelwe isikhathi se-estrogen ne-progesterone yilokho okwenza isikhathi sakho sihlale njalo, cishe njalo ezinsukwini ezingu-28.
Indima ye-Hormone Ukungalingani
Ukungalingani kwe-hormonal okuphethwe i-endometrial hyperplasia yisilinganiso esiphezulu se-estrogen kuya ku-progesterone
I-Estrogen yi-hormone eyabangela ukuqina okujwayelekile kwe-endometrium phakathi nengxenye yokuqala yomjikelezo wakho wokuya esikhathini.
Uma ulinganisela ngesilinganiso esifanele se-progesterone i-endometrium yakho iyakhuphuka kepha ingabe ivikela ngaphandle kokuvumela ukukhula okungavamile okungavamile. Kodwa uma kunesidingo esingaphezu kwesihlobo se-estrogen, ubhedu luphelile futhi luqhubeka lukhukhula. Ngokuhamba kwesikhathi isikhala esibanzi siqala ukuthuthukisa izinguquko ezingavamile.
Izingozi Zezingozi
Izimo ezibangelwa ukudlula ngokwe-estrogen ezingabangela i-hyperplasia ye-endometrial zihlanganisa:
Ukukhuluphala
Izicubu zamafutha ziguqula amanye ama-hormone ku-estrogen. Lokhu kubangela i-estrogen eyengeziwe evuselela uketshezi kwesibeletho ngaphezu kwe-estrogen evamile ye-cyclic ekhiqizwa ama-ovaries akho. Uma i-BMI yakho ingaphezu kuka-35 unobungozi obukhulu kakhulu bokuthuthukisa i-hyperplasia ye-endometrial uma kuqhathaniswa nawe ngesisindo somzimba esihle.
Anovulation
Kungaba nezizathu eziningana zokuthi kungani ungase ungavumeli. Uma ungagcini i-ovary yakho ngeke ukwandise ukukhiqizwa kwayo kwe-progesterone. Lokhu kwanda ku-progesterone kuyadingeka ukuze uhlaka lwesisu lwakho lubekwe. Ngamanye amazwi, ngeke uthole isikhathi sakho. Kwezinye izinhlobo zemijikelezo ye-anovulatory, lokhu kungabikho kwe-progesterone okuvumela ukuthi isihlobo esingaphezu kwesisrogen siphume. Le-estrogen engenakulinganisela ibangela ukuqina okungavamile kwe-endometrium. Ekugcineni, uzothola uhlobo oluthile lwegazi olungavamile. Amaphethini okugcoba okujwayelekile nalolu hlobo lokugcoba kufaka phakathi izikhathi ezingajwayelekile futhi ezinzima noma ukuphaphama phakathi kwesikhatsi sakho. Izimbangela ezivamile zalolu hlobo lokungalingani kwamangqamuzana zihlanganisa:
AmaHormoni ajwayelekile
Ngokusobala ukuthatha isikhundla se-estrogen kuzokwandisa amazinga e-estrogen wakho ngokuqondene namazinga wakho we-progesterone.
Yingakho uma unesibindi udinga ukuthatha uhlobo lweprogesterone (progesterone) ukuvimbela i-endometrium yakho ukuthi ingapheli.
Enye imithi ye-hormonal engabangela ukuqina okungavamile kwe-endometrium yi- Tamoxifen . I-Tamoxifen iyisidakamizwa esibizwa ngokuthi i-selectogen receptor modulator noma i-SERM. Ama-SERM yizidakamizwa ezithinta izingxenye ezibucayi ze-estrogen zomzimba wakho ngezindlela ezahlukene. I-Tamoxifen ivame ukusetshenziselwa ekwelapheni amakhemikhali abelethwe yi-hormone-sensitive ngoba iphikisa imiphumela ye-estrogen emathisini asebele. Kodwa-ke, i-Tamoxifen ivuselela ama-estrogen receptors ekwakhekeni kwesibeletho ngakho yenza njenge-estrogen futhi ingabangela i-endometrial hyperplasia.
Uma usebenzisa i-hormone-substitution therapy noma i-Tamoxifen futhi uhlakulela ukuphuma kwe-uterine okungavamile kubaluleke kakhulu ukuthi ubone udokotela wakho futhi uhlolwe.
I-Estrogen ikhiqiza izicubu ze-ovarian
I-hormone yokukhiqiza izicubu akuyona imbangela evamile kakhulu ye-endometrial hyperplasia. Kodwa-ke, kunezinye izicubu ezivame ukungena ezikhiqiza i-estrogen ngokweqile.
Ukuxilongwa
Uma ubona udokotela wakho ngezikhalazo zokuphuma kwegazi lomzimba okungavamile kungenzeka ukuthi uzothola i-biopsy ekwakhekeni kwesibeletho sakho. Udokotela wakho angase ancome noma i-office endopriop biopsy noma inqubo encane yokuhlinzwa ebizwa ngokuthi i-hysteroscopy ne-curettage noma isampula ye-endometrium.
I-biopsy ye-Endometrial
Lena yindlela ejwayelekile kakhulu yokusekela i-office esekelwe ehhovisi. Ngokuvamile, kuhle kakhulu ukubekezelela.
Ngomkhuba wami, ngithola ukuthi ukulindela nokukhathazeka kokuba nenqubo kubi kakhulu kune-biopsy yangempela. Uma udinga ukuba ne-biopsy ye-endometrial, umqondo omuhle ukuthatha u-600 mg we-ibuprofen futhi ube nesidla esincane cishe ihora ngaphambi kwenqubo. Ungase ufune ukuletha iphakethe elincane elifudumele noma u-patch nawe ukusiza ukunciphisa ukuchoboza ngesikhathi nangemva kwenqubo. Udokotela wakho angakunikeza eyodwa ngesikhathi se-biopsy.
I-set up for the biopsy ifana ne-pap smear yesimiso. Ngemuva kokuthi i-speculum ibeke udokotela wakho uzohlanza isisu sakho somlomo wesibeletho ngesifo esincane somzimba. Mhlawumbe udokotela wakho uzobe esebeka i-grasper ukubamba isibeletho sakho endaweni ngenkathi idivayisi encane ye-aspirator efakwa. Ngezinye izikhathi uzothola ukungakhululeki. Ngeke uzizwe ukhaliphile kodwa uzoba nokunye ukuchofoza. Ukungahambi kahle kungabuka ezinkampanini ezimnene zesikhumba kuze kube yinkimbinkimbi efana nezinhlungu zokuqala zomzimba. Izindaba ezinhle yinkqubo esheshayo futhi ngokuvamile ihlala emaminithi angaphansi kweyodwa. Ukuthatha ibuprofen ngaphambi kwenqubo bese usebenzisa iphakethe elifudumele ngesikhathi senqubo ngokuqinisekile, kusiza ukunciphisa ubuhlungu.
I-Hysteroscopy
Udokotela wakho angase asikisele ukuthi ube nesampula ye- hysteroscopy ne-endometrial esikhundleni se-biopsy ye-endometrial. Lolu suku olufanayo lwenqubo yokuhlinzwa kanye neminye imikhuba yokubeletha, futhi kwenziwa ehhovisi esikhundleni segumbi lokusebenza. Inzuzo ye-hysteroscopy yukuthi ivumela udokotela wakho ukuba aqaphele ngqo umgqa wesibeletho ukuqinisekisa ukuthi zonke izindawo ze-endometrium zithathwa ngokufanelekile. Kukhona izimo ezithile lapho udokotela wakho angase akhombise le nqubo encane kakhulu yokuhlasela.
I-endometrial hyperplasia ayikwazi ukuhlolwa ngegazi noma i-ultrasound. Kodwa-ke, kungenzeka ukuthi udokotela wakho angancoma ukuhlolwa kwegazi ezithile ukuze abone ezinye izimbangela zokuphuma kwamagciwane okungavamile. Kungenzeka nokuthi udokotela wakho angalawula i-ultrasound yangaphakathi ye-pelvic ukusiza ekutholeni imbangela yokuphuma kwegazi elingavamile.
I-endometrial hyperplasia ingatholwa kuphela ngemva kokuba i-endometrium yakho isampuliwe futhi ihlolwe ngaphansi kwe-microscope yophiko lwezemvelo.
Izinhlobo
Uma udokotela wezilwane ebheka isampula ye-endometrium yakho ngaphansi kwe-microscope babheka ngokuqondile izinguquko ezingxenyeni ezimbili ze-endometrium yakho, izigulane kanye nezicubu ezisekelayo ezibizwa ngokuthi i-stroma. I-endometrial hyperplasia itholakala uma kunezinhlayiya eziningi ezihlobene nesimo se-stroma kunokuba uzothola endometrium evamile noma yokuhamba ngebhayisikili. I-pathologist izobe ibeke amazwana ngokuthi kukhona ama-cell atholakala e-atypical kule-endometrium engavamile kakhulu eholela ekuhlukanisweni kokubili kwe-endometrial hyperplasia:
- I-Hyperplasia ngaphandle kwe-atypia
- I-hyperplasia ye-Atypical
Kubalulekile ukukhumbula ukuthi i-hyperplasia ye- endometrial ayiyona umdlavuza we-endometrial kodwa kubhekwe njengesimiso esinqunyiwe. Eqinisweni, kwezinye izimo ze-hyperplasia ebalulekile e-atypical, isifo somdlavuza we-endometrial sekusenokwenzeka kakade.
Ukwelapha
Kubaluleke kakhulu ukuthi yonke i-hyperplasia ye-endometrial ilandelwe eduze noma ilashwe.
I-endometrial hyperplasia ngaphandle kwe-atypia
Uma kungekho amangqamuzana angama-atypical avela, ithuba le-endometrial hyperplasia ekugcineni liba ngumdlavuza we-endometrial cishe akunakwenzeka. Ubufakazi bubonisa ukuthi abesifazane abangaba ngu-5% abane-endometrial hyperplasia ngaphandle kwe-atypia bazokwakha umdlavuza we-endometrial. Kungenzeka nokuthi lolu hlobo lwe-endometrial hyperplasia luzozixazulula ngokwayo ngokuhamba kwesikhathi.
Umzila wokuqala wezokwelapha ukubhekisisa izinto eziyingozi ezingaguqulekayo.
Isibonelo, uma ukhuluphele ngokweqile noma ukhuluphele kakhulu, ukulahlekelwa isisindo kuzosiza ukunciphisa i-estrogen eyengeziwe eyenziwa ngama-fat cells. Lokhu kuzokuvumela ukuba uhlaka lwamagciwane akho luzilungiselele. Ngokufanayo, uma uthatha i-hormone therapy esikhundleni sokuthi ukhethe ukushintsha esikhundleni sakho udokotela angase adingeke alungise umthamo wakho noma uncoma ukuthi uyeke ukuyisebenzisa.
Udokotela wakho angancoma ukusebenzisa imithi ye-progestin ukulwa nomphumela wokuqina we-estrogen engaphezu kwe-endometrium yakho. Izizathu udokotela wakho angase akuphakamise ukukuphatha nge-progesterone zihlanganisa:
- Ukuguqulwa nokuguquka kwendlela yokuphila akusebenzi
- Uthola igazi elingavamile legazi
- Ufuna umphumela osheshayo
Lezi zinhlobo ezimbili ze-progesterone eziphakanyisiwe ukwelashwa kwe-endometrial hyperplasia ngaphandle kwe-atypia yi-progesterone yomlomo noma i-progesterone ene-IUD. Ubufakazi bujabulela ukusebenzisa i-levonorgestrel IUD ( iMirena ). Uma ukhuluphele nge-BMI> 35 kungenzeka ukuthi ukwelashwa kwe-progesterone ngeke kusebenze kahle ngaphandle kokuthi ulahlekelwe isisindo. Kufanele uxoxe nodokotela wakho ukuthi yiluphi uhlobo lwezokwelapha lwe-progesterone olungcono kuwe.
Kungakhathaliseki ukuthi ukhethe ukubuka noma ukwelashwa nge-progesterone kuzomele ulandelwe eduze nesampuli ye-endometrial esinqunyiwe ukuze uqinisekise ukuthi i-hyperplasia ye-endometrial isiphelile futhi ayibuyanga.
Ochwepheshe bathi i- hysterectomy akufanele ihlinzekwe njengendlela yokwelapha yokuqala ye-endometrial hyperplasia ngaphandle kwe-atypia ngenxa yokuphumelela jikelele kokuphathwa kwe-progesterone kanye nengozi ephansi yokuthuthukisa umdlavuza we-endometrial. Kodwa-ke, ochwepheshe bayavuma ukuthi kunezimo ezithile lapho i-hysterectomy ingase ibe yindlela yokwelapha efanele kunazo zonke kwabesifazane ezenziwa izingane. Udokotela wakho angase ancoma i-hysterectomy uma:
- Ngesikhathi sokulandelela, uthuthukisa i-hyperplasia ye-atypical
- I-hyperplasia ayithuthuki emva kwezinyanga ezingu-12 zokwelashwa kwe-progesterone
- Uthola ukuphuma okungavamile okungavamile
- Uthuthukisa i-endometrial hyperplasia futhi ngemuva kokuphathwa ngempumelelo
- Awudingi ukuphindaphindiwe kwe-biopsies ye-endometrial edingekayo nge ukwelashwa kwe-progesterone.
I-endometrial hyperplasia ene-atypia
Kukhona ingozi enkulu kakhulu yokuthuthukisa umdlavuza we-endometrial uma une-hyperplasia ne-atypia Abaphathi banobudlova kakhulu ngenxa yengozi eyengeziwe. Eqinisweni, ochwepheshe batusa hysterectomy njengendlela yokwelashwa kokuqala kwe-hyperplasia yama-atypical kwabesifazane okwenziwa nabantwana.
Uma ngabe uthola ukuthi une-hyperplasia ye-atypical futhi usahlela ukuzama ukukhulelwa cishe uzophathwa nge-progesterone, mhlawumbe nge-levonorgestrel IUD.
Uzoba nesampula ye-endometrial ejwayelekile ukuze uqinisekise ukuthi i-hyperplasia ye-atypical iphathwe ngokwanele. Udokotela wakho cishe uzosikisela ukuthi ubone ochwepheshe bezala futhi uqedele ukubeletha kwakho ngokushesha nje uma kungenzeka. Kungenzeka ukuthi udokotela wakho uzosikisela ukuthi abe ne-hysterectomy ngemuva kokuba usuqedile ukuba nezingane ngenxa yesikhundla esiphakeme sokuphindaphinda kwe-hyperplasia ye-endometrial ye-atypical.
Ngenxa yokuthi ukuphuma kwe-uterine okungavamile kuyisibonakaliso esivame kakhulu ukuthi ungaba ne-endometrial hyperplasia, kubalulekile ukubona udokotela wakho ukuxoxa ngalezi zinguquko ekuphumeni kwakho. Udokotela wakho anganquma ukuthi ngabe ukuhlolwa nokuhlolwa okuqhubekayo kuyadingeka yini.
Imithombo:
Gallos, ID., Et al, 2016.BGSE / RCOG Umhlahlandlela ohlangene: Ukuphathwa kwe-Endometrial Hyperplasia. [Online] London: BGSE / RCOG. Itholakala ku-https: //www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg67/