bubble_chart Overview

Uterine hypertrophy refers to a condition where the uterus is uniformly enlarged, with the thickness of the muscular layer exceeding 2.5 cm, accompanied by varying degrees of uterine bleeding.

bubble_chart Etiology

(1) Chronic subinvolution of the uterus in multiparous women: In multiparous women, the elastic fibrous tissue proliferates within the myometrium between smooth muscles and around blood vessels, leading to uterine hypertrophy.

(2) Ovarian dysfunction: Persistent estrogen stimulation can cause hypertrophy of the myometrium. Clinically, patients with functional uterine bleeding, especially those with a longer course of the disease, often exhibit varying degrees of uterine enlargement.

(3) Inflammatory causes: Chronic adnexitis, pelvic connective tissue inflammation, and chronic myometritis lead to collagen fiber proliferation within the myometrium, resulting in uterine fibrosis.

(4) Pelvic static blood: This causes hyperplasia of uterine connective tissue and can also lead to uterine hypertrophy.

(5) Vascular sclerosis of the myometrium: Primary uterine vascular lesions, among others.

bubble_chart Pathological Changes

The basic pathological changes of this disease involve alterations in smooth muscle cells and vascular walls within the myometrium of the uterus.

(1) Gross findings: The uterus appears uniformly enlarged, with a thickened myometrium measuring 2.5–3.2 cm. The cut surface shows a grayish-white or pinkish color, increased firmness, and a woven arrangement of fiber bundles. The outer one-third of the myometrium exhibits prominent blood vessels, while the endometrium is either normal or thickened. Occasionally, small leiomyomas (less than 1 cm in diameter) or endometrial polyps may be observed.

(2) Microscopic examination: The findings vary and include the following patterns: ① Simple hypertrophy of smooth muscle cells. Microscopically, this resembles normal myometrium without collagen fiber proliferation or significant vascular wall changes; ② Proliferation of collagen fibers within the myometrium, leading to uterine fibrosis; ③ Changes in vascular walls within the myometrium: marked dilation of arteries and veins, with clusters of elastic fiber proliferation around newly formed blood vessels.

bubble_chart Clinical Manifestations

The main symptoms include excessive menstrual flow and prolonged duration; some cases may present with a shortened cycle of around 20 days, with no significant changes in the amount or duration of menstruation; or prolonged menstrual periods with minimal flow.

Most patients are multiparous women, typically with three or more pregnancies. Those with prolonged illness and heavy bleeding may exhibit signs of anemia. Gynecological examination reveals a uniformly enlarged uterus, generally equivalent to the size of a 6-week pregnancy, with a few cases exceeding the size of an 8-week pregnancy, and a relatively firm texture. Both ovaries may be slightly enlarged, with multiple follicular cysts.

bubble_chart Diagnosis

A multiparous woman with excessive menstruation and uniformly enlarged uterus, where the uterine membrane is normal or thickened, and some appear polypoid, but pathological examination is mostly normal, with a few showing hyperplasia, can be diagnosed as uterine hypertrophy. It should be differentiated from uterine fibroids, especially when the fibroid is a single intramural or submucosal type, as the uniformly enlarged uterine body is often difficult to distinguish from uterine hypertrophy. Diagnostic curettage to explore the uterine cavity and B-ultrasound examination can assist in diagnosis. However, there are still a few cases that can only be confirmed during exploratory laparotomy.

In addition, attention should also be paid to differentiating it from diseases such as adenomyosis and carcinoma of the endometrium.

bubble_chart Treatment Measures

Chinese medicinals can help control hypermenorrhea and improve overall health; androgen therapy can reduce bleeding volume. If conservative treatment is ineffective, a total hysterectomy may be considered. For those under 50 years old with normal ovaries, the ovaries should be preserved.

bubble_chart Prevention

The causes of the disease are multifaceted, and some can be prevented, such as practicing family planning and preventing postpartum infections. For those with poor postpartum uterine contractions, uterine contraction medications should be promptly administered. Attention should be paid to appropriate prone or knee-chest positions postpartum, as well as postpartum exercises, to prevent uterine retroversion and reduce pelvic congestion. Active treatment of ovarian dysfunction is necessary to avoid prolonged estrogen stimulation.