Endometrial polyp is a pathological process that is characterized by the formation of a benign tumor on the inner lining of the uterus, formed from the basal layer of the endometrium.
The size of endometrial polyps can have different options - from a few millimeters to several centimeters. Some very large polyps may even have small blood vessels. Endometrial polyps on the pedicle may protrude into the vagina through the cervix.
Most often polyps occur between the ages of 35 and 50 years and above, but in some cases they are observed in young girls.
Based on the characteristics of the structure and composition of cells, endometrial polyps are divided into several types:
- glandular polyp of the endometrium. It consists of stroma and glands and is most often seen in women of childbearing age,
- endometrial fibrous polyp. The structure of this formation is dominated by connective tissues, are extremely rare in older women,
- endometrial glandular fibrous polyp. Consists of a small number of glands and connective tissue, occurs in women after 35 years,
- endometrial adenomatous polyp (precancerous). It consists of glandular epithelium, but at the same time has atypical cells.
Causes of endometrial polyp
Modern medicine can not unambiguously and fully answer the question that contributes to the occurrence of endometrial polyps. But there are a number of factors that increase the risk of the disease:
- violation of hormonal ovarian function as a result of increased estrogen levels against the background of progesterone deficiency,
- traumatic injuries of the uterus due to abortions, multiple diagnostic curets, wearing the intrauterine device for a long period of time,
- spontaneous miscarriages, termination of pregnancy, difficult childbirth, as a result of which there are blood clots in the uterus, parts of the placenta, which are subsequently replaced by connective tissue,
- extragenital diseases and disorders of the endocrine system of the body (thyroid disease, obesity, diabetes, hypertension),
- psychological factors (depression and severe stress),
- reduced immunity
- chronic inflammatory diseases of the pelvic organs (infections, endometritis, inflammation of the appendages).
Very often, endometrial polyps have no clinical manifestations (especially if their sizes are very small) and you can detect them completely by chance during an ultrasound examination. But in some cases, the disease may be accompanied by the following symptoms:
- violation of the menstrual cycle, which is manifested by the appearance of scant bleeding that is not related to menstruation of a smearing nature (in the intervals between the monthly periods). In postmenopausal women, these symptoms are not consistent, but most often appear once in the form of blood discharge from the genital tract. In young women, on the contrary, the appearance of polyps is accompanied by copious menstruation (menorrhagia),
- colic pains in the lower abdomen, which are usually worse during intercourse,
- the appearance of pathological secretions from the genital tract - whiter, characteristic of very large polyps,
- the appearance of bleeding from the genital tract of a contact nature (after intercourse),
- female infertility in young reproductive age.
Diagnosis of endometrial polyps in our time is not difficult. If the polyp is located in the area of the cervix, then it can be detected during an examination on a gynecological chair using mirrors. In this case, the external pharynx has the form of an organ filled with some pink formation. If the polyp is located inside the body of the uterus, then its detection is possible only with the help of ultrasound. To clarify the diagnosis carried out:
- ultrasound examination of the pelvis, which reveals the expansion of the uterine cavity with the presence of education with clear contours,
- diagnostic hysteroscopy
- histological examination of a removed polyp.
Endometrial polyps differentiate with endometriosis, myomas, and early stages of pregnancy.
It is impossible to cure this disease by conservative methods (without surgery). Therefore, the only and primary way to remove a polyp is surgery. Under the control of a hysteroscope, the endometrial polyp is removed, and the uterine cavity is scraped out. If the size of the polyp reaches from 1 to 5 cm, then polyctomy is performed (removal of the formation by unscrewing). During surgery, a scraping is taken from the uterine mucosa, which is necessarily sent for histological examination.
To prevent recurrence after the removal of the endometrial polyp, the place to which it was attached is cauterized with liquid nitrogen or electric current. On the 4-5th day after the curettage was performed, the patient was prescribed a control ultrasound examination of the small pelvis.
If the occurrence of an endometrial polyp is not accompanied by impaired menstrual function, and the formation itself has a fibrous structure, then therapeutic manipulations include only scraping the endometrial polyp and uterine mucosa using hysteroscopy.
Women of any age to regulate the menstrual cycle and normalize the level of hormones when detecting endometrial glandular polyps and glandular fibrous structure are shown hormonal treatment.
In cases where a woman is in the premenopausal or postmenopausal period when an endometrial adenomatous polyp is detected, a more radical treatment is indicated, namely the removal of the uterus. If this form of the disease is accompanied by endocrine disorders and causes oncological alertness, it is recommended to remove the uterus along with the appendages.
Reproductive age and the absence of metabolic disorders allows hormone therapy as a restorative treatment after curettage of the endometrial polyp. For this purpose, use:
- combined oral contraceptives (Yarin, Regulon, Zhannin),
- progestins (Utrozhestan, Norkolut, Duphaston),
- hormonal coil "Mirena".
The postoperative period passes, as a rule, without complications. After hysteroscopy for 10 days, the patient may have a spotting blood from the vagina. During this period, shown low-calorie diet, as well as a complete rejection of sexual relationships.
Although endometrial polyps are benign tumors, treatment should not be neglected, as this can lead to a number of complications:
- violation of the menstrual cycle with the subsequent development of anemia,
- endometrial polyposis recurrence after curettage,
- malignancy of education in adenomatous polyps - endometrial cancer.
As you know, any disease is better to prevent than to cure. As prophylactic measures for endometrial polyps, it is recommended:
- regular visits to the gynecologist,
- obesity prevention for weight control,
- rejection of abortion
- use of hormonal contraceptives,
- timely treatment of inflammatory diseases of the uterus and its appendages.
Taking care of their health and following the recommendations of specialists, every woman can avoid many problems.
The uterus inside is covered with a special layer of cells - the endometrium, which plays a significant role during the implantation of the ovum and the preservation of pregnancy. The thickness and consistency of this layer is constantly changing depending on the natural hormonal changes associated with the phases of the menstrual cycle. In some cases, oblong processes can be formed on the surface of the mucous membrane, called polyps in gynecology.
The endometrial polyp is a neoplasm that appears inside the body of the uterus, has a benign character and several varieties (depending on the cell composition). Most often, the pathology is found in women older than 40 years who notice the first signs of premenopause, however (in general) tumors can be diagnosed in patients of all ages.
Causes of endometrial polyps in the uterus
The appearance of polyps is associated with hormonal disorders, inflammation or mechanical trauma, namely:
- Childbirth - the more numerous they were, the greater the risk of endometrial polyp formation.
- Abortions - during this manipulation occurs not only a mechanical injury of the uterus, but also a serious hormonal failure.
- Dysfunction of the ovaries and adrenal cortex. Especially in cases when a woman’s analysis shows a high level of estradiol in the blood and a lack of a second-phase hormone, progesterone.
- Constant inflammatory processes in the uterus, which are not properly treated.
- Long-term use of spirals.
- Perennial regular use of hormonal drugs.
- The use of emergency contraception, which provoke the strongest hormonal disruptions in a short period of time.
- Diagnostic curettage of the uterus.
- Incomplete removal of the placenta during labor.
- Incomplete removal of large blood clots from the uterus after delivery.
Polyp formation mechanism
All changes in the internal mucous layer of the uterus are associated with the level of hormones, in particular, estrogens. With their oversupply, the monthly processes of building and rejection of the endometrium are violated, and its growth becomes uncontrollable.
As a result, the endometrium in certain parts of the uterus begins to grow in height - this is a polyp. If the hyperplastic process is not extensive, the outgrowths can be sporadic. If hyperplasia affects the entire inner layer, the location of the polyps is focal.
Types of polyps and structural features
There are several types of endometrial polyps in the uterus. They differ in their structure as well as in the risk of malignancy.
Glandular endometrial polyp - soft in consistency, consists entirely of glands and stroma. At the base of the leg is a large number of blood vessels that support blood circulation in it. At small sizes, the polyp has an asymptomatic course. With increasing diameter, a violation of the duration of menstruation appears. When giant glandular polyps in patients, there is a feeling of discomfort, distention in the lower third of the abdomen, slight pain that does not have a cramping character.
Glandular fibrous endometrial polyp is a neoplasm consisting of fibrous tissue and glands. Its characteristic location is the area of the bottom of the uterus. It has a rounded body and a leg. Prone to malignancy, as in its structure contains atypical cells. For a polyp of this type are characterized by intermenstrual bleeding, pain during intercourse. If the tumor reaches a large size, it may cause cramping pain.
Adenomatous endometrial polyp - located on the bottom of the uterus and in the mouth of the fallopian tubes. Almost always has a small size (no more than 1 cm in diameter). Diagnosed mainly in premenopausal women. An adenomatous polyp always has a pedicle, and the blood vessels at its base are unevenly arranged. Gynecologists note a 15% risk of malignant neoplasm.
Common symptoms of the disease
Each type of polyp is characterized by individual signs, but in general, symptoms that indicate the presence of a tumor in the body of the uterus may be the following:
- Increase the number of whiter.
- The color change is whiter: they can be mixed with blood or have a grayish tint.
- Nagging pains throughout menstruation.
- The increase in the duration of menstruation, the protracted period of bleeding after it.
- Discomfort during sexual intercourse, especially if it is intense.
- Feeling of abdominal distention (with large polyps).
- Disruption of the menstrual cycle, delay
- Regular anovulation
- Intermenstrual bleeding
- General weakness, deterioration of well-being (with large polyps or with multiple foci of polyps).
Medication treatment or removal?
The basis of therapy should be based on the understanding that, in order to avoid relapses, it is necessary to get rid of the reason for the uneven growth of the internal mucous layer. And even if this root cause is identified, the treatment of an endometrial polyp without an operation will still not be enough, since the mechanical removal of a tumor is the only guarantee that it will completely disappear.
In addition to surgery, the patient must be prescribed a conservative treatment, which will be aimed at eliminating the pathological processes that led to the appearance of a polyp.
Alignment of hormonal background - if it is established that the proliferation of the endometrium was due to endocrine dysfunction, then a course of hormonal drugs is prescribed. It can be both oral contraceptives, and hormonal agents, selected for each hormone on an individual basis.
- The duration of treatment will be at least 3 months, because hormonal levels are usually leveled off and difficult.
Reduction of the inflammatory process - often the cause of a tumor becomes long-lasting inflammation, which has not been eliminated for a long time. In this case, the doctor will prescribe antibacterial drugs and anti-inflammatory drugs - this treatment should be continued after the removal of the endometrial polyp to consolidate the result.
The operative part of the treatment
After the root cause of the disease is detected and treated, the doctors proceed to the mechanical removal of the neoplasm. Surgical minimally invasive intervention can be performed both during hysteroscopy and during curettage of the uterus.
- Hysteroscopy removal
The operation must be performed at the beginning of the menstrual cycle immediately after the cessation of bleeding. During the procedure, a hysteroscope is inserted into the vagina and cervix, which is a tube with a mini-camera attached to it. This procedure is painful, so it is performed under epidural or under general anesthesia. The image of the hysteroscope is displayed on the monitor - this allows doctors to assess the condition of the endometrium.
The uterus cavity is filled with a special substance or air - this is necessary in order to see the contours of the genital organ, as well as to facilitate inspection.
The detected polyp is removed with small scissors attached to a hysteroscope. Then the excision site is processed, the solution from the uterus is removed, and the hysteroscope is removed. Biological material is sent for histology.
After removal of the endometrial polyp, bleeding and aching pain in the lower abdomen will be observed for 4–5 days. In some women, the length of the menstrual cycle is disturbed.
- Removal by scraping
It is used in cases where diagnostic measures have shown the presence of multiple foci of polyps. The procedure is performed under general anesthesia and is more traumatic than the removal of single tumors during hysteroscopy.
The essence of the method lies in the fact that the upper mucous layer of the uterine cavity is removed with a scalpel, and then curettage is performed - the removal of biological material beyond the uterus and vagina. During curettage, endometrial polyps are eliminated along with the mucous layer and sent for research on the subject of malignancy.
- Removal by hysterectomy
Elderly patients who have found multiple foci of polyps are recommended to remove the uterus. This is done because with age the risk of malignancy of neoplasms increases, especially if the damage to the reproductive organ is extensive.
The operation is performed under general anesthesia. Before surgery, the doctor may preliminarily take a material for histology to determine the type of polyps. If it is found that the tumors are adenomatous, then not only the uterus is removed, but also the appendages, in order to reduce the risk of developing a malignant tumor.
Polyp endometrium during pregnancy
Polyps in the uterus can become an obstacle to conception, so for many women only their removal can be a treatment for infertility.
During pregnancy, polypectomy is impossible - the risk of miscarriage is too high. If a polyp is rapidly increasing in size, then the doctor prescribes a conservative treatment: hormonal or anti-inflammatory and antibacterial drugs (depending on the reason that caused the appearance of neoplasia).
It should be understood that such therapy is only a temporary measure that will inhibit tumor growth. After the baby is born, it should be removed using the operation, if it was not eliminated itself during the birth.
What is a polyp
Очаговое разрастание слизистой матки доброкачественного характера, представляющее собой вырост мукозного слоя, называется полипом эндометрия (код по МКБ-10). The centers can be, both single, and multiple. Most growths are small, only a few millimeters, but sometimes reach several centimeters in size. Multiple formations or re-formed after resection indicate the development of a disease such as endometrial polyposis. The growth of uterine tissues are found in women of any age, but more often they are diagnosed after 35 years.
How fast a polyp grows
The size of the growths can be different, but more often they do not exceed 10 mm. An endometrial glandular fibrous polyp may not give a woman trouble for a long time, but if provoking factors are present, for example, pregnancy, curettage of the uterus, surgical abortions, progesterone deficiency, the polypous formations can increase due to a large production of secretory fluid. The growth rate depends on the patient’s health condition. The danger of growths is not in size, but in the possibility of transforming their cells into malignant neoplasms.
Single growths of small size are formed without any symptoms. Basically, they are a random finding during an ultrasound examination of the uterine cavity. The main signs of the endometrial polyp are infertility or the non-occurrence of the desired pregnancy against the background of the general health of the female body. After the growth of tumors, the following symptoms appear:
- copious painful menstruation,
- uterine bleeding that occurs in the middle of the cycle
- blood discharge after intercourse outside menstruation,
- increased whites more thick consistency with a whitish tinge.
If you delay with the diagnosis or a visit to the doctor, then with the late treatment of a polyp in the uterus, there may be some complications. Among them:
- severe post-hemorrhagic anemia,
- health bleeding,
- pinching growth,
- the growth of the endometrium to large sizes
- uterine fibroids,
- necrosis of a polyp with ischemic changes,
- endometrial cancer.
Polyposis during pregnancy
In most cases, in the presence of a polyp, a long-awaited pregnancy does not occur, so an operation to remove it immediately resolves the issue of infertility. If the woman is still pregnant, the surgery is delayed for the postpartum period. Polyposis does not have any dangerous effect on the health of the mother and the full development of the child. However, if they are formed in the cervical canal of a pregnant woman, she is prescribed antimicrobial therapy.
This is a gynecological procedure in which a probe with LEDs and a video camera is inserted into the uterus. When diagnosing endometrial growths, the doctor examines the condition of the mucous membrane to refute or substantiate the alleged diagnosis. Surgical hysteroscopy involves the removal of a polyp. Indications for such a diagnosis are:
- suspicions of malignant neoplasms,
- overgrowth of the mucous membrane (endometriosis),
- the assumption of the presence of a tumor (fibroids),
- remaining after childbirth fragments of the shell of the fetus in the cavity,
- excessive profusion or irregular menstruation,
- infertility or repeated miscarriages,
- out-of-cycle vaginal bleeding.
Polyp alone can resolve after menopause. In all other cases, it should be treated. Therapeutic methods have three schemes: continuous monitoring of a small growth, the use of drugs, surgical excision. When choosing a method of treatment, the doctor takes into account the type and size of the education, the age of the patient, the symptoms, her wishes regarding further pregnancies and the ability to bear the child. If surgical removal is selected, then hormone therapy is prescribed in parallel.
Surgical treatment is indicated only for atypical and fibrous polyps. In all other cases, possible medical treatment. Conservative methods can be prescribed to women who did not give birth, with contraindications to surgery or with the patient's categorical refusal of surgical intervention. For the treatment of mucous glandular and placental polyps are allowed to use popular recipes. After treatment of the formations in the uterus, the woman should be monitored by a gynecologist, as recurrences of the disease may again appear.
Conservative treatment is phased and multifaceted. It includes drug therapy, hormones, homeopathy. Conservative treatment is aimed at suppressing the growth of uterine tissue, the disappearance of tumors, reducing the risk of complications. Popular drugs include:
- Janine. Combined oral contraceptive, restoring the balance of hormones, stimulating the production of progesterone. Take pills from the first to the last day of menstruation. The duration of treatment is determined by the doctor individually. During the use of medication possible side effects: depression, decreased libido, stomach discomfort.
- Duphaston. Progestin, the active substance of which is the female sex hormone progesterone. The drug restores homeostasis, adjusts the menstrual cycle, normalizes the level of progesterone, improves the endocrine system. Drink pills for 1 pc / day for 3-6 months. The drug is not prescribed to patients suffering from lactase deficiency.
- Nafarelin. A drug from the group of agonists. Nafarelin - an analogue of gonadotropin-releasing, stimulating the secretion of pituitary hormones. It reduces the amount of estrogen that provokes the growth of the endometrium. The course of treatment from 3 months to six months. Daily dose - 400 mg. Among the adverse reactions possible redness of the face, vaginal dryness, a decrease in the size of the mammary glands, emotional lability.
What are polyps in the uterus?
Endometrial polyps are benign tumors in the uterus. Under certain conditions, abnormal cell proliferation occurs in its mucosa. At the same time there are growths that have thin legs that connect the polyps with the epithelium. Each of them has an extensive network of vessels passing through the leg and connecting with the circulatory system of the endometrium. In this way, the supply of neoplasms with blood occurs, which ensures their growth.
Polyps can be in diameter as a few millimeters, and a few centimeters. They usually occur in women older than 40 years. Malignant degeneration of neoplasms can occur.
Possible occurrence of both single and multiple endometrial polyps.
The reason for the abnormal growth of the endometrium is the fluctuation of the ratio of sex hormones estrogen and progesterone. In the first phase of the cycle, estrogen is responsible for updating the mucosa after menstruation, and in the second phase, an increase in the content of progesterone leads to an increased proliferation of the blood vessel network, an increase in the number of glands. Lack of progesterone causes the mucous membrane to develop unevenly. As a result of hyperplasia of the glandular and fibrous tissues, an endometrial polyp is formed.
Progesterone deficiency can occur if the ovaries function with impairments as a result of various endocrine abnormalities in the body. Another cause of hormonal imbalance is long-term use of drugs with a high content of estrogen.
During abortion or curettage of the uterus, incomplete removal of the endometrium is possible. The remaining particles and blood clots prevent the proper growth of the mucous membrane, which leads to the appearance of growths in it. Usually they are formed in the bottom of the uterus or in the folds.
Mechanical damage to the mucous membrane occurs with prolonged use of the intrauterine device.
Inflammatory and infectious processes
As a result of the inflammatory process, scars and adhesions form in the uterine cavity. Endometrium is damaged, begins to grow pathologically. This leads not only to the formation of endometrial polyps, but also to endometriosis.
Most often, such diseases appear in women with weak immunity. The penetration of infection into the uterus contributes to the deterioration of the vaginal mucosa during menopause. This is due to aging of the ovaries and a sharp decrease in estrogen production.
Symptoms of such diseases are copious discharge with a bad smell, having a yellow-green or grayish-white color, heterogeneous consistency.
Symptoms of endometrial polyposis
A small polyp in the uterine cavity does not cause discomfort to the woman and does not manifest anything. With its increase, the formation of multiple polyps violated the nature of menstruation. They become long and painful. Perhaps the appearance of spotting bleeding with a musty smell before menstruation and after them.
Damage to a large endometrial polyp is accompanied by bleeding between periods. Blood loss causes symptoms of anemia, such as weakness, headache, dizziness, nausea, fainting, a heartbeat that is not normal, a drop in blood pressure.
The formation of polyps in elderly women usually causes the appearance of scanty single secretions that are brown in color due to the ingestion of a small amount of blood. A characteristic sign of the formation of endometrial polyps is the presence of recurrent spasmodic pains in the lower abdomen, as well as bleeding after sexual intercourse.
When a polyp is “born,” it falls into the neck, pain in the abdomen resembles contractions.
Surgical treatment methods
Polypectomy. The operation to remove a polyp is performed by curettage of the uterus under the control of hysteroscopy. At the same time twist his leg until the polyp comes off. The surface of separation is cauterized with the help of an electrode. Sometimes liquid nitrogen is used for cauterization. The removed material is sent for histological examination. A few days after the endometrial polyp removal procedure, a control ultrasound examination is performed. This method of treatment is used in the case when the patient has a small fibrous polyp. It is important to completely remove the foot so that it does not grow in this place again.
Scraping the uterus. Such a procedure (curettage) is performed if there are several polyps. When using this method often relapses occur, in addition, possible damage to the surface, the occurrence of the inflammatory process. Often this leads to the emergence of other diseases of the genital organs.
Ablation of the uterus. In the case when an endometrial polyp occurs in a woman of menopausal age, and if there is a risk of other similar tumors and their cancer transformation, the endometrium is removed using a laser, electric current, radio frequency waves, liquid nitrogen. This makes growth of the mucous membrane impossible.
Such an operation is not performed to treat women of reproductive age, since after it a woman cannot bear the child.
Hysterectomy. The uterus is completely removed if a malignant degeneration of the polyps is detected.
Types of endometrial polyps
Polyposis can develop at different ages. Increases the risk of menopause, starting at age 40. The proliferation of tissues of a healthy endometrium occurs due to hormonal imbalance, inflammation in the genitals, under the influence of adverse factors. To the mucous membrane of the uterus education is attached with the leg, consisting of many vessels or a wide base.
The structure of the polyp does not initially differ from the structure of the endometrium, but changes with time. In this regard, there are several types.
Intrauterine neoplasm is associated with enhanced proliferation of cells of the upper functional (germ) layer of the endometrium, the basal. Formed in the uterus, her cervix. Polyps are singular and plural. Often appear on the background of other pathological processes in the genitals. Neoplasms of irregular shape, elongated or flattened. They differ in the structure of cells, in size - from 1 mm to 8 cm.
The uterus mucosa is formed from the basal layer, functional with a large number of glandular cells, vessels. The latter is subject to regular changes throughout the monthly cycle. In the first half, it grows, in the second - preparation for rejection.
Unlike endometrial hyperplasia, with polyposis, excessive cell growth occurs only in a specific place, does not cover the entire layer. The structure of tumors is not different from its tissues. Symptomatically does not manifest itself.
The polyp can disappear after menstruation as the functional layer of the endometrium is rejected, and it can begin to form when the uterus is incompletely cleansed. Consists of glandular cells, the minimum number of glandular stroma.
Most often formed at a young age, proceeds without pronounced symptoms, is detected by chance. Allocate another type of glandular polyps - placental. Formed from the lobes of the placenta left after childbirth, miscarriages, abortions. The main method of treatment is the histology of polyps, you should first be examined (examination by a gynecologist, laboratory tests of secretions, blood, urine, colposcopy, ultrasound).
The endometrial polyp has a glandular structure, but at the base, fibrous tissue forms. This type of polyposis is rarely diagnosed.
The true cause of the development of the glandular fibrous polyp is not clear, it is formed in women with a regular monthly cycle. The neoplasm provokes bleeding during menstruation, pain, specific discharge between periods.
Polyps are made up of glandular tissues, they are irregularly shaped. They are attached to the base with the help of supporting stromal cells - fibrous tissue. Vessels thicken, are placed in different parts of education. On examination, inflammation of the mucous membrane is observed, and blood circulation is impaired. Treatment - surgical, after a thorough examination.
This type of neoplasm is characteristic of women after 40 years of age during menopause. The main reasons are not hormonal changes, as in most cases, but a change in the structure of the mucous membrane, chronic endometritis, reduced immunity, injuries, vascular, endocrine diseases.
The tumor consists of cells of the basal layer, a small number of glands. The leg of the polyp is elongated or absent, the neoplasm is attached with a wide base. Cell fibrosis is asymptomatic, only with a significant increase in size is manifested by bleeding, prolonged periods, pain.
The presence of polypoid fragments on the endometrial layer is a single phenomenon developing on the background of mucosal atrophy. The maximum size is 1 cm. The leg is drawn out over time. Diagnostic methods - inspection, ultrasound, hysterography, hysteroscopy, scrape examination. Therapy - operational.
A polyp is formed in the endometrium in women of menopausal age, but there are exceptions. The development of atrophy of the mucous membranes, immunological, endocrine pathologies, circulatory disorders. The number of adenomatous formations is different. They differ in shape and size.
It is characterized by excessive proliferation of glandular tissues, a small amount of fibrous, and there is also a mutation of cells. The structure is dense, the size of pathological polyps - from 1 mm to several centimeters. Adenomatous type is the most dangerous because it increases the likelihood of the formation of cancer cells. Experts call it the precancerous condition of the uterus.
Diagnostics includes various methods, treatment is complex, including surgical.
Reasons for education
The exact causes of neoplasm development are unknown, but suggestive factors have been established. The manifestation of polyposis and signs of pathology are associated with hormonal disruption and an increased amount of estrogen, inflammation in the genitals, and injuries. Another of the provocateurs are the disruption of the functioning of the blood-vascular system, enhanced vascular growth in the uterus.
The cause of the development of endometrial polyps is the simultaneous influence of several adverse factors, such as:
- diseases of the adrenal glands, thyroid, pancreas,
- long-term use of hormonal drugs,
- depletion of the nervous system, severe psychological stress, prolonged depression,
- late abortions,
- curettage for various reasons
- intrauterine device,
- genetic predisposition
- autoimmune disorders
- weak immunity,
- puberty, the extinction of reproductive functions,
- genital infection
- chronic inflammatory processes (not only in the organs of the reproductive system).
To prevent the appearance of tumors should promptly seek help from specialists, to prevent the weakening of the protective functions of the body.
Symptoms of pathology
In most cases, the endometrial polyp is asymptomatic or with minor manifestations. The symptoms are similar to many gynecological diseases, so self-diagnosis is complicated.Neoplasms are detected by chance during routine inspection or when clarifying the cause of infertility.
A hormonal imbalance accompanies the appearance of polyps, so there is a change in the monthly cycle. Sometimes a menstrual abnormality is the only alarming symptom that causes women to seek help from specialists.
- The aching pain in the lower abdomen, in particular, with fibroids.
- Spotting with small polyps, neoplasms of large size in the middle of the cycle.
- Delayed menstruation followed by prolonged bleeding.
- Permanent abundant white, yellowish discharge.
- Discomfort in the vagina, pain in the process of intercourse.
- Minor bloody ointment or blood after sex in moderation.
- Bleeding after heavy physical exertion, nervous breakdown.
- Sudden menstruation after a long absence during menopause.
- Infertility, miscarriages.
Observed a decrease in efficiency, general weakness, sleep disturbance, nervousness, irritability, deterioration of general well-being. In the presence of genital infections, itching, burning in the vagina, urination problems, unpleasant odor, specific discharge are additionally present.
Endometrial polyp removal
The cardinal method of getting rid of polyps is to remove the entire layer of the endometrium or neoplasm.
- Scraping the uterus - prescribed in the absence of a therapeutic result after drug treatment, removal of the polyp. It is carried out in a hospital under general anesthesia. The advantage is a quick result, the disadvantage is a possible relapse. Apply when a polyp occurs in giving birth.
- Hysteroscopy - the most common method of removal of the polyp, which allows point to influence the pathological neoplasm. It is performed under local anesthesia, healthy tissues are not affected. Recovery is fast enough. After the procedure, a short course of antibiotics is prescribed, and, if necessary, hormonal therapy. Among the shortcomings are possible relapses. Not carried out in the presence of inflammatory processes, elevated body temperature, pregnancy, problems with blood coagulation. The cost depends on the complexity of the operation.
- Laser removal - cutting a polyp under the influence of a laser. Modern high performance method. The least traumatic, practically does not cause side effects. Within a few hours there is pain in the lower abdomen, there is a slight discharge. The procedure is carried out under local anesthesia, lasts from 5 minutes to half an hour (depending on the complexity of the situation). The main disadvantage is the high price. Contraindications are similar to hysteroscopy.
In the absence of a therapeutic effect after the application of various treatment methods, the uterus is removed.
Treatment of the disease
Eliminate the tumor is not particularly difficult, the main task is to prevent relapse. To achieve this, it is necessary to identify the root cause, which is not easy to do.
Many important systems of the body are involved in the pathological process - central nervous, endocrine, immune, sexual. It is not always possible to establish a true connection between the functioning of a particular system, the formation of a tumor, which is the cause of relapses.
One of the indicators of the influence of adverse factors on the formation of the endometrium is hormonal failure. In this case, prescribe a long course of therapy with hormonal drugs. The mechanism of action of products with the content of synthetic hormones for women during menopause, reproductive age is different.
In the presence of an inflammatory process, antibiotics of local, systemic action are prescribed. Treatment of genital infections is carried out with the help of special preparations, which are selected individually depending on the pathogen.
The main method of removal (extraction) of a neoplasm is hysteroscopy of a polyp, more precisely polypectomy. With the help of a hysteroscope, a targeted effect on the neoplasm is carried out. Removed body and leg. Manipulation is performed under local anesthesia, it does not take much time. After the procedure, prescribed a course of antibiotics, if necessary - hormonal drugs. The advantage of the procedure in the absence of serious side effects. The wound is cauterized, due to which adhesion processes do not occur, the possibility of getting pregnant and carrying the child remains. Minor bleeding is present for 3 days, then replaced by white.
Other surgical methods are cryodestruction, laser removal.
With the localization of the endometrial polyp in the cervix, the neoplasm is unscrewed using a special clamp. In order to destroy the base, electrocoagulation is performed.
In the case of re-occurrence of polyps, curettage of the uterus is prescribed. The procedure is called "curettage." It is performed under general anesthesia. In the process, the upper layer of the endometrium is removed along with the neoplasms. Indication for endometriosis is also indicated.
The removal of a polyp is surgically contraindicated in the presence of an infection, an inflammatory process. Initially, this problem is eliminated with medicines. In order to prevent recurrence after surgery prescribed a course of antibiotics, hormones, as well as restorative, folk remedies.
Therapy folk remedies
To improve immunity, it is recommended to regularly take Echinacea tincture, Eleutherococcus, Ginseng. To normalize the hormones, it is recommended to use herbs containing phytoestrogens. They have a beneficial effect on the nervous system, strengthen the body, contribute to the restoration of hormonal balance. These plants include:
- Borovaya uterus. In case of polyposis, it relieves inflammation, anesthetizes, restores hormonal balance, strengthens the body, normalizes blood circulation, prevents relapses. Should take a long time - at least 2 months, once a day, 30 drops of tincture. Treatment is contraindicated for high levels of estrogen, uterine bleeding, and normal menstruation.
- Red brush. If the previous herb is recommended to take with a low amount of estrogen, then this drink with insufficient progesterone levels. The tool normalizes hormones, strengthens the immune system, resists the re-development of polyps. Should take 1 tbsp. spoon a day an hour before meals for 1-2 months. Women of reproductive age are recommended to combine a boron uterus with a red brush, with a change of drugs every 2 weeks.
- Cowberry healing infusion, hips, crushed nettle take 250 ml twice a day. Mix 3 tbsp. spoons of all ingredients, pour a glass of boiled water, incubated in a closed container for 4 hours.
Folk remedies for the treatment of polyps cannot cure polyposis, but they help reduce symptoms and reduce the risk of recurrence.
Endometrial polyp and pregnancy
The presence of lesions in the uterus often causes infertility, since the appendix interferes with the passage of spermatozoa and the attachment of a fertilized cell. In the presence of endometrial polyposis increases the likelihood of miscarriage, penetration of infection into the uterus. In the case when the conception occurred, the egg had time to attach to the wall of the reproductive organ, there was no threat to the woman, there was no development of the fetus.
In most cases, the removal of the polyp is carried out after delivery, the entire pregnancy is under the close supervision of specialists. There are cases when hormone-dependent education self-resolves during pregnancy.
The location of tumors in the cervix, endometrium dangerous infection, the development of the inflammatory process. In this case, women are prescribed an ultrasound of the endometrial polyp, as well as histology. Prescribed antibiotics short course. In the first trimester of pregnancy with special indications may be removed surgically.
Bloody discharge after sexual intercourse can cause a polyp, and also be the beginning of bleeding. When a specific secret appears, you should immediately see the gynecologist.
Endometrial polyp is detected by chance during routine inspection, ultrasound, does not manifest itself symptomatically. Only in isolated cases there is a slight bleeding after intercourse, or just like that. This situation requires immediate treatment to specialists, since it is possible that bleeding and miscarriage may begin.
Endometrial polyp is a benign neoplasm that does not threaten a woman’s life, but can cause serious complications (the tumor is transported to the cancer, infertility develops, anemia is observed during prolonged bleeding).
The structure resembles the inner layer of the uterine epithelium: fibrous tissue with the location of the glands in the depth of connective fibers. Depending on the features of the structure, growths are fibrocystic, glandular or fibrous.
Endometrial polyps do not always consist only of fibrous and glandular tissue. Sometimes, after histological examination, atypical cells are found in the structure, which may be the germ of cancer transformation. Often these forms are observed in women after 40 years.
Classification of endometrial polyps of the uterus:
- Ferrous - from stroma and glands.
- Fibrous - from connective tissue.
- Glandular fibrous - a small amount of glands on the background of connective tissue.
- Adenomatous (precancerous) - atypical cells are located in the glandular structure.
Causes of polyps
So far, no prerequisites have been established. It is believed that the main role in the pathology belongs to hormonal factors. Amid increasing estrogen, glandular tissue growth is stimulated. The process can proceed atypically - with excessive growth of the endometrium. Nevertheless, adherents of the hormonal theory cannot explain the localized nature of the formations.
Some scientists are pushing an infectious version of the appearance of benign growths in the uterus. However, it was impossible to isolate the pathogen pathogen. Another view is the enhanced growth of vascular tissue in the uterus.
Factors accelerated growth of the endometrium are:
- small amount of progesterone,
- frequent abortions,
- age after 50 years
- inflammation of the inner layer of the endometrium,
- genetic predisposition
- genital endometriosis.
Polypous growths are called hyperplastic, as they represent a limited proliferation of the uterine mucosa. Only in cancerous degeneration can an active growth of formation be observed over the entire surface and germination through the shells. Despite its good quality, polyps must be under scrutiny, as they can be a source of chronic bleeding, infertility, and cancer reincarnation.
About 100 years ago it was believed that pathology is characteristic of women of childbearing age. Modern clinical studies have refuted this opinion and found that outgrowths can be observed in young girls before puberty, as well as in women after menopause.
Symptoms of polypous endometrial growths
Classic polyp growth is not accompanied by clinical manifestations. Usually they are detected by chance during an ultrasound examination of the uterus on a routine examination by a gynecologist, as well as in identifying the causes of infertility. Endometrial polyps are accompanied by:
- mid cycle bleeding
- scanty vaginal discharge,
- copious menstruation
- bleeding in menopause.
Symptoms of growths significantly depend on the size and number of uterine polyps. For large women, there may be pain in the lower abdomen. When such manifestations are found, differential diagnosis between polyposis and uterine myoma is necessary.
How to detect uterine polyposis
In most cases, the gynecologist fails to identify the pathology with the help of mirrors, the disease can be detected by ultrasound, the main diagnostic method. True, with the usual ultrasound education is not visualized on the monitor. To determine it, it is necessary to conduct hysterosonography - a study of the uterine cavity using ultrasound after the introduction of saline. The substance enters the cavity through a special catheter, which is installed by doctors before the procedure.
After the detection of the lesion of the endometrial growth, hysteroscopy is performed - curettage of the pathological area with taking material for histological examination. The doctor will be able to confirm the diagnosis only by the results of histology.
Hysteroscopy without ultrasound is not aimed, a specialist can make a mistake when taking a biopsy, since it is difficult to detect a polyp through mirrors. The growth will increase until the clinical symptoms appear and the person will seek medical help. To detect polyposis in a timely manner, you should use hysterosonography. If an adenomatous polyp is detected during a histological analysis of a smear, the gynecological oncology specialist reviews the environment.
How to treat endometrial polyps
Polypous growths do not respond to hormone therapy. You can get rid of them only by surgical methods. Removal of the polyp is made under the control of hysteroscopy. It is very important to excise the pedicle of the formation, since as a result of clinical studies it has been established that in this case there is no repeated growth in this place. The frequency of relapses increases with curettage.
After removing a polyp, hormone therapy may be required to prevent irregular menstruation. Drugs for prescribing are selected individually depending on the results of the histology and the general condition of the woman. Treatment of adenomatous polyps is carried out together with the gynecologist-oncologist. Due to the high probability of cancerous reincarnations, thorough cleaning of the outbreak is necessary.
If polyposis in women is found during menopause, you can remove the inner layer of the uterus (ablation), which prevents the likelihood of re-growth of the epithelium. Complete hysterectomy is performed in cases of cancer transformation.
In conclusion, we note that the polyp is better to remove in time than to expect terrible complications. The operation takes several minutes, but will prevent the likelihood of cancerous degeneration of the outgrowth of the uterine mucosa.
There are several types of endometrial polyp:
- glandular (made up of endometrial gland cells),
- fibrous (consists only of stromal cells),
- adenomatous (precancerous).
The type of polyp is important for the gynecologist when making a diagnosis and developing a treatment regimen. The clinical picture of the disease does not depend on the type of polyp.
Symptoms of endometrial polyp
Uterine bleeding is the main symptom of endometrial polyposis. The severity of bleeding will depend on the stage of the process. Possible asymptomatic disease. In this case, the polyp is detected by chance during an ultrasound scan.
In reproductive age, uterine bleeding occurs according to the type of heavy and painful menstruation. Perhaps the appearance of bloody discharge in the middle of the cycle, shortly before the expected menstruation or immediately after it. When combined with GPE massive breakthrough bleeding is not excluded.
During menopause, bleeding from the genital tract irregular, of varying intensity. Most often against the background of polyps there is a spotting brown discharge. Of particular danger are postmenopausal bleeding, i.e. occurring a year or more after the last menstruation in a woman’s life. Such bleeding can be a symptom of precancerous adenomatous polyps and endometrial cancer.
Small polyps usually do not affect the delivery of the fetus. Problems arise with large formations in the uterus. Occupying free space, the polyp does not allow the ovum to attach to the endometrium. The formation of the placenta is impaired, the supply of oxygen and nutrients to the embryo is reduced. Miscarriage with polyps usually occurs for up to 12 weeks. In the future significantly increases the likelihood of preterm birth.
Massive bleeding is a serious danger that awaits a woman. The likelihood of breakthrough bleeding increases with large polyps, as well as their combination with HPE and uterine myoma. With the appearance of heavy bleeding from the genital tract, it is necessary to urgently call an ambulance and get ready for hospitalization in the gynecological department.
Hydro sonography is an ultrasound examination of the uterus with the introduction of fluid into its cavity. The information content of this method is higher than with a simple ultrasound. Hydrosonography makes it possible to distinguish a polyp from another intrauterine pathology (synechia, myoma), and also to accurately determine the location of the formation.
The endometrial site, taken during hysteroscopy, is sent to the laboratory. По результатам исследования можно определить тип полипа и выявить сопутствующую патологию (ГПЭ, хронический эндометрит).Pre-cancerous processes and endometrial cancer are also determined in the laboratory. The final diagnosis is made only after the histological examination.
The endometrial polyp found during hysteroscopy should be removed. Removal of the polyp is carried out with special tools under visual control from the screen. Small single formations are removed with forceps introduced through the channel of the hysteroscope. For excision of large polyps, a loop electrode is used, which allows cutting the formation together with the underlying muscle layer.
After removal of the polyp, curettage of the uterus and the cervical canal is performed. During curettage, you can hook on the remaining elements of the polyp, as well as eliminate bleeding. The resulting material is sent to the compulsory histological study in the laboratory.
Hysteroscopy with the removal of the polyp is carried out in a planned manner. Emergency surgery is indicated for massive bleeding. In this case, separate curettage of the uterus and the cervical canal is performed (preferably under the control of hysteroscopy). Further actions will depend on the general condition of the woman and the nature of the revealed pathology.
Other surgical treatments:
- endometrial ablation
Endometrial ablation is an operation to remove the lining of the uterus. The procedure is indicated for heavy bleeding, as well as in the case of recurrence of polyps and hyperplastic process. Ablation is recommended for patients of reproductive age who are not planning children. Before ablation, endometrial cancer must be completely eliminated.
Hysterectomy is the removal of the uterus. The operation is indicated when polyps are combined with HPE, adenomyosis or uterine myoma in women in menopause. Before the onset of menopause, such an operation is rarely performed. Women of reproductive age, doctors are trying to save the uterus and do without radical methods of treatment.
Do I need medication after removing a polyp? Opinions gynecologists on this subject diverge. Some experts believe that the operation solves all problems, and additional hormone intake is not required. Other doctors say that after curettage and removal of the polyp, hormone therapy is indicated. Acceptance of hormones allows you to avoid recurrence of the disease and prevent further bleeding.
Indications for drug therapy:
- glandular and adenomatous polyps,
- combination of polyps with HPE and uterine myoma,
- pregnancy planning.
Drugs used to treat:
- estrogen-progestin drugs (COC),
- gonadotropin releasing hormone agonists.
All of these drugs have a similar effect: inhibit the proliferation of the endometrium and the formation of new polyps. The course of therapy lasts 3-6 months. Upon completion of the course, a mandatory ultrasound test is carried out. During the year after recovery is recommended to be monitored by a gynecologist.
Focal growth of the mucous membrane of the uterus of a benign character, which is an outgrowth of the mucosal layer, is called an endometrial polyp. The centers can be both single and multiple. As a rule, the length of the growth does not exceed several (10) millimeters, but in some cases it is possible to grow to a few centimeters.
It is possible to detect a growth in a patient of any age, however, most often education occurs in women who have overcome the 35-year-old barrier.
When multiple or re-formed after resection of growths, suggest the development of endometrial polyposis.
Endometrial polyp can asymptomatically "sit" in the body, without causing the owner any trouble. However, under the influence of provoking factors, such as: abortion, pregnancy, progesterone deficiency, and so on, glandular-fibrous growth can increase due to an increase in secretion. Moreover, the rate of its growth is directly related to the general condition of the patient. Although the danger of a polyp is not in size, but in the risk of turning it into a malignant neoplasm.
Causes of formation
The exact reason is unknown. However, it has been proven that a risk factor is an imbalance in the estrogen-progesterone system. At the same time, a decrease in the amount of progesterone entails an enhancement of the proliferative effects of estrogens and, as a consequence, activation of the division of endometrial cells. Polyps are most commonly identified in patients with the following "problems":
- polycystic ovary syndrome,
- Chronic and functional disorders in the ovaries,
- chronic endometritis, frequent medaborts, scraping and other manipulations inside the uterus,
- adrenal hyperplasia of the cortex,
- extragenital level problems: diabetes mellitus, thyroid diseases, obesity, liver pathologies,
- inadequate, uncontrolled treatment with sex hormones,
- constant stress
- chronic inflammatory diseases of the sexual sphere,
- endometrial trauma during surgery.
If the diagnosis of endometrioid polyp is confirmed, its cause is determined in accordance with the patient's history, that is, the presence of one or another of the past or present diseases that led to hormonal imbalance.
In its structure, the uterine mucosa has two layers: sprout (basal), located on the myometrium and external (functional), facing the lumen of the organ. Growths are formed mainly from the basal lining. Polyps are divided according to location (neck, wall or bottom of the uterus) and according to histological features:
The growth rate of the center of hyperplasia can not be predicted. The uterus lumen is normally slit-shaped, of small size and the developing hyperplastic process does not exert significant pressure on the myometrium and does not expand the uterus. The danger in this case is not the growth of education, but the degree of differentiation of the cells that make it up: the lower it is, the higher the risk of becoming a dangerous malignant process. Adenomatous form of the disease is subject to such changes to the greatest extent.
Manifestations of pathology can be of varying intensity. In some cases, if the size of the polyp does not exceed 1 cm, the process may be asymptomatic.
In other cases, the presence of a polyp is manifested by uterine bleeding of these types:
- menometrorrhagia (heavy menstruation),
- contact bleeding (for example, after a gynecological examination or sex),
- acyclic bleeding (its appearance does not depend on the cycle).
In addition to bleeding, the patient may be bothered by cramping pain appearing in the lower abdomen. Such a symptom is characteristic of large polyps, it may be a consequence of tissue necrosis and torsion of the legs. Very often, women with this pathology suffer from primary infertility and anovulatory cycle resulting from hormonal problems. Pregnancy in this condition can occur only if the endometrium is unchanged, but the risk of its interruption is very high.
In the case of a normal cycle, a functional polyp may appear that occurs in the second half of the MC. Similar formations change with the rest of the endometrium. In this case, the growth responds to progesterone and estrogen administered.
If treatment is not started on time (too late), the course of the polyp may be complicated. Among these complications are most common:
- pinching a polyp
- bleeding and post-hemorrhagic severe anemia,
- endometrial cancer,
- growth of education to large sizes
- necrosis of a polyp with ischemic disease.
In order to prevent the development of these pathologies, it is necessary to start the therapy of polyps as early as possible.
Modern diagnostic methods make it easy to detect the presence of polyposis in the uterus. If the growth is located in the cervical canal, then it is visualized during the examination as the formation of a pinkish color. However, not always polyps can be detected during examination. Therefore, in most cases, additional methods of research are used to detect them:
1. Histological examination of the scraping.
2. Ultrasound of organs located in the pelvis. This method is informative if the patient has fibrous or glandular-fibrous polyps. At the same time expansion of a uterine cavity and a hyperplasia of an endometria comes to light. All types of polyps on ultrasound have common features:
- the uterus is enlarged,
- the boundaries of the focus are clear,
- the median linear part of the M-echo is deformed,
- education round shape
- the presence of cystic inclusions
- acoustic effect in the form of attenuation or signal amplification.
Ultrasound can only confirm the presence / absence of education and its magnitude. Information about the qualitative composition of the polyp (that is, its type) is given by histology (microscopic examination of a uterine scrape).
3. Hysteroscopy. It represents the introduction of a probe with a video camera and LEDs into the uterine cavity. Indications for the implementation of the procedure are suspicions for the presence of endometriosis, fibroids, malignant tumors, as well as with non-menstrual bleeding, multiple miscarriages or infertility, too abundant or irregular menstruation and the release of residues of the fetal membranes from the uterus after childbirth.
Hysteroscopy can be carried out not only for diagnostic purposes, but also for medical purposes (removal of a polyp).
Spontaneous resorption of a polyp is possible only after menopause. All other cases require compulsory treatment.
All methods of treatment used for endometrioid polyps can be divided into three groups: observation, surgical removal, and drug therapy. The method of therapeutic treatment (that is, how to treat education) is determined by the doctor based on the size and type of the polyp, the patient's age, wishes for subsequent pregnancies and severity of symptoms. In cases where surgical treatment was chosen, the patient is prescribed additional use of hormone-containing agents.
Indications for surgical therapy are fibrous and atypical polyps. In all other cases, the use of conservative methods is permitted. Drug treatment, as a rule, is assigned to patients with contraindications to interventions, for non-giving women and with a categorical unwillingness to be operated on. In the treatment of placental and glandular polyps are allowed to use folk recipes. After completing the course of treatment, a woman is necessarily observed by a gynecologist in order to prevent a relapse of the disease.
One of the non-surgical methods for eliminating growth is laser removal. With the help of a laser it is possible to perform a resection without the subsequent formation of a scar. The advantage of the method is the targeting effect, that is, the ability to excise exclusively pathological tissue. The disadvantage of the technique is the relapse of the pathology in some patients.
An intervention to remove a uterine polyp is called a polypectomy. This method is most effective among all methods of treating polyposis. At the request of a woman, any polyp, except adenomatous, is removed immediately after detection. In the case of pregnancy, the formation is removed only after delivery. The operation is carried out only in the hospital when using a hysteroscope and under general anesthesia.
Before the intervention, the localization and the exact size of the formation are determined, after which it eliminates it. As a preventive measure, the resection site is treated with electric current or liquid nitrogen. For large polyps, located on the leg, apply the method of unscrewing. After surgery, the uterus is scraped out, and the material is examined.
The presence in the uterus of the adenomatous polyp type in women older than 45 years of age is an indication for performing a hysterectomy. If an adenomatous formation is found in a uterine patient, hysteroscopic elimination of the defect is performed, and then hormone medications are prescribed and it is strongly recommended to quickly become pregnant and give birth. In the case of recurrence of adenomatous polyp, uterus excision without appendages is performed.
Surgical intervention is the first stage of complex therapy, after which preventive measures of purulent-septic complications (Sumamed, Cefotoxime) and hormonal correction are carried out. In the case of a glandular polyp of the endometrium, treatment after removal is necessarily hormonal. Hormone therapy involves the use of oral combination drugs "Yarin", "Zhanin", "Regulon" in patients under 40 years of age and "Utrogestan", "Duphaston" after 40 years. In addition, prescribed vitamins and, if necessary, weight loss.