Uterine polyps is a focal hyperplasia of the endometrium, characterized by pathological growth of the uterine mucosa in the form of single or multiple neoplasms on a wide base or pedicle. Disease is manifested by uterine bleeding, periodic pain, infertility. Uterine polyps is diagnosed during a comprehensive gynecological examination – examination, ultrasound, hysteroscopy, histological examination. Treatment is surgical, including polypectomy and curettage of the uterine cavity, sometimes supravaginal amputation or extirpation of the uterus.
Uterine polyps, or endometrial polyps, are local benign outgrowths from the basal layer of endometrioid cells that rise above the uterine mucosa in the form of separate tubercles. The size varies widely – from a few millimeters (the size of a sesame seed) to several centimeters (a golf ball). Endometrial polyps can be either single or multiple, connected to the uterine wall by a thin leg or a wide base. In the case of multiple endometrial polyps, they speak of uterine polyposis.
Usually endometrioid polyps do not spread beyond the uterine cavity, but in rare cases they can germinate through the cervical canal into the vagina. Uterine polyp is detected in patients of various age groups – young girls, women of middle and menopausal age; the frequency of pathology ranges from 6 to 20%. Endometrial polyps are often combined with cervical canal polyps. Pathology in gynecology is regarded as a precancerous condition and is subject to mandatory removal.
The structure of the this disease is represented by three main components: endometrial glands, endometrial stroma and the central vascular canal. The surface of the polyp is covered with epithelium, the pedicle includes a fibrous stroma and thick-walled vessels. Uterine polyp can ulcerate, become infected, necrotize, undergo cellular metaplasia.
According to the morphological structure, it is customary to distinguish uterine polyps of the glandular, glandular-fibrous, fibrous and adenomatous type. Uterine glandular polyps are formed by endometrial tissue containing glands; they develop more often at a young age. Glandular-fibrous polypous formations are microscopically represented by endometrial glands and connective tissue (stroma); they occur in mature women. Fibrotic uterine polyp is formed mainly by dense connective tissue, in which single glands are present; such polyps are usually diagnosed in women over 40 years of age. Adenomatous uterine polyps consist of glandular epithelium with signs of proliferation, structural restructuring of the glands; they have prerequisites for the transition to endometrial cancer, therefore they require increased attention.
Among the uterine polyps, placental polyps are separately distinguished, which are formed from fragments of the placenta that has not been completely removed due to complicated abortion, childbirth, spontaneous termination of pregnancy, frozen pregnancy. Placental uterine polyps are manifested by prolonged, profuse bleeding, which can later lead to infection and infertility.
In the genesis of uterine polyps, the main role is assigned to the neurohormonal influence and inflammatory changes of the endometrium. Uterine polyps, as a rule, develop against the background of hormonal dysfunction of the ovaries and hyperestrogenism, which are accompanied by focal endometrial hyperplasia in the form of polypoid mucosal growths. Along with uterine polyps, such patients may also have other diseases caused by estrogenism – glandular endometrial hyperplasia, uterine fibroid, adenomyosis, mastopathy, polycystic ovary syndrome, etc.
The occurrence of uterine polyps is promoted by chronic sexual infections and female inflammatory diseases (endometritis, adnexitis, oophoritis), traumatization of the uterus by surgical abortions, endometrial scraping, prolonged wearing of the IUD. The risk group for the development of endometrial polyps includes women with arterial hypertension, obesity, thyroid diseases, diabetes mellitus, immune disorders, neuropsychiatric injuries.
Regardless of the structure of uterine polyps, they all cause similar symptoms. After a period of asymptomatic course, dysfunctional uterine bleeding occurs, which can be cyclic or acyclic in nature. With uterine polyps, menorrhagia is noted – copious menstruation, succulent premenstrual discharge, spotting blood discharge outside menstruation and after sexual intercourse, metrorrhagia, bleeding during menopause. Constant blood loss often leads to significant anemia, accompanied by pallor of the skin, dizziness, weakness.
For large uterine polyps, the appearance of pathological mucous whites, cramping pains in the lower abdomen, discomfort and pain during sexual intercourse is typical. In women of reproductive age, endometrial polyps often cause infertility, in pregnant women they increase the risk of miscarriage and premature birth.
The symptoms are similar to the manifestations of endometriosis, uterine fibroids, and the threat of miscarriage, therefore they require a professional examination by a gynecologist.
Examination includes the collection of gynecological and reproductive anamnesis, vaginal examination, pelvic ultrasound, hysteroscopy and metrography, separate diagnostic curettage with histological examination of the endometrium.
During gynecological examination, cervical polyps can be detected in mirrors, while endometrial polyps are usually inaccessible to visualization and palpation. When performing pelvic ultrasound, attention is drawn to the presence of an enlarged uterine cavity, a thickened endometrium with clear growths of a mucous homogeneous structure.
The standard examination for uterine polyps is hysteroscopy – examination of the uterine cavity with a flexible device with a video camera inserted through the cervical canal. At the same time, single or multiple, rounded or oblong formations are visually determined in the uterine cavity, the color of which can be pale pink, yellowish or dark purple. With the help of hysteroscopy, the number, size, location of polyps are determined, and their simultaneous removal is performed under visual control with subsequent morphological verification of the diagnosis.
Diagnostic endometrial scraping is also performed to obtain tissue samples. In the process of metrography – radiography of the uterine cavity with a contrast agent, uneven outlines of the uterine cavity and the presence of polypoid outgrowths in them are revealed. Before planning the transcervical removal of uterine polyps, a woman needs to be examined for infections (mycoplasmosis, chlamydia, gonorrhea, trichomoniasis, candidiasis), bacteriological, oncocytological and microscopic examination of smears from the genital tract.
The optimal method of treating uterine polyps is endoscopic polypectomy – removal of formations during hysteroscopy followed by endometrial scraping. Polyps on the leg are removed by “unscrewing”, the polyp bed is cauterized by electrocoagulation or cryogenic method to exclude relapses. After polypectomy and curettage, a control gynecological ultrasound is performed on 3-4 days.
After hysteroresectoscopy of uterine polyp for 10 days, spotting spotting from the genital tract, spasmodic pain may occur. To prevent infection, sexual activity is limited for this period. Further therapeutic tactics are determined by the histotype of the uterine polyp, the age of the patient and the existing menstrual cycle disorders.
With the fibrous structure of the uterine polyp and the absence of menstrual dysfunction, treatment is limited to polypectomy with curettage of the uterus. Glandular or glandular-fibrous uterine polyps after their removal at any age require additional hormonal treatment. To normalize hormonal processes, oral contraception is selected (COC – ethinyl estradiol in combination with dienogest or deogestrel), the installation of a hormonal intrauterine device “Mirena”, treatment with progestogens (progesterone, norethisterone, didrogesterone).
In case of detection of adenomatous uterine polyps, more radical treatment is required. Women of premenopausal and postmenopausal age have their uterus removed – supravaginal amputation or hysterectomy. In case of oncological alertness or the presence of endocrine disorders, a pangisterectomy is indicated – removal of the uterus with adnexectomy.
Prognosis and prevention
A feature of the course of uterine polyps is their tendency to relapse. Recurrent uterine polyps are susceptible to malignant transformation in 1.5% of cases; the greatest risk of endometrial cancer is associated with adenomatous polyps. Therefore, after the end of treatment for uterine polyps, patients remain under the supervision of a gynecologist. In the absence of treatment of uterine polyps, anemia and infertility develop. The presence of endometrial polyps increases the likelihood of miscarriage and requires consideration of this factor during pregnancy.
Prevention of endometrial polyps consists in timely and thorough treatment of inflammatory diseases of the uterus and appendages, correction of ovarian dysfunction, careful intrauterine manipulation.