Современные подходы к диагностике и профилактике гиперплазии эндометрия

Кузнецова И.В., Ведзижева Э.Р. Современные подходы к диагностике и профилактике гиперплазии эндометрия. Гинекология. 2025;27(1):73–80. DOI: 10.26442/20795696.2025.1.203179

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Kuznetsova IV, Vedzizheva ER. Current approaches to diagnosing and preventing endometrial hyperplasia: A review. Gynecology. 2025;27(1):73–80. DOI: 10.26442/20795696.2025.1.203179

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Аннотация

Проблема гиперплазии эндометрия (ГЭ) сохраняет свою значимость на протяжении многих лет прежде всего по причине связи патологической пролиферации эндометрия с развитием злокачественной опухоли матки. Факторы риска рака эндометрия (РЭ) известны, среди них важную роль играет доброкачественная ГЭ, тогда как атипическая ГЭ относится, скорее, к прогностическим факторам развития аденокарциномы. Основным клиническим симптомом ГЭ являются аномальные маточные кровотечения, однако данный симптом не специфичен и встречается при большом числе гинекологических и негинекологических заболеваний. Во избежание ненужных инвазивных вмешательств в мире разрабатываются клинико-лабораторные критерии, которые позволяют отбирать для дальнейших диагностических манипуляций пациенток с высоким риском ГЭ/неоплазии эндометрия. В статье обсуждаются современные подходы к инструментальной диагностике и клинической оценке факторов риска у женщин в репродуктивном периоде и постменопаузе с симптомами и без симптомов маточных кровотечений. Лечение ГЭ, особенно при наличии клеточной атипии, достаточно сложно и не всегда эффективно, поэтому профилактика ГЭ и РЭ представляется лучшим стратегическим выбором. С этой целью могут использоваться комбинированные оральные контрацептивы, канцеропротективный потенциал которых хорошо известен. Приводятся варианты выбора комбинированных оральных контрацептивов, наиболее подходящих для контрацепции у женщин с риском ГЭ и РЭ.

Ключевые слова: гиперплазия эндометрия, рак эндометрия, аномальные маточные кровотечения, постменопаузальные кровотечения, факторы риска, комбинированные оральные контрацептивы, прогестины

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The problem of endometrial hyperplasia (EH) has been relevant for many years, primarily due to the association of abnormal endometrial proliferation with uterus malignancies. Endometrial cancer (EC) risk factors are known, with benign EH being one of the most important, while atypical EH is more likely to be a prognostic factor for the development of adenocarcinoma. The main clinical symptom of EH is abnormal uterine bleeding, but this symptom is not specific and occurs in many gynecological and non-gynecological conditions. In order to avoid unnecessary invasive interventions, clinical and laboratory criteria are being developed for selecting patients with a high risk of EH/endometrial neoplasia and for further diagnostic manipulations. The article discusses modern approaches to instrumental diagnosis and clinical assessment of risk factors in women of reproductive age and the postmenopausal period with and without symptoms of uterine bleeding. Treatment of EH, especially in the presence of cellular atypia, is challenging and not consistently effective, so prevention of EH and EC is the best strategic choice. For this purpose, combined oral contraceptives can be used due to their well-known carcinoprotective potential. The options for the choice of combined oral contraceptives most suitable for contraception in women at risk of EH and EC are given.

Keywords: endometrial hyperplasia, endometrial cancer, abnormal uterine bleeding, postmenopausal bleeding, risk factors, combined oral contraceptives, progestins

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1. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016;27(1):16-41. DOI:10.1093/annonc/mdv484
2. Contreras NA, Sabadell J, Verdaguer P, et al. Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions. Int J Mol Sci. 2022;23(5):2531. DOI:10.3390/ijms23052531
3. Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941-93. DOI:10.1002/ijc.31937
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6. Pennant ME, Mehta R, Moody P, et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017;124(3):404-11. DOI:10.1111/1471-0528.14385
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8. van Hanegem N, Breijer MC, Slockers SA, et al. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial. BJOG. 2017;124(2):231-40. DOI:10.1111/1471-0528.14126
9. Xue H, Shen WJ, Zhang Y. Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium. World J Clin Cases. 2022;10(7):2159-15. DOI:10.12998/wjcc.v10.i7.2159
10. Bel S, Billard C, Godet J, et al. Risk of malignancy on suspicion of polyps in menopausal women. Eur J Obstet Gynecol Reprod Biol. 2017;216:138-42. DOI:10.1016/j.ejogrb.2017.07.013
11. Ignatov A, Ortmann O. Endocrine Risk Factors of Endometrial Cancer: Polycystic Ovary Syndrome, Oral Contraceptives, Infertility, Tamoxifen. Cancers (Basel). 2020;12(7):1766. DOI:10.3390/cancers12071766
12. Petersdorf K, Groettrup-Wolfers E, Overton PM, et al. Endometrial hyperplasia in pre-menopausal women: A systematic review of incidence, prevalence, and risk factors. Eur J Obstet Gynecol Reprod Biol. 2022;271:158-71. DOI:10.1016/j.ejogrb.2022.02.015
13. Zhao J, Hu Y, Zhao Y, et al. Risk factors of endometrial cancer in patients with endometrial hyperplasia: implication for clinical treatments. BMC Womens Health. 2021;21(1):312. DOI:10.1186/s12905-021-01452-9
14. Nees LK, Heublein S, Steinmacher S, et al. Endometrial hyperplasia as a risk factor of endometrial cancer. Arch Gynecol Obstet. 2022;306(2):407-21. DOI:10.1007/s00404-021-06380-5
15. Doherty MT, Sanni OB, Coleman HG, et al. Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PLoS One. 2020;15(4):e0232231. DOI:10.1371/journal.pone.0232231
16. Verbakel JY, Heremans R, Wynants L, et al. Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: Results from the prospective IETA-1 cohort study. Int J Gynaecol Obstet. 2022;159(1):103-10. DOI:10.1002/ijgo.14097
17. Lucas E, Chen H, Molberg K, et al. Mismatch Repair Protein Expression in Endometrioid Intraepithelial Neoplasia/Atypical Hyperplasia: Should We Screen for Lynch Syndrome in Precancerous Lesions? Int J Gynecol Pathol. 2019;38(6):533-42. DOI:10.1097/PGP.0000000000000557
18. Murugappan G, Li S, Lathi RB, et al. Risk of cancer in infertile women: analysis of US claims data. Hum Reprod. 2019;34(5):894-902. DOI:10.1093/humrep/dez018
19. Amiri M, Bidhendi-Yarandi R, Fallahzadeh A, et al. Risk of endometrial, ovarian, and breast cancers in women with polycystic ovary syndrome: A systematic review and meta-analysis. Int J Reprod Biomed. 2022;20(11):893-914. DOI:10.18502/ijrm.v20i11.12357
20. Harris HR, Terry KL. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertil Res Pract. 2016;2:14. DOI:10.1186/s40738-016-0029-2
21. Coelingh Bennink HJT, van Gennip FAM, Gerrits MGF, et al. Health benefits of combined oral contraceptives – a narrative review. Eur J Contracept Reprod Health Care. 2024;29(2):40-52. DOI:10.1080/13625187.2024.2317295
22. Heremans R, Wynants L, Valentin L, et al. Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA-1 multinomial regression model: validation study. Ultrasound Obstet Gynecol. 2024;63(4):556-63. DOI:10.1002/uog.27530
23. Epstein E, Fischerova D, Valentin L, et al. Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study. Ultrasound Obstet Gynecol. 2018;51(6):818-28. DOI:10.1002/uog.18909
24. Stachowicz N, Smoleń A, Ciebiera M, et al. Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems. Diagnostics (Basel). 2021;11(3):442. DOI:10.3390/diagnostics11030442
25. Jiang T, Yuan Q, Zhou Q, et al. Do endometrial lesions require removal? A retrospective study. BMC Womens Health. 2019;19(1):61. DOI:10.1186/s12905-019-0756-8
26. Giri SK, Nayak BL, Mohapatra J. Thickened Endometrium: When to Intervene? A Clinical Conundrum. J Obstet Gynaecol India. 2021;71(3):216-25. DOI:10.1007/s13224-020-01415-4
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Авторы

И.В. Кузнецова*¹, Э.Р. Ведзижева²

¹ООО «Витбиомед+», Москва, Россия;
²ГБУЗ «Городская клиническая больница им. Д.Д. Плетнева» Департамента здравоохранения г. Москвы, Москва, Россия
*ms.smith.ivk@gmail.com

________________________________________________

Irina V. Kuznetsova*¹, Elina R. Vedzizheva²

¹Vitbiomed+ LLC, Moscow, Russia;
²Pletnev City Clinical Hospital, Moscow, Russia
*ms.smith.ivk@gmail.com

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