Cystic endometrial hyperplasia (CEH) is a uterine pathology that frequently affects the bitch and other female mammals. It is a hormone-dependent process in which a proliferation of the endometrial glands of the uterus occurs. Although it is not a serious disease, it usually evolves towards the development of endometritis and pyometra.
If you want to know more about cystic endometrial hyperplasia in dogs, its causes and treatment, we recommend that you read the following article from our site where we also explain the symptoms and diagnosis of this reproductive pathology.
What is cystic endometrial hyperplasia?
Cystic endometrial hyperplasia (CEH) is a pathological process characterized by proliferation of the uterine endometrial glands and hypersecretion of these glands, which causes an accumulation of exudates in the lumen of the uterus. This hyperplasia and hypersecretion of the endometrial glands facilitates the formation of cysts, hence the name of the disease.
This is a reproductive pathology that frequently affects the uterus of bitches and other female mammals, such as sheep and cats. Specifically, affects 25% of bitches, of which 75% are nulliparous (have never given birth).
Although it can occur at any age after puberty, on average it usually appears at 7, 5 years old This is due to because, in each estrous cycle, the uterus becomes sensitized to the effect of hormones, until endometrial hyperplasia finally develops. A characteristic aspect of HEQ is that it occurs mainly during the luteal (right-handed) phase of the estrous cycle, so it can be considered a right-handed disease
Although it is a non-inflammatory pathology of the uterus, the presence of uterine secretions can favor upward contamination of vaginal origin, which leads to the formation of:
- An endometritis: inflammation of the endometrium.
- A pyometra: accumulation of purulent exudate inside the uterus. Find out more about canine Pyometra: its causes, symptoms and treatment in this article on our site that we recommend.
Because they are processes that usually appear together, they are usually referred to as "cystic endometrial hyperplasia complex – pyometra in dogs".
Causes of cystic endometrial hyperplasia in bitches
During the estrous cycle or reproductive cycle, the uterus undergoes a series of morphological changes under the influence of estrogens and progesterone The Cystic endometrial hyperplasia occurs as an abnormal response of the uterus to these hormones. Specifically, there is first an influence by estrogens, which increase the number of estrogen and progesterone receptors. Next, progesterone acts by favoring the proliferation of the endometrium and increasing the secretion of the uterine glands.
Therefore, we can say that there are two factors that act together to give rise to HEQ in the bitch:
- High estrogen levels (hyperestrogenism): for HEQ to occur there must be a high influence of estrogen, since these They cause an increase in the number of estrogen and progesterone receptors. The cause of hyperestrogenism can be endogenous (due to ovarian cysts or granulosa cell tumors, which produce estrogen) or exogenous (due to drug administration).
- Continuous Progesterone Stimuli: Progesterone increases secretion from the endometrial glands, reduces muscular contraction of the uterus, and closes the cervix. Continuous progesterone stimuli can appear during the diestro phase of the estrous cycle, or after its exogenous administration (usually by progestin drugs used to inhibit estrus).
Symptoms of cystic endometrial hyperplasia in bitches
The clinical signs associated with cystic HEQ in bitches depend fundamentally on their stage of development:
- When HEP is poorly developed, the symptomatology is nonexistent, that is, the bitches remain asymptomatic.
- When HEP progresses, infertility and mucous-type vaginal discharge. often appear.
However, as we have explained in previous sections, HEQ usually evolves towards the development of endometritis and pyometra. In these cases, we will see more serious signs such as:
- Purulent vaginal discharge
- Anorexia and depression
- Polyuria and polydipsia
- Fever
- Abdominal distension
- Vomiting and diarrhea
If not treated urgently, bacteria and endotoxins present in the uterus can pass into the bloodstream, causing septic shock or endotoxic, followed by multi-organ failure and death of the animal.
Diagnosis of cystic endometrial hyperplasia in bitches
For the diagnosis of HEQ in bitches, the following points should be taken into account:
- Moment of the estrous cycle: in bitches with signs compatible with HEQ it is important to assess the moment of the estrous cycle in which they are. As we have pointed out, hyperplasia of the endometrial glands usually occurs during the diestrus phase, but the signs do not usually appear until 2-12 weeks after the last heat.
- Vaginal cytology: the image of the vaginal smear will be normal, since the alteration is at the uterine level. However, when the process is complicated by an infection (pyometra), degenerated polymorphonuclear cells and intra- and extracellular bacteria can be seen in the smear.
- Ultrasound: In early stages, hardly any changes are seen in the ultrasound image of the uterus. However, as the pathology progresses, a thickened endometrium with irregular cystic elevations and the presence of secretion in the uterine lumen can be observed.
Treatment of cystic endometrial hyperplasia in bitches
The treatment of HEQ in bitches can be approached from two points of view:
- Conservative treatment: based on pharmacological treatment based on aglepristone, in order to block progesterone receptors. However, we must bear in mind that even if conservative treatment is effective, the process can reappear in the next estrous cycle.
- Surgical treatment: consists of performing a castration (ovariohysterectomy) of the bitch. Unlike pharmacological treatment, surgical treatment is curative and definitive, since it manages to eliminate the hormonal influence that triggers the pathology. Don't hesitate to consult this article with more information on Neutering a dog: price, postoperative period, consequences and benefits.
Remember that castration manages to reduce hormone levels and prevent or resolve many of these hormone-dependent processes. For this reason, we recommend that you consider sterilization as a good option to prevent these and other multiple reproductive pathologies in the bitch.
