Polyp of the uterus (endometrium): the removal, treatment, symptoms
Among the variety of pathological processes that may occur in the inner lining of the uterus, perhaps polyps and hyperplasia are the most common. Probably will not find women that have never heard of polyps in the uterus, and most have encountered at least once in life with some form of endometrial hyperplasia.
According to various sources, up to 25% of women of all ages can suffer from this disease, but some patients still dominated by ladies eligibility age and status of menopause.
The inner membrane of the uterus has a complex structural organization, and the dependence of the structure and functioning of fluctuations in the level of female hormones makes it very vulnerable during any disturbance of a hormonal background. The excess estrogen contributing to enhanced proliferation of endometrial cells, leading to diffuse hyperplasia, when increasing the thickness of the whole layer of the inner lining of the uterus, or to focal growths in the form of polyps.
Endometrial polyp is considered a benign tumor formation, but the likelihood of malignancy (malignancy), there is always the risk depends on the type of polyp, the peculiarities of its structure, the nature of comorbidities, particularly from the endocrine system, age of the woman. It is believed that malignancy is exposed to no more than 2-3% of polyps.
Endometrial polyp may be solitary, and in some patients had diffuse polyposis with multiple centers of growth. Women of young age and eligibility in the period when the hormonal function of the ovaries has not yet faded, the appearance of a polyp may on a background of diffuse hyperplasia of the endometrium, while during menopause polyp occurs when the atrophic, non-functioning inner lining of the uterus.
Causes and types of endometrial polyps
The most likely causes for polyp uterus are:
- Hormonal disorders when increased estrogen and decreased progesterone;
- Infectious-inflammatory changes of the endometrium (endometritis), especially in combination with reduced immunity;
- Injury of the endometrium in the past (abortion, diagnostic curettage, postpartum complications);
- Endocrine pathology and diseases of other organs and systems (obesity, diabetes, impaired thyroid function).
The debate about the causes of endometrial polyps is conducted to this day.
Until recently it was believed that the most likely pathology in disorders of hormones, but recent studies show that infectious factor and reduced immunity to an even greater extent capable to cause hyperplastic changes of the endometrium. So, up to 75% of women diagnosed with endometrial polyp, do not suffer from hormonal disorders, but more than 95% of cases this pathology includes infection of the mucous membrane of the uterine body.
Cause chronic inflammation in the lining of the uterus can be infections, sexually transmitted diseases, and banal microflora (staphylo — and streptococci, fungi, E. coli etc.). Especially likely to develop endometritis women with established intrauterine spiral, various endocrine and metabolic diseases, disorders of the immune system. In addition, certain immunosuppressive effect have the hormones estrogen and a decrease in their number in the menopause causes slowing of metabolic processes in the mucosa of the uterus, which makes the endometrium is very sensitive to any damaging agent, including microorganism.
Hormonal changes, accompanied by the overproduction of estrogen by the ovaries, stimulate the proliferation of cells of the endometrium, excessive and non-uniform growth, which is manifested in the form of diffuse hyperplasia and polypoetry. In some cases a polyp is detected on a background of diffuse hyperplasia or polyp fragments there are areas of glandular hyperplasia of the endometrium. This combination of hyperplastic processes reflect the significant variation in the level of hormones and is more typical for women of reproductive age.
Patients receiving drugs with anti-estrogenic activity (tamoxifen, clomiphene), have a higher risk of polypoetry. Among women undergoing treatment for breast cancer, a polyp of the uterus can be diagnosed almost every tenth, while it is quite large in size and with a predominance of the fibrous component.
Injuries of the mucous membrane of the uterus during intrauterine manipulations (abortion, diagnostic curettage, hysteroscopy) lead to the development of inflammation, followed by scarring, and often this process is a chronic recurrent nature, the result of which is the appearance of intrauterine adhesions, changes in the structure and growth of endometrial polyp.
Polyp uterus – often single formation in the form of a growth on a thin stalk or broad base, pink color, changing to dark-red when blood circulation. Its dimensions rarely exceed 1 cm, but there are large polyps occlude the lumen of the uterus and even hanging in the cervical canal. A favorite place of growth of a polyp is considered the bottom of the cavity of the uterus and its corners.
Microscopically, the polyp is an outgrowth of the basal layer of the inner lining of the uterus with scattered glands, usually with no signs of hormonal changes, with a certain amount of connective tissue. Usually it looks simple glandular polyp. By increasing the proportion of connective tissue component in the structure of the polyp and makes it dense, and it is called fibrous. Such formations more frequently in elderly patients. A sign capable of distinguishing a polyp from areas of normal mucosa of the uterus, is called the tangle of vessels with thick walls. This tangle is the stalk of a polyp, which is nutrition education.
Depending on the number of glands, their location, relations with the surrounding stroma, decided to allocate the kind of polyp:
From a clinical perspective, the identification of particular species of polyp has no special meaning, and serves only for the differential diagnosis with diffuse hyperplasia, which is important for the doctor prescribing the treatment. With the exception of cases when detected adenomatous polyp, which indicated increased formation of bizarre shape of the breast with the reproduction of the epithelial cells.
Adenomatous polyps, particularly with signs of atypia, is considered precancerous endometrium. Such a diagnosis requires continuous dynamic monitoring of the woman after removing it, and in case when the patient is of advanced age, doctors prefer not to remove the uterus to avoid cancer later.
Recurrence of polyp, that is, his re-appearance, may be associated with incomplete removal of previous education and progressive changes of the endometrium. Particularly worrying recurrence of a polyp in women of perimenopausal age who have hormonal ovarian activity has not yet ceased, and hormones fluctuate widely. In these cases, the relapse is perceived as a risk factor for cancer (adenocarcinoma). In order to avoid diagnostic errors, the removal of polyps is recommended under the supervision of hysteroscopy to vascular pedicle and education were removed fully.
As manifest polyps in the uterus?
Symptoms of an endometrial polyp so nonspecific that to suspect this pathology through clinical signs can be difficult. Many women, especially in menopause, endometrial polyp and is asymptomatic.
However, indirect signs indicate the presence of a hyperplastic process is. These include:
- Uterine bleeding, which are quite abundant;
- Scant spotting outside of menstruation;
- Bleeding in menopause;
- When large polyps cramping pain in the lower abdomen;
- Contact bleeding after intercourse, medical procedures;
The participation of polyp in the development of infertility is still controversial, and many doctors are of the opinion that their connection is doubtful. Since the cause of polyps is often irregular menstruation and lack of ovulation, then infertility is likely formed for this reason. However, removal of polyp increases the chance of successful pregnancy.
The symptoms listed above can occur at other gynaecological pathology (uterine fibroids, endometriosis, polycystic ovaries), so that only medical examination will help accurate diagnosis.
Methods for detection of polyps of the uterine body
Turning to the doctor, women with bleeding from the genital tract, menstrual cycle, bleeding in menopause, the expert first finds out the nature of the complaints, the intensity, the frequency of bleeding, their relationship to menstruation. It is also important to know whether the patient tolerated abortion, curettage of the endometrium, surgery on the pelvic organs, whether there was obstructed labour, etc. the Presence of chronic infections of the reproductive tract or infertility can also speak in favor of a possible hyperplastic processes.
After a detailed survey, the gynecologist will examine the patient on the chair will determine the size and structure of the uterus, the presence of pain and other changes.
Often the overall examination of the evidence in favor of one or another pathology. If a woman is fat, suffers from high blood pressure or diabetes, has stripes, stretch marks or hair growth of male type, there is a high likelihood of endocrine pathology accompanied by lack of ovulation, which in turn predisposes to the disruption of the normal functioning of the endometrium and poledourisbasil.
After examination, the doctor prescribes additional studies:
The first instrumental method, which will be offered to the patient is ultrasound. Ultrasound is harmless, no contraindications, and diagnostic value for endometrial polyps reaches 95-98%. The study is carried out using a vaginal sensor, in some cases complemented by the introduction into the uterine cavity saline solution.
Ultrasound assessment of the structure of the so-called median M-echo, reflecting the anteroposterior size of the uterine cavity. If it is enlarged, especially when a woman more than 5 years in a state of menopause, if it finds any on or additional structures, there is a high likelihood of hyperplastic changes of the endometrium. Ultrasound may be supplemented by Doppler to determine the blood flow in the vessels of the polyp, and the introduction into the uterine cavity with saline solution gives you the chance to clarify the localization of the vascular pedicle of the polyp.
Another important method for diagnosing endometrial polyps is hysteroscopy, in which the uterus is injected optical device, giving you the opportunity to consider in more detail the condition of the endometrium, to localize existing polyps and to determine their characteristics. The method is pretty informative, but it does not always gives a positive result, and sometimes even errors are possible. Thus, the fibrous polyps can recall the fibroids of the uterus, but if such education is large, the surface may be mistaken for an atrophic mucosa. To improve the quality of diagnosis is introduced into the uterus air or fluid, and oscillatory motion and shape change existing formations testify in favor of the polyp.
Hysteroscopy has an important advantage: in this procedure, it is possible to make and removal of a polyp. After treatment, the hysteroscopy will be repeated to monitor the usefulness of the operation.
Since the ultrasound, and hysteroscopic picture may be different in different phases of the menstrual cycle and it is particularly difficult to differentiate between the norm and pathology on the eve of menstruation, when the endometrium is thick enough, with well-developed glands, numerous major blood vessels, the study is recommended immediately after a phase of bleeding.
Curettage of the uterine cavity can be considered a diagnostic procedure in which a receiving material for histological study, and treatment, because it vaporizes the endometrial tissue could be removed.
The most accurate way to determine the nature of the pathological process, is considered a histological examination, which may establish the type of polyp, signs of atypia, the state of the mucosa of other departments of the uterus.
Treatment of endometrial polyps
The main method of treatment of polyps is surgical removal, which is possible to produce in the course of hysteroscopy or during the curettage. It is important to remove not only the polyp, but also its vascular pedicle, which, if non-radical surgery can be a source of disease recurrence. After removal of a polyp, and the pedicle is coagulated with a laser, electrical current, liquid nitrogen.
Curettage of the uterine cavity when you remove the polyp, you need to monitor the status of the endometrium, removal of other parts, which can also be hyperplastic, and the thus obtained material is necessarily sent for histological examination.
Sparing treatment if recurrent polyps are considered ablation (resection) of the mucous membrane of the uterus. This procedure removes the entire inner layer of the uterus, so getting pregnant afterwards would be virtually impossible. Ablation is applicable to women older than 35 years who already have and/or not planning children in the future.
If these techniques of removal of polyps did not lead to a complete cure and recurrence occurs again, and by detection of cell atypia polyp in women in menopause, the doctors are forced to resort to the most radical treatment is removal of the uterus. In cases where a polyp has signs of malignancy, justified the removal of another and appendages. This unconstrained allows to avoid the development of cancer in patients at risk.
Women of reproductive age after removal of endometrial polyps in need of hormone therapy, directed to normalization of menstrual cycle. When glandular polyps patients of reproductive age can be assigned to combined oral contraceptives according to the usual contraceptive scheme (lindinet, LOGEST, silest). Women in premenopausal women it is better to use progestin drugs (the main monitor) as the estrogenic component of contraceptives may increase the cell proliferation of the endometrium. Hormonotherapy shall be appointed for a period of up to 6-9 months and under mandatory periodic ULTRASOUND.
If the patient of reproductive age detected adenomatous polyp or signs of atypia, hormonal medication continuously, often – antigonadotropin (Zoladex, danazol). These drugs lead to a complete inhibition of ovarian hormonal function, resulting in growth and maturation of the endometrium during the menstrual cycle, and, hence, the likelihood of re-hyperplastic process is minimal. During the treatment pregnancy does not occur, but after it, in the case of a positive result, a woman may plan conception.
A conservative approach even in case of a threat in terms of the risk of malignization of polyps in young women not only to preserve the uterus, but also to realize the reproductive function.
Fibrous polyps in menopause, of course, do not require hormone therapy, but enough for the healing surgery. In case of atypical changes in these patients always raises the question of the need for complete removal of the uterus.
It is important to remember that the earlier a woman will go to the doctor, the easier it will be to treat existing pathology. Detection of a polyp of the uterus in the early stages allows to quickly get rid of education, preserving reproductive function. Self-treatment, wait-and-see tactic, hoping that the polyp «came out» lead to higher education and increased risk of malignant transformation. A polyp is quite firmly attached to the uterine wall, so only the surgeon’s hand can qualitatively and radically to remove it.
Treatment of folk remedies for endometrial polyps is only valid in combination with conventional medicine and only in consultation with your doctor. Of medicinal plants that can be used, appropriate chamomile flowers, nettle leaves, oak bark, wild rose, which has antiseptic and hemostatic properties. Recommended by many healers douches and vaginal swabs with herbs, garlic, alcohol tinctures are best avoided, as there is a risk of allergic reaction and damage of the vaginal mucosa and cervix, and help in the treatment of a polyp in this case is questionable.
If you notice any unusual symptoms from the reproductive system it is better not to self-medicate and not to rely on traditional medicine. The first step is to consult a specialist who will deliver an accurate diagnosis and choose the most optimal and effective treatment, allowing the woman to preserve hormonal and reproductive function to the extent that she needs. Timeliness of prenatal visits not only helps in successful treatment of hyperplastic processes, it is also very important for the prevention of cervical cancer. After successful treatment of an endometrial polyp required clinical supervision during the year with regular checkups and ultrasound examination of the uterus.