Endometrial polyp is the formation of a benign character, located inside the uterus.
The formation of endometrial polyps is a hyperplastic process, that is, an excessive, uncharacteristic formation originating from an expanding endometrium (inner wall of the uterus). In the formation of multiple polyps or in the recurrence (re-formation) of a polyp, one already speaks of a polyposis as a disease.
A polyp (and not only in the uterus) is a typical pathological formation consisting of a body and a leg, with which it is attached to its base within the organs.
If we talk about endometrial polyps, they, based on the characteristics of the structure and composition of cells, are divided into:
- glandular polyp consisting of stromal cells with the inclusion of uterine glands,
- glandular fibrous polyp, which has a mainly fibrous structure with a rare inclusion of the uterine glands,
- fibrous polyp – it consists exclusively of fibrous cells, no other cells are found in the structure,
- Adenomatous or precancerous polyp are predominantly glandular cells, some of which have atypical signs (signs of degeneration into cancer).
Endometrial polyps can occur at any age, regardless of sexuality, pregnancy or childbirth.
But, for the most part, their formation is noted after 30-35 years, the risk of polyposis increases by 50 years.
At a young age, when women become pregnant and give birth, glandular types of polyps appear more often, in old age, after the onset of menopause, fibrous and adenomatous formations, but fibrous glandular polyps can form at any age.
The main causes of the development of both single and multiple endometrial polyps can be identified:
- hormonal abnormalities in excess estrogen or deficiency progesterone.
- carrying out traumatic uterus manipulations: abortion, curettage for the purpose of diagnosis without proper control, or too long wearing of the intrauterine device.
- termination of pregnancy, miscarriages or difficult childbirth – while the remaining pieces of tissue or blood clots will be replaced by elements of the connective tissue, i.e. a polyp will form.
- disorders in the endocrine system (disruption of the thyroid gland, obesity or diabetes mellitus ), violating the exchange of sex hormones.
- chronic pelvic inflammatory process – genital infections with development endometritis, inflammation of the inner lining of the uterus.
Symptoms of an existing endometrial polyp can be very diverse, they depend on the number of polyps in the uterus and their size.
With a single small polyp, manifestations may not occur at all, and it is accidentally detected during routine examinations.
If the endometrial polyp is large, or there are many, manifestations may occur in the form of:
- disorders of the cycle of the type of spotting or intermenstrual bleeding,
- abundant or prolonged menstruation,
- pain during menstruation,
- lower abdominal pains, aggravated after orgasm or sexual intercourse, spotting after intercourse,
- increased secretions, whiter, especially with large polyps,
- in older age, when menopause occurs, there may be occasional bleeding after exercise or stress.
If one or more of the symptoms described previously, the gynecologist’s consultation is necessary.
Today, endometrial polyps can be detected quite easily. When examining the chair, if there is a polyp in the area of the cervix, it can be detected when viewed in the mirrors. The outer mouth looks filled with pink color.
But if the polyp is located inside the body of the uterus, an ultrasound can reveal it.
For accurate diagnosis is carried out:
- Ultrasound of the pelvis, with the detected expansion of the uterus, there is a clear contouring education.
- Conducting diagnostic hysteroscopy – under general anesthesia, a special device with a camera and optics is inserted into the uterine cavity, it allows you to visually detect a polyp and, at the same time as the diagnosis, remove it. In addition, the uterus is carefully inspected for its various injuries.
- A removed polyp is examined histologically. This allows you to determine its type, structure and confirm the diagnosis.
Polyps must be distinguished with small fibroids, endometriosis and early stages of pregnancy, including non-viable.
Treatment of fibrous forms
Endometrial polyp is a direct indication for diagnostic hysteroscopy and its removal.
During hysteroscopy, the polyp itself is removed, and the area of the uterus, where it was attached, is scraped with a curette under the control of the camera.
With a large size of a polyp with the presence of a clearly defined leg, it is “twisted off” as it were – a polypectomy is performed. In the place of attachment of the polyp, its bed is treated with liquid nitrogen or electric current, this helps prevent recurrence.
The operation is quick, under general anesthesia, approximately ten days can be bloody issues from the uterus.
In order to prevent infection, after surgery, broad-spectrum antibiotics are prescribed. The material obtained during the operation is necessarily sent to histology, since in determining the adenomatous polyp the treatment will be continued more radically.
On the third day after the operation, ultrasound is monitored and further therapy is determined.
With endometrial fibrous polyp and the absence of irregularities in the menstrual cycle, treatment is completed.
When glandular and glandular-fibrous forms after curettage shows a course of hormonal therapy.
For her apply:
- Combined oral contraceptives of the type of Yarin , regulon or zhanin. The purpose of these drugs is shown to women under 35-40 years old,
- gestagenovye preparations for duphaston type utrogestan or norkoluta. Assign women after 35-40 years.
Hormone therapy lasts from three to six months.
The hormone-containing Mirena helix can be used. It is suitable for women of reproductive age, not planning more children, or those who have polyposis combined with myomas. Put for up to five years.
Treatment of adenomatous polyps
This type of polyp predisposes uterine cancer, so its treatment is active and radical. For women over the age of 45, only hysterectomy is indicated (removal). If the family has oncological predisposition or a woman has hormonal disorders, the uterus with appendages is removed.
A woman of childbearing age is shown to remove a polyp with the appointment of hormones after surgery, as well as active observation. In the case of recurrence of adenomatous polyp of the endometrium – removal of the uterus is shown.
The most important of the complications is the development of infertility, also there are irregularities in the menstrual cycle, loss of a large volume of blood with the development of anemia.
In addition, relapses may occur – the polyp re-grows, turning into polyposis.
In rare cases, endometrial polyps can turn into malignant tumors, endometrial cancer, the inner lining of the uterus, basically it is possible only with adenomatous form.