Often, when contacting a specialist for spotting or prolonged infertility, after examination, endometrial polyps are detected in a woman. They belong to benign formations that are located inside the uterine cavity, developing from its inner shell. Formations can be single or multiple, then we are talking about a disease (polyposis). What reasons contribute to the formation of polyps, what is the role of hormones, intrauterine interventions and other factors in the genesis of pathology.
Endometrial polyps: what are they?
Formations growing from the mucosa, which are benign and located inside the uterine cavity, are called endometrial polyps. Growths are formed as a result of hyperplastic processes — uncharacteristic, excessive growth of the inner membrane lining the uterus. Often, a single endometrial polyp is detected, but if there are relapses of the process, or multiple formations are formed, then the diagnosis of «polyposis» is made. This is already a pathological process, provoked by certain failures in the female body.
It is worth emphasizing the fact that the endometrial polyp is classified as a non-cancerous pathological formation, in which a body of different sizes with a thin stalk is isolated. It is attached to the uterine wall with it, the capillaries that feed it pass through it.
Types of uterine polyps
Those polyps that form inside the uterine cavity, based on their constituent tissues and the specifics of the structure, are divided into several categories:
- Polyp glandular type. It is represented by stromal cells with the presence of uterine glands.
- Fibrous-glandular, having a basis of fibrous cells with periodic inclusions of glandular elements of the endometrium.
- A fibrous-type polyp includes only fibrous tissue, not revealing other cell variants in its structure.
The most dangerous in relation to the transition to malignant tumors is the adenomatous type polyp (it is sometimes called precancerous). Glandular cells predominate in its structure, but some of them have an atypical structure, with signs of malignant degeneration.
Reasons for the formation of polyps: the role of hormones, age, interventions
Such formations are likely in a woman from the onset of puberty to menopause, they do not depend on pregnancy, childbirth or sexual activity. Most often they are registered in the age category of 30-40 years, and the risk of polyposis, as a disease, gradually increases to 50 years and older. Against the background of active production of hormones, after gestation and successful delivery, glandular formations are more often formed. In mature women approaching menopause, fibrous or adenomatous polyps are more typical. If we talk about the fibro-glandular type, then it does not depend on age.
The most common causes that lead to the development of polyps are hormone imbalances and intrauterine traumatic interventions. The growth and activity of the endometrium is influenced by the female sex hormones — estrogens with progesterone. Sharp violations of their balance with a deficiency of progesterone or an excess of estrogens become one of the provoking factors for the growth of polyps.
Not always only sex hormones can affect this pathology. Predisposing factors are disorders of the thyroid gland, long-term diabetes, the presence of obesity, which in a certain way affects the exchange of steroid hormones.
Relate to factors that increase the risk of polyposis, and repeated abortions, diagnostic curettage, prolonged stay inside the uterus of the spiral, difficult childbirth, as a result of which placental remains or blood clots are retained in the uterus. They are then replaced by connective tissue, and subsequently a polyp can form at this site.
Manifestations of polyps: discharge, pain, discomfort
Manifestations can be very variable, in many respects they depend on what type of polyp grows, and what is the number of formations, what maximum sizes they form, whether the uterus and its cervix are deformed. A single element of a small size can be completely asymptomatic, being detected during routine ultrasound.
If these are multiple growths or it is one, but reaches a large diameter, the most typical discharge is of a smearing nature between or before menstruation. During the period of the next monthly discharge, they become longer (up to 6-7 days) and plentiful. Often there is pain in the perineum, back and lower abdomen. There may also be periodic pain or severe discomfort during sexual intercourse, scarlet discharge after it. Also, one of the signs of polyposis can be infertility in the absence of any other alarming manifestations.
Examination methods: palpation of the uterus, ultrasound, hysteroscopy
First of all, in the presence of any complaints, it is necessary to contact a gynecologist, the identification of polyps today is not difficult. When viewed on a chair, the uterus is palpated, the condition of the cervix is assessed in the mirrors. Formations in its area are detected visually, a pink formation is determined inside the external pharynx. Then the uterus with appendages is examined by ultrasound, where an expansion of the cavity and a clearly contoured single polyp or several formations are detected.
If polyps are detected on ultrasound, diagnostic hysteroscopy is indicated, which can simultaneously become a treatment. A woman is given general anesthesia (short-term), and the doctor drives a device into the uterine cavity, with which he examines the cavity from the inside. When polyps are found, they are immediately removed. The material obtained during the intervention is necessarily sent to the laboratory for histological examination in order to determine its nature and determine the further tactics of the patient.
Why do polyps need to be removed?
If polyps progress, they can contribute to certain complications, including the formation of infertility. In addition, against their background, there are failures of the menstrual cycle. Usually this is a delay, algomenorrhea, which leads to an increase in the volume of blood loss and the formation of iron deficiency anemia. In some cases, when an adenomatous variant of polyps is detected, they, with prolonged growth inside the uterine cavity, can lead to the development of a cancerous lesion of the endometrium. To prevent this, polyps are removed and their histological structure is determined, and then a targeted observation of the woman is carried out. In some situations, polyps are prone to recurrence, and then the treatment tactics change.
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Gynecology. National leadership / Ed. G. M. Savelyeva, G. T. Sukhikh, I.B. Manukhin — 2013
Long-term results and optimization of tactics for the treatment of endometrial polyps in postmenopausal women / Sarkisov S.E., Khitrykh O.V., Kukovenko E.M. // obstetrics and gynecology — 2009 — #5