Medical program about the signs of a uterine endometrial polyp. Endometrial polyp: causes, methods of treatment and removal of the polyp. Fibrous endometrial polyp

An endometrial polyp is a benign formation located inside the uterine cavity.

The formation of endometrial polyps is a hyperplastic process, that is, an excessive, uncharacteristic formation originating from the growing endometrium (the inner wall of the uterus). With the formation of multiple polyps or recurrence (re-formation) of a polyp, they already talk about polyposis as a disease.

Kinds

A polyp (and not only in the uterus) is called a typical pathological formation, consisting of a body and a leg, with which it is attached to its base inside the organs.

If we talk about endometrial polyps, they, based on the structural features and composition of the cells, are divided into:

• glandular polyp, consisting of stromal cells with the inclusion of the 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,
• an adenomatous or precancerous polyp is predominantly glandular cells, some of which have atypical signs (signs of degeneration into cancer).

Causes and risk factors

Endometrial polyps can occur at any age, regardless of sexual activity, pregnancy and childbirth.

But, for the most part, their formation is noted after 30-35 years, the risk of polyposis increases by the age of 50.

At a young age, when women become pregnant and give birth, glandular types of polyps occur more often, in old age, after the onset of menopause, fibrous and adenomatous formations occur, but fibroglandular polyps can form at any age.

Of the main reasons for the development of both single and multiple endometrial polyps, one can distinguish:

• hormonal disorders with an excess of estrogens, or a lack of progesterone.
• carrying out traumatic manipulations of the uterus: abortion, curettage for the purpose of diagnosis without proper control, or wearing an intrauterine device for too long.
• abortion, miscarriage or difficult childbirth - in this case, the remaining pieces of tissue or blood clots will be replaced by elements of connective tissue, i.e. a polyp will form.
• disorders in the endocrine system (dysfunction of the thyroid gland, obesity or diabetes mellitus) that disrupt the exchange of sex hormones.
• chronic inflammatory process in the pelvic area - genital infections with the development of endometritis, inflammation of the inner lining of the uterus.

Manifestations of an endometrial polyp

Symptoms of an existing endometrial polyp can be very diverse, they depend on the number of polyps in the uterine cavity 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 of them, manifestations may occur in the form of:

• cycle disorders such as spotting or intermenstrual bleeding,
• heavy or prolonged menstruation
• pain during menstruation,
• pain in the lower abdomen, aggravated after orgasm or intercourse, spotting discharge after intercourse,
• increased discharge, whiter, especially with large polyps,
• at an older age, when menopause has come, there may be episodic bleeding after exertion or stress.

Diagnostics

With the manifestation of one or more of the symptoms described earlier, a consultation with a gynecologist is necessary.

Today, endometrial polyps are detected quite simply. When examining on a chair, if there is a polyp in the area of ​​​​the cervix, it can be detected when viewed in the mirrors. The external pharynx looks filled with a pink formation.

But if the polyp is located inside the body of the uterus, it can be detected by ultrasound.

For accurate diagnosis is carried out:

• Ultrasound of the small pelvis, while an expansion of the uterine cavity is detected, there is a clear contouring formation.
• Conducting diagnostic hysteroscopy - under anesthesia, a special apparatus with a camera and optics is inserted into the uterine cavity, it visually allows you to detect a polyp and, at the same time with diagnosis, remove it. In addition, the uterine cavity is carefully examined for various injuries.
• The removed polyp is examined histologically. This allows you to determine its type, structure and confirm the diagnosis.

Polyps must be distinguished from small fibroids, endometriosis and the initial stages of pregnancy, including frozen.

Treatment of endometrial polyps

Treatment of fibrous forms

An endometrial polyp is a direct indication for diagnostic hysteroscopy and its removal.

During hysteroscopy, the polyp itself is removed, and the area of ​​\u200b\u200bthe uterus where it was attached is scraped out with a curette under camera control.

With a large size of the polyp with a clearly defined leg, it is as if “unscrewed” - a polypectomy is performed. At the site of attachment of the polyp, its bed is treated with liquid nitrogen or electric current, this helps prevent recurrence.

The operation takes place quickly, under general anesthesia, for about ten days there may be bloody discharge from the uterine cavity.

In order to prevent infection, broad-spectrum antibiotics are prescribed after surgery. The material obtained during the operation is necessarily sent for histology, since when 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 a fibrous polyp of the endometrium and the absence of a violation in the menstrual cycle, treatment is completed.

In the glandular and glandular-fibrous forms, after curettage, a course of hormonal therapy is indicated.

For it apply:

• combined oral contraceptives such as yarin, regulon or janin. The appointment of these drugs is indicated for women up to 35-40 years old,
• gestagenic preparations such as duphaston, utrozhestan or norkolut. Assign women after 35-40 years.

Hormone therapy lasts three to six months.

A hormone-containing Mirena coil may be used. It is suitable for women of reproductive age who do not plan more children, or for those who have polyposis combined with fibroids. Set for up to five years.

Treatment of adenomatous polyps

This type of polyp predisposes to uterine cancer, so its treatment is active and radical. Women over the age of 45 are shown only extirpation of the uterus (removal). If the family has an oncological predisposition or a woman has hormonal disorders, the uterus with appendages is removed.

A woman of childbearing age is shown the removal of a polyp with the appointment of hormones after surgery, as well as active monitoring. In case of recurrence of an adenomatous polyp of the endometrium, removal of the uterus is indicated.

Complications

The most important of the complications is the development of infertility, there are also menstrual irregularities, loss of a large volume of blood with the development of anemia.

In addition, relapses may occur - the polyp grows again, turning into polyposis.

In rare cases, endometrial polyps can turn into malignant tumors, cancer of the endometrium, the inner lining of the uterus, basically this is only possible with the adenomatous form.

Despite the fact that often this pathology is asymptomatic, at the same time, its presence is the cause of most cases of intrauterine bleeding. Early detection and timely treatment of the endometrial polyp is also necessary because of the ability of some of their types to transform into a malignant formation, especially in older women.

Causes

Endometrial polyps can develop in women at any age, but more often after 35 years. Among all gynecological pathology, they occur in 5-25% (according to various sources), and among gynecological patients of the postmenopausal period - in 39-70%, ranking first among all intrauterine pathology.

Certain causes of polyps have not been definitively established. The influence of multiple factors is assumed, but the following theories are preferred:

1. Hormonal imbalance of sex hormones - an excess of estrogens and a decrease (relative or absolute) in the content of progesterone in the second phase of the menstrual cycle. This can occur as a result of functional or organic disorders in the system of the endocrine glands (hypothalamus - pituitary gland - ovaries), in the ovaries, with metabolic syndrome, which is a complex of disorders in the endocrine system and is clinically manifested by obesity, hypertension syndrome, diabetes mellitus and hyperplastic changes in the endometrium.
2. A chronic inflammatory process in the cervix and uterine cavity, in the uterine appendages, caused by conditionally pathogenic microorganisms or an infection that is sexually transmitted.

Additional causes and risk factors are:

• age after 35-40 years;
• ectopic hormone-producing tumors;
• diseases of the adrenal glands, thyroid and pancreas (diabetes mellitus), in which there is a violation of the synthesis of steroid hormones;
• the presence of fibromyomas and internal endometriosis ();
• diseases of the liver, biliary tract and intestines, in which the utilization and excretion of excess estrogens are disturbed;
• long-term use of glucocorticoid and sex hormones;
• hypertension, obesity, in which the risk of developing polyps increases 10 times;
• long-term negative psychological stress, stressful and depressive conditions;
• violations of the immune state of the body, which is of particular importance for the development of relapses of these tumor-like formations;
• frequent artificial termination of pregnancy, especially instrumental;
• incomplete removal of the placenta during spontaneous abortion or after childbirth (placental polyp);
• surgical interventions on the uterus and ovaries, including diagnostic and therapeutic curettage of the uterine cavity;
• long period of use;
• hereditary factor - the presence of tumor-like formations in maternal relatives;
• combination of risk factors.

Types of endometrial polyps

They are a local intrauterine neoplasm of a benign nature associated with a pathological proliferation of cells of the functional or basal (growth) layer of the endometrium - the inner lining of the uterus.

Polyps can be single and multiple (polyposis), develop on an unchanged mucous membrane or against the background of other hyperplastic processes (diffuse or focal endometrial hyperplasia).

Tumors differ in size, shape and cellular structure. Their size can range from single millimeters (1-2 mm) to 10-80 mm or more. The shape is usually irregular, oval or round, and the formations themselves can be elongated like a cone on a wider base or on a stalk, in which sclerotic vessels with a thick wall are located in the form of a ball.

Types of polyps

The mucous membrane of the uterus (endometrium) consists of two layers - the basal, or growth layer, which is located directly on the myometrium, and the outer, or functional, facing the uterine cavity and containing a large number of glandular cells and vessels.

The functional layer is most susceptible to changes in accordance with the menstrual cycle and is torn away from the basal layer of the endometrium in the absence of fertilization, that is, during menstruation. If rejection in a local area is incomplete, a functional endometrial polyp may form, which consists mainly of glandular and a small number of stromal (supporting) cells.

During the menstrual cycle, this tumor-like formation undergoes the same changes as the entire endometrium. It occurs most often in women of reproductive age, especially young women, and rarely presents with any symptoms.

Another type of polyps is placental, formed from placental lobules left after pregnancy and childbirth or miscarriage.

The rest are formed mainly from the cells of the basal layer. Among them, there are formations in the form of glandular or glandular-cystic growths with the presence of adenomatous transformation and without it. In addition, polyps in the region of the fallopian tube closest to the uterus (isthmic uterine) may consist of endometrial or epithelial cells typical of the mucous membrane of the internal os of the cervix.

Histologically, these tumors are mainly combined into the following (except those described above) main pathological and morphological types.

1. Fibrous.

Fibrous endometrial polyp

It is formed mainly from cells of fibrous connective tissue. It may contain collagen fibers and only single glands lined with non-functioning epithelial cells. Vessels are also single, they are characterized by thickened sclerotic walls.

Glandular fibrous type

It occurs relatively rarely in women of reproductive age and even less often (2 times) in the postmenopausal period. At the same time, compared with other types, glandular fibrous formations predominate in women with a stable menstrual cycle.

They consist of glands of irregular shape and varying lengths. The lumens of some of the glands are stretched in the form of a cyst or unevenly expanded. One of the morphological features of the latter is the unevenness of their location in different directions. Stromal (supporting) structures predominate.

In the upper layers of the tumor, the stroma contains a larger number of cells, and in the stalk, especially closer to the base, the structure is much denser and often consists of fibrous tissue. The walls of the vessels are also sclerosed, thickened and placed in balls in different areas. Phenomena of inflammation and circulatory disorders in formations of the glandular-fibrous type are more common than in others.

Adenomatous endometrial polyp

This type develops extremely rarely. Tumors with focal adenomatosis are more common. They are characterized by abundant distribution of the glandular component throughout the polyp and intense focal growth from glands with structurally altered epithelial cells.

Along with them, there are interlayers of morphological structures characteristic of the previous type. Irregularly shaped glands are small. In their lumen, a tendency to form and / or already formed outgrowths of the type of false papillae are revealed.

The glandular epithelium of adenomatous formations is characterized by polymorphism (heterogeneity, diversity) with a disturbed ratio of the nucleus and cytoplasm of cells, the presence of mitoses (divisions), including pathological ones. In the pedicle of the tumor formation there are tangles of vessels with very thick walls. Polyps of this type are the most dangerous in terms of malignant transformation in the postmenopausal period, especially against the background of metabolic and neuroendocrine disorders.

The severity of proliferation of epithelial cells during the period of extinction of the sexual functions of the woman's body and in postmenopause depend on the morphological structure of the polyp itself, the histological structure of the surrounding mucous membrane, concomitant pathological changes in the myometrium and endometrium.

In 95% of the postmenopausal period, endometrial polypous formations develop against the background of atrophic processes in the latter. Therefore, their pathomorphological composition does not correspond to that in the uterine mucosa. The highest degree of activity of epithelial proliferation was noted with a combination of adenomatous and (somewhat less) glandular forms with endometrial glandular hyperplasia and adenomyosis.

These facts have become the reason for the allocation of glandular and, especially, adenomatous formations in a group characterized by a high risk of uterine cancer, that is, they are classified as precancerous diseases.

Symptoms and diagnosis of the disease

Transvaginal ultrasound

Symptoms of an endometrial polyp

Despite the presence of diverse forms, their clinical manifestations have been studied quite well, although subjective symptoms do not have specific features and largely depend not on the type of formation, but on its size and localization (cervix or body of the uterus).

Main features:

1. Whitish discharge from the genital tract.
2. Menstrual disorders, which can be manifested by profuse spotting during menstruation or a few days before it, scanty (spotting) blood in the intermenstrual period.
3. Contact (during sexual intercourse or significant physical exertion) bleeding or spotting.
4. Spotting or even heavy bleeding in the postmenopausal period.
5. Pain in the lower abdomen, especially during intercourse. This symptom, as a rule, occurs only in the presence of formations of considerable size and/or the development of inflammatory processes in this area.

In many cases (from 15 to 56% according to different authors), this pathology proceeds without any clinical manifestations and is detected incidentally only as a result of gynecological screening studies.

Hysteroscopy for endometrial polyps

One of the main methods of its diagnosis is abdominal and, especially, transvaginal ultrasound.

Previously used for almost any intrauterine diseases, the routine method of diagnosis and treatment in the form of curettage of the cervix and uterine cavity, including curettage of the endometrial polyp, has been used much less frequently over the past 20 years.

The "gold standard" at present is in combination with a targeted scraping or separate diagnostic curettage, performed for the purpose of treatment and further pathomorphological examination. In recent years, the so-called "office" hysteroscopy has been increasingly introduced. It is carried out on an outpatient basis by doctors of gynecological consultations and medical centers using an optical device (hysteroscope), the tube of which is inserted into the uterine cavity through the vagina.

Instrumental hysteroscopy makes it possible to visually diagnose the presence and number of pathological formations, their localization, size and shape, determine their qualitative characteristics, by which one can roughly judge the type of formation - color (bright red, dull grayish, pale pink), surface condition (uneven, ulcerated), etc.

In addition, this technique allows not only visual diagnostics, but also the necessary diagnostic and therapeutic procedures, as well as surgical operations (hysteroresection of the endometrial polyp).

The efficiency of diagnostics through echographic examination is on average 95.5%, hysteroscopic - 96.2%, and the combination of these methods with the addition of histological examination - 100%.

Endometrial polyp and pregnancy

Is it possible to get pregnant with it? Infertility in this disease occurs mainly in cases where the neoplasm is localized in the area of ​​​​the isthmic section of the fallopian tube, located in the wall of the corner of the uterus and open into its cavity. It can prevent the migration of sperm into the fallopian tubes.

At the same time, if the polyp is of considerable size and is located in the cervix or fundus of the uterus, in the area of ​​​​attachment of the placenta, this can lead to a partial latter and malnutrition of the fetus, as well as to spontaneous miscarriages.

If the tumor is localized in the region of the external os of the cervix, it is easily removed by unscrewing with a clamp and subsequent electrocoagulation in order to destroy the base.

Previously, when a polyp was localized in the uterine cavity, only curettage curettage of the entire cavity was used as the main diagnostic and treatment method. However, the mechanical removal of the functional layer of the endometrium over a large area is a high degree of trauma to the procedure. It causes the risk of developing inflammatory and adhesive processes. , bleeding after removal for several days, often profuse and conducive to the development of infection, the risk of infertility. In addition, incomplete removal of the tumor, that is, without its base, is not uncommon, as a result of which the polyp recurs.

These and many other reasons have led to a significant decrease in the use of curettage as a treatment method. It remains relevant mainly in the presence of multiple formations. However, before and after the procedure, a diagnostic hysteroscopy is mandatory, which allows you to make a conclusion about the complete removal along with the base.

In the case of the formation of a new formation with a radical removal of the previous one, it is concluded that the new tumor is a recurrent endometrial polyp as a form of the disease that requires appropriate treatment. Otherwise, we can talk about a recurrence of a non-radically removed tumor. Single or single formations of the uterine cavity are removed, as a rule, with the help of a hysteroresectoscopy operation, followed by superficial diagnostic curettage.

What is hysteroresectoscopy of an endometrial polyp?

The operation is usually performed under intravenous anesthesia. It is the aforementioned hysteroscopy by means of a tube with an optical camera and channels for passing special instruments through them. The image from the high-resolution camera is displayed on the monitor screen, which allows a clear assessment of the identified pathology and provides the ability to accurately manipulate instruments.

The frequency of recurrence of the disease after hormonal therapy, despite the availability of modern and effective contraceptives, remains at a fairly high level (up to 60%).

Endometrial polyp in the uterus: what is this pathology and how to treat it

An increase in the number of identified endometrial hyperplastic processes is associated with an increase in women's life expectancy, the number of neuroendocrine disorders and lifestyle changes. This naturally leads to an increase in the number of patients with endometrial cancer. To reduce the risk, it is necessary to diagnose and treat early endometrial polyp.

• Endometrial polyp: what is it and how to treat
• Symptoms: on what grounds can a polyp be suspected
• Glandular endometrial polyp
• Fibrous endometrial polyp
• How to determine polyposis using ultrasound
• Treatment Methods
  • Examination before surgery
  • Treatment after surgery
• Recovery period
• Pregnancy after surgery

What is an endometrial polyp

Very often, in the period of pre- and postmenopause, benign pathological changes in the internal tissues of the uterus are detected, but they can also be detected in patients of childbearing age. The endometrium is a hormone-sensitive tissue, therefore, absolute or relative changes in the concentration of estrogens can lead to the appearance of foci of hyperplasia - endometrial polyps (ICD-10 code N84).

Treatment of an endometrial polyp in the uterus: hysteroresectoscopy operation. After the material is sent for histology, which determines the type of polyp and gives the doctor the opportunity to prescribe the correct treatment.

Endometrial polyp in the uterus: causes

Risk factors are conditions in which the ratio of estrogens and is disturbed. leads to increased proliferative action of estrogen and increased division of endometrial cells. But the exact causes of endometrial polyps in the uterus are unknown.

Most often they are diagnosed in women with the following pathologies and conditions:

• ovarian dysfunction and chronic;
• syndrome;
• hyperplasia of the adrenal cortex;
• incorrect therapy with sex hormones;
• extragenital disorders: obesity, diseases, liver pathologies;
• , frequent intrauterine manipulations (abortions, curettage).

If a diagnosis of an endometrial polyp in the uterus is made, the causes of this condition are determined by the presence of a gynecological pathology in a woman that can disrupt the ratio of hormones. Some types of neoplasms can degenerate into cancer.

The classification of growth types adopted in Russia is based on the one proposed by WHO in 1975. According to it, histological types of polyps are distinguished:

• glandular;
• glandular fibrous;
• fibrous;
• adenomatous.

It is impossible to predict how quickly the focus of hyperplasia grows. The uterine cavity is normally slit-like, small in size, the hyperplastic process is not able to exert pressure on the myometrium and expand the uterus. Sometimes it can stop at a certain size and not grow again. Much more dangerous is not its size, but the degree of cell differentiation: the lower it is, the higher the likelihood of transformation into malignant forms. The adenomatous process is more susceptible to this.

What symptoms can be suspected pathology

When an endometrial polyp is suspected, symptoms vary in severity. Sometimes an asymptomatic course is possible, when the size of the focus is small, up to 1 cm.

The leading signs of endometrial pathology are several types of uterine bleeding:

• acyclic, which appear regardless of the phase of the monthly cycle;
• contacts are observed after sex or examination by a gynecologist;
• menometrorrhagia - heavy menstrual flow.

Cramping pain in the lower abdomen may appear with a large outgrowth, torsion of the leg and tissue necrosis.

In reproductive age, the causes and symptoms of overgrowth often cause. The lack of ovulation that accompanies most women with this pathology is a consequence of hormonal imbalance. So, is it possible to get pregnant without treatment, it is impossible to say for sure. If the neoplasm is formed against the background of an unchanged endometrium, then pregnancy can occur, but the risk of its spontaneous interruption is increased.

In women with a preserved monthly cycle, a functional polyp may appear. It is formed in the second half of the MC and is able to change cyclically, like the rest of the endometrial layer. Such growths respond to the introduction of estrogens and progesterone.

Glandular endometrial polyp

Below the functional layer of the uterine epithelium, which is shed during menstrual bleeding, is the basal layer. Hyperplastic foci begin to form from it, gradually pushing and protruding tissues in the endometrium. Such formations are hormonally inactive and do not respond to progesterone stimulation. They differ in structure from the surrounding tissues, this is especially noticeable in the second phase of the cycle. Determine the histological variant, if developed glandular endometrial polyp functional type:

• secretory option;
• proliferative variant;
• hyperplastic variant.

Women with preserved menstruation are characterized by the identification of a basal type of immature cells that does not respond to progesterone therapy. Against the background of such a polyp is able to change, to form a proliferative endometrium. On histology, these signs confirm the hyperplastic variant. If the study reveals that the tissue corresponds to the secretory or proliferative period of the cycle, it means that the focus responds to the effects of the ovaries.

In the glandular polyp, the stromal component is poorly expressed; glandular tissue predominates in most foci. Stroma is a loose connective tissue, represented by cells with tangles of vessels at the base. Polyps with focal stromal fibrosis can hardly be classified as glandular. The glands are located in it at different angles, differ in length.

From any type of polyp, an adenomatous type can form. At the same time, proliferating epithelial cells without atypia are detected focally or diffusely.

With the help of ultrasound, the presence of pathology can be assumed. It has clear boundaries, expands the uterine cavity, the structure is homogeneous or with many inclusions. They are located in the area of ​​​​the mouths of the fallopian tubes or the bottom. Through ultrasound, a small polyp can be determined, only 0.2-0.4 cm.

Treatment of a glandular polyp involves two stages - surgical removal and hormonal therapy. A simple and effective method - and removal of the endometrial polyp. If the feeding vessels were removed and the attachment site was coagulated or cauterized with liquid nitrogen, then there is no reason to resume growth. The cracked polyp is sent for histology to confirm the diagnosis.

When an endometrial glandular polyp is confirmed, treatment after removal involves taking hormonal drugs. These can be combined contraceptives and pure gestagens. Drugs are prescribed for a period of 3-6 months. How to treat with their help the consequences of a polyp with stromal fibrosis will be explained in detail by the doctor. After that, a woman can plan both pregnancy and IVF. See photos of some drugs nearby.

Glandular fibrous endometrial polyp

Histological analysis of fragments of biopsy material of a glandular-fibrous neoplasm allows us to determine that the glands in it are placed randomly, are in the process of proliferation. Functionally active epithelium is not expressed, and in the cystic glands it is proliferative or does not function and is thickened. The leg is rich in cellular elements with stromal fibrosis. The stromal component predominates over the glandular one.

The diagnosis indicates the type of polyp:

• indifferent option;
• retrogressive version.

The latter type is more typical for postmenopause (menopause). The polyp of the proliferative type is large - from 2.5 to 3.5 cm.

With a glandular-fibrous polyp of the endometrium, treatment also combined in the form of surgery and conservative treatment. During hysteroscopy, curettage of the uterine cavity is necessarily performed, which means a reduction in the risk of recurrence. Since the causes of the glandular fibrous polyp require treatment after removal, hormonal drugs are prescribed for up to 6 months. After that, you can plan a pregnancy.

Fibrous endometrial polyp

The causes of this type of uterine polyp are similar to the others. In the fibrous polyp of the endometrium, the stroma predominates, the glandular tissue occurs singly, there are few vessels. The basis of therapy is surgery. It is supplemented with treatment after removal: antibiotics and hormonal drugs are used.

Adenomatous endometrial polyp

This type of polyp is rare, it is more typical for women after 40 and postmenopausal. The size of the polyp is small, rarely up to 30 mm. It is possible to determine that this is hyperplasia or this is a polyp only histologically. Often there is a combination of pathology with myoma,. In older women, pathology can develop against the background of endometrial atrophy. The cells of the adenomatous polyp become younger in morphological structure. As the condition progresses, it transforms into adenocarcinoma.

Is surgery necessary for this condition? Treatment is complex. An adenomatous polyp of the endometrium must be operated on to prevent its malignancy and metastasis.

How to determine the pathology using ultrasound

On ultrasound, any type of neoplasm has characteristic common signs:

• clear boundaries of the focus;
• deformation of the median linear part of the M-echo;
• expansion of the uterine cavity;
• acoustic effect in the form of signal amplification or attenuation;
• round shape of formations;
• the presence of cystic inclusions.

Ultrasound signs differ slightly based on the type of polyp. This means that ultrasound can only determine the presence of an overgrowth of the formation, and the type and further treatment after removal of the endometrial polyp is determined by the results of histology.

Removal of an endometrial polyp

After diagnosing an endometrial polyp, treatment is selected depending on its histological type and the age of the woman. Removal of the endometrial polyp is a mandatory step in therapy. This is associated with a high risk of its transition to cancer. Also, a polyp is an obstacle to pregnancy in women of childbearing age.

Some suggest that the polyp may come out with menstruation. But it's not. The source of neoplasm growth is the basal layer, which does not exfoliate during menstruation. On which day of the cycle is removed, in a particular case, the doctor decides. But the optimal time is considered when the menstruation ends and no later than 10 days from their beginning. At this time, the endometrium is thin and its position and the polyp stem are visually clearly visible. This allows you to correctly remove the polyp to healthy tissues and prevent its reappearance (relapse). During menstruation, a resection can be performed according to emergency indications.

What is an endometrial polyp and how to treat should be decided by the doctor on an individual basis.

Endometrial polyp in the uterus and treatment without surgery

Complete treatment without surgery is impossible. Alternative methods of treatment are not effective. Do not waste time looking for recipes and checking the effect of the funds found. There are minimally invasive techniques that minimally injure surrounding tissues, are not accompanied by bleeding, and have a short recovery time after manipulation, for example,.

Treatment without surgery of the endometrial polyp in the uterus can be called laser removal. This method allows resection of only pathological tissues without scar formation. When removing the laser, you can select the required power and target the tissue. The disadvantage of the method is that in some cases a relapse of the disease occurs after a few months.

Hysteroresectoscopy of the endometrial polyp - what is it

The main method of treatment of endometrial polyps in the uterus of all types, except for adenomatous, is resectoscopy. adenomatous polyp in patients older than 45 years is an indication for hysterectomy. In nulliparous girls, they resort to hysteroresectoscopy of the endometrial polyp - this is such an excision using a hysteroscope. Subsequently, hormonal preparations are prescribed and it is recommended to become pregnant and give birth in the near future. In case of recurrence of the adenomatous focus, the uterus is removed without appendages.

Hysteroscopy of the endometrial polyp is the method of choice in the treatment of pathology.

Examination before surgery

If an endometrial polyp is found in the uterus, the operation is scheduled in a planned manner. Only bleeding and neoplasm necrosis are indications for emergency intervention. Routine examinations include:

• general blood and urine tests;
• coagulogram;
• blood type and Rh factor;
• biochemical analysis;
• testing for HIV and syphilis;
• Ultrasound of the pelvis.

According to indications, other additional methods of examination are possible.

Hysteroscopy and its consequences

The removal operation is performed in the gynecology department in the operating room under anesthesia. Local anesthesia is not used. After the polyp is removed, it is recommended to curettage the uterine cavity. This is especially true for endometrial hyperplasia.

The postoperative period takes place in the ward. Awakening from anesthesia, diuresis (urine separation) is controlled. Allocations after hysteroscopy of the endometrial polyp in the form of dark blood for 2-3 days. Then they brighten, become slimy with a slight tint of yellowness. It can last up to 10 days after removal.

Hysteroscopy can result in endometritis. With an increase in body temperature, the appearance of discharge with a smell, pus, you need to inform the doctor about this. Heavy bleeding a few days after hysteroscopy also indicates a deterioration in the condition and requires emergency medical attention.

A tissue sample from the polyp is sent for histology. The result is ready in about 7-10 days. Based on the analysis data, you can adjust further treatment and decide what to do next.

Treatment after removal of the endometrial polyp

Surgical manipulation is the first stage of medical care. Treatment after removal of the endometrial polyp in the uterus consists in the prevention of purulent-septic infection and hormonal correction. Non-hormonal treatment includes broad-spectrum antibiotics (Cefotaxime, Sumammad), vitamins. Nutrition must be balanced. Women who are overweight need to follow a diet.

Hormonal therapy includes the appointment of combined oral contraceptives for women under 40 years of age (Zhanin, Yarina, Regulon). Older than 40 use progestin preparations Duphaston, Utrozhestan.

Discharge after hysteroscopy of endometrial polyp: rehabilitation period

Menstruation after removal of the endometrial polyp may come with a delay if curettage has not been performed. The first menstruation after cleaning the uterine cavity appears after 28-30 days. In this case, the day of operation is considered the first day of the cycle. When using hormonal drugs, there is practically no delay in menstruation.

Women who are not going to become pregnant, who have fibroids or are recommended to use an intrauterine device with the Mirena progestogen component as a treatment after the removal of hyperplastic foci.

Endometrial polyp and pregnancy

Polyp and pregnancy are incompatible. The presence of a polyp in the uterus - prevents, even if conception has occurred. It is mechanical and. to the "unhealthy" endometrium and will be released along with menstrual flow. If the embryo is implanted in the early stages of pregnancy, a miscarriage will occur. Often it is in nulliparous girls that endometrial polyposis is found as the cause of a long absence of pregnancy.

They give good prognosis for recovery and preservation of reproductive function.

A benign formation that forms from the basal layer of the endometrium in the uterus is classified in medicine as an endometrial polyp. This disease can occur at any age of a woman, but most often polyps are diagnosed in patients over the age of 35 years.

Doctors cannot clearly identify the causes of the appearance of the benign formation in question, but they can identify several predisposing factors:

• abortion, spontaneous miscarriages, complicated childbirth (for example, after them blood clots or fragments of the placenta remained in the uterus - over time they are replaced by connective tissue and a polyp is formed);
• violations in the process of hormone production - the level is lowered, and the level is increased;
• endocrine disorders - thyrotoxicosis;
• traumatization of the uterine cavity - diagnostic curettage (frequent), abortions, wearing an intrauterine device for a long time;

Clinical picture with endometrial polyps

If the benign neoplasm under consideration is small, then the symptoms will be absent. Most often, such polyps are diagnosed by chance, when a woman undergoes pelvic organs. With large neoplasms, or when several polyps occur, the following symptoms may be present:

1. . They are manifested by bloody discharge from the vagina between menstruation, in young women such discharge can be abundant, but during menopause, single discharges are more common.
2. Cramping. They cannot be associated with anything, but women note that this symptom appears during or immediately after the end of sexual intercourse.
3. contact bleeding. So called spotting immediately after intercourse.

Note:in women of reproductive age, against the background of an existing endometrial polyp, it is diagnosed. Many doctors do not link these two problems, but it has been noted that after the removal of the benign neoplasm in question, the likelihood of conception increases dramatically.

The clinical picture with an endometrial polyp is not characteristic, the above symptoms are inherent in both the inflammatory process in the endometrium and the inflammatory process. If a woman notes the appearance of these signs, then she should consult a gynecologist - the doctor will be able to make a diagnosis and prescribe an effective treatment only after a full examination of the patient.

Treatment of the endometrial polyp

Diagnosis of the considered benign neoplasm, as a rule, does not present difficulties for the doctor - it is enough to make the patient an ultrasound examination of the pelvic organs.

The main method of treating endometrial polyps is surgical intervention, when the neoplasm is simply removed from the uterine cavity. Such an operation is called hysteroscopy, it is carried out using a special instrument - a hysteroscope, inserted into the uterine cavity. In the process, the surgeon examines the uterine cavity and removes the polyp. Be sure to scrape the endometrium during the operation - this biomaterial is sent to the laboratory for, which makes it possible to determine the type of polyp.

In the future, treatment tactics depend on the type of polyp and the age of the patient. If the histological examination showed that the neoplasm has a fibrous structure, then no therapy is carried out. In case of detection of glandular-fibrous or glandular polyps, the patient is shown hormone therapy, which will normalize and stabilize the menstrual cycle and the overall hormonal balance in the body.

Hormone therapy is carried out in a long course (from 3 to 6 months), the doctor usually prescribes certain drugs:

• Yarina, Janine, Regulon - estrogen-progestin contraceptives that are great for women under 35;
• Duphaston, - gestagens, they are usually prescribed as postoperative therapy for women over 35 years old;
• intrauterine system "Mirena" - it releases the hormone levonorgestrel into the uterine cavity, is placed in women who do not plan pregnancy in the next 5 years.

It is worth paying special attention to one point: if during the histological examination of the biomaterial an adenomatous form of a polyp was detected, then radical treatment will be required, since this form of polyps is considered a precancerous condition. If a woman is already 45 years old, then doctors perform a complete removal of the uterus, in the case of a combination of the disease in question with endocrine disorders, it is recommended to remove the appendages. Women of reproductive age will have to undergo a long course of hormone therapy, which will allow them to become mothers, but when the period

Often a woman undergoing a gynecological ultrasound will learn from the doctor about the presence of a polyp in the uterus. Often repeated in this case, the doctor's words "it's not scary" or the silent appointment of curettage does not inspire confidence in one's health. What is an endometrial polyp, is it worth worrying about and how to treat it - these are the main questions that you should know the answer to.

Endometrial polyp - what is it and how to treat it?

What it is? An endometrial polyp is a focal benign growth of the uterine mucosa, which is a limited outgrowth of the inner layer of the endometrium on a stalk pierced by blood vessels. Overgrown foci can be single and multiple.

Soft, often small (several mm) growths sometimes reach several centimeters in size. Multiple endometrial outgrowths, as well as re-formed after their radical removal, indicate the development of polyposis in a woman as a painful condition.

Endometrial polyp photo

Therapeutic tactics directly depends on the size of the polyp and its histological type, the state of the reproductive system. Types of endometrial outgrowths depending on their cellular structure:

1. Glandular - consists of the uterine glands and stroma;
2. Glandular fibrous - the most common type in women of childbearing age, uterine glands and fibrous inclusions are found in the growth;
3. Fibrous - only fibrous cells are found in the structure;
4. Adenomatous - the most dangerous (precancerous) type of polypous formation of the endometrium, is represented by glandular cells, some of which have atypical signs.

Endometrial polyps in women are found at any age, but they are more often diagnosed after 35 years. Modern medicine cannot accurately indicate the causes of an endometrial polyp. However, there is a list of conditions against which it is often found:

• - lack of progesterone, excessive estrogen synthesis;
• Abortions, spontaneous miscarriage;
• Prolonged use of an intrauterine device;
• Difficult course of childbirth (especially aggravated by placenta accreta and its manual separation);
• Inflammatory diseases of the genital area of ​​a chronic nature with the development of endometritis;
• Endocrine disorders - thyroid pathology, obesity, diabetes mellitus;
• Taking Tamoxifen (hormonal drug) to treat breast cancer.

Solitary small polyps often form without any symptoms and are an incidental finding on ultrasound examination of the uterus.

The main sign of the presence of an endometrial polyp in the uterus is the failure of the desired pregnancy and infertility against the background of general health.

The growth of uterine polyps (multiple foci, large sizes) is manifested as follows:

• Periodically occurring pain (sharp or aching) in the lower abdomen, aggravated by intercourse;
• Beli - increased compared to the usual amount of whitish discharge;
• Bloody discharge - scanty spotting outside of menstruation, after intercourse;
• Bleeding - occurs 1-2 weeks after the end of menstruation;
• Painful, profuse menstrual bleeding.

The fact that the polyp is the cause of non-pregnancy has not been proven. However, the inverse relationship is clearly traced: with infertility, hyperplastic growths of the endometrium are often found, after the removal of which problems with the conception of a child are eliminated.

Even multiple repetition of the IVF procedure may not give a result. But even with the onset of the desired pregnancy, the uterine polyp significantly increases the risk of miscarriage and premature delivery. Removal of polyposis overgrowth is often carried out after childbirth.

Diagnosis of a polyp

The diagnosis of an endometrial polyp is usually not difficult. For this, the following are carried out:

• Ultrasound - an outgrowth with clear boundaries is found in the uterine cavity against the background of a homogeneous endometrium.
• - instrumental examination of the uterus under anesthesia with the possibility of simultaneous removal of the detected polyp.
• Histological analysis - determination of the cellular composition of the removed polyp.
• Laboratory research on the hormonal background - an analysis of sex hormones and the thyroid gland, is necessary for the correct prescription of the treatment regimen and the prevention of relapses.

Differential diagnosis is carried out with pregnancy (the first weeks, frozen), myoma (growth of the muscular layer of the uterus), endometriosis (large-scale, non-focal growth of the endometrium).

Endometrial polyp treatment - surgery, therapy, herbs

The only way to eliminate the endometrial polyp is to remove it. Neither drug therapy nor folk recipes cleanse the uterine cavity from pathological growths.

It is naive to believe that the endometrial polyp can resolve on its own. A full-fledged medical complex includes the removal of a polyposis outgrowth and only after that, mandatory drug therapy to prevent its reappearance.

Surgical methods for removing uterine polyps

• Gynecological curettage

Curettage of the endometrial polyp involves mechanical rejection of its entire inner layer along with polyps. The procedure is performed under local or general anesthesia on an outpatient basis.

Its main disadvantage is that polyposis legs cannot be removed, and often recur. Gynecological curettage is advisable in case of combined damage to the uterus by polyps and endometrial hyperplasia in menopausal women.

• Therapeutic hysteroscopy

It is a targeted technique for excising polyps. Under general anesthesia, a mini-camera is inserted into the uterine cavity of the patient, the identified polyp is removed along with the leg without traumatizing the surrounding tissues.

This method is most suitable for the treatment of young women. With developed, large polyposis growths with a well-formed pedicle, a polypectomy is performed - “twisting” the pedicle.

Physical methods: laser therapy, radiotherapy, cryodestruction, electrocoagulation

These techniques are based on temperature exposure (cryodestruction - freezing with liquid nitrogen, radiotherapy - heating with radio waves) or a cauterizing effect (laser or electric current).

The choice of a minimally traumatic method for removing polyposis outgrowths in the uterus remains with the attending physician and depends on the availability of appropriate equipment in the clinic.

Such technologies are guaranteed to remove small polyps along with the stem and complement the hysteroscopic excision of large formations (cauterization of the polyp bed) to prevent recurrence.

Uterus removal

When diagnosing adenomatous polyps (high risk of cancerous degeneration!) Patients in the postmenopausal period are recommended radical removal of the uterus and its appendages.

This is the most traumatic method used to avoid the development of oncology in women with a hereditary predisposition.

In case of hormonal failures - up to 40 years old, combined contraceptives (Zhanin, Yarina) are recommended, young patients are treated with progestin medications (Utrozhestan, Duphaston). Treatment with hormones after removal of the endometrial polyp lasts 3-6 months.

The newest remedy - the Mirena spiral - contains a therapeutic dose of hormones, is used to treat patients of reproductive age who no longer want to give birth. Effective with massive uterine polyposis with simultaneous detection of fibroids. Duration of use - up to 5 years.

After surgical excision of endometrial polyps, it is imperative to influence the accompanying pathological abnormalities: anti-inflammatory therapy, treatment of impaired synthesis of thyroid hormones, etc.

Symptoms, signs and diagnosis of endometriosis in women:

Herbal treatment

The main medicinal herbs that contribute to the treatment of uterine polyps are red brush, hellebore and upland uterus. Their action is based on the restoration of hormonal levels. The best effect is achieved when they are combined.

However, such treatment of endometrial polyps without surgery, like hormone therapy, will not resolve the polyps and will not even reduce them in size, but will only prevent their growth and the formation of new foci.

Regular visits to the gynecologist for preventive purposes are the main recommendation for women who want to maintain their health. In case of any changes in the genital organs (pain, discharge, bleeding), you should immediately seek medical help.

Consequences of uterine polyps, complications

• Anemia due to blood loss.
• Polyposis of the uterus.
• Oncology (extremely rare with glandular-fibrous endometrial polyp).