Endometrial polyps .Endometrial polyp - Causes, Symptoms and Treatment .MF .
Polyposis endometrial - a disease that is characterized by the formation of multiple benign tumors - polyps in the uterus.Polyps are referred to as endometrial hyperplastic processes in which there is a "proliferation" of the basal layer of the endometrium (the inner layer of the uterus).
Polyposis endometrium can occur at any age, but most cases occur in adult polyps (35-50 years) and in the elderly.
polyp has a leg and the body, consisting of epithelial cells.
Depending on the building structure - Endometrial polyps are of the following forms:
- glandular consisting of stroma and glands;
- glandular-fibrous polyps are composed of connective tissue and a small amount of iron;
- fibrous polyps, consisting only of connective tissue formations;
- adenomatous polipy- "precancerous" polyps, which consist primarily of glandular epithelium, but having with atypical cells.
In women younger reproductive age are more common polyps, glandular structure, and older women more often fibrotic and adenomatou
Possible causes endometrial polyposis:
- narusheniya- hormone estrogen excess and lack of progesterone;
- trauma cavity matki- abortion, dilatation and curettage, long wearing an intrauterine device;
- abortion, miscarriage, childbirth with incomplete removal of the placenta.And fibrin blood clots, which are then in the uterus, are replaced by connective tissue, forming a polyp.
- endocrine disorders and extragenital diseases: diabetes, obesity, hypertension, thyroid disease;
- psychological factors-severe stress and depression;
- chronic inflammatory diseases of the pelvic organs: the appendages inflammation, endometritis, an infection;
- reduced immunity.
symptoms of endometrial polyposis
symptoms of endometrial polyposis varied.Quite often, there are no clinical manifestations of polyposis, (especially if the polyp size small) and found by chance during an ultrasound.However, if the disease makes itself known, it appears most often nizheperechislennnoy symptoms:
- irregular menstrual tsikla- often appear meager smearing of bleeding between periods, is not related to menstruation.In women younger polyposis can manifest itself in the form of more abundant menstruatsii- "menorrhagia" in a scientific way.
In postmenopausal women, similar clinical manifestations are not of a permanent nature, can only be a one-time bleeding from the genital tract;
- cramping pain in the abdomen, usually worse during sexual intercourse;
- Belikova abnormal discharge from the genital tract.The symptom is typical for large polyps;
- "contact" krovotecheniya- discharge from the genital tract after sex;
- infertility in young women of childbearing age.
on signs of endometrial polyps is often confused with the symptoms of uterine fibroids or endometriosis.Intermenstrual bleeding can be confused with the threat of miscarriage in early pregnancy.In any case, such symptoms require consultation of the gynecologist.
diagnosis of endometrial polyps
Today, diagnosis of endometrial polyposis presents no particular difficulties.If polyps, endometrial addition, located in the cervical kanale- that when viewed in the outer cervix throat visible education pinkish color.However, this is not always, in most cases, polyps diagnosed by additional methods of research:
- pelvic ultrasound.The method is particularly informative in the presence of fibrous and glandular fibrotic endometrial polyps.the uterine cavity is expanded, clearly identifies a homogeneous structure
- Hysteroscopy (a special optical system, which is introduced into the uterine cavity) - the most reliable method for diagnosis.Typically, polyps are located near the bottom corners and uterus.Hysteroscopy main advantage compared with other methods consists in the fact that one can simultaneously remove polyps visually monitoring the uterus during diagnosis.
- Histological examination of scrapings of the endometrium - can not only detect the presence of a polyp, but also determines the shape t.e.strukturu polyp.
In our country, as a rule, endometrial polyps, diagnosed by ultrasound, then the patient is sent to a hysteroscopy to remove the polyp.
Treatment of endometrial polyps
Operative treatment of endometrial polyposis - this is the main method of treatment of endometrial polyposis.During hysteroscopy the doctor removes a polyp and scrape the mucous membrane of the uterus under the supervision of a hysteroscope.If a large polyp (from 1 to 3 cm), it is removed by "loosening".The operation is called " polypectomy ".
Lodge remote cauterize a polyp electrocution or liquid nitrogen to prevent a recurrence.The resulting scraping necessarily sent for histological examination.After scraping
3-4 day shows the control pelvic ultrasound.
Depending on the shape of the polyp, the patient's age, the presence or absence of menstrual disorders is determined by further tactics of treatment.
If the patient is not impaired menstrual function, and the polyp has a fibrous structure, the treatment is only possible to limit hysteroscopy with curettage polyps and uterine cavity.
When glandular and glandular-fibrous polyps at any age after scraping shown hormonal treatment to normalize hormone levels and the settlement of the menstrual cycle.As hormone therapy use:
- -gestagennye estrogen COCs (combined oral contraceptives) for contraceptive skheme- Janine, regulon and so on Yarina.Preparations of this group are suitable for women to 35 years old;
-gestageny -Suitable women with endometrial polyposis, which for 35.
Use Djufaston, Norkolut, Utrozhestan 16- 25 day menstrual cycle;
course of treatment with oral hormones is from 3 to 6 months.
- hormonal spiral "Mirena" distinguishes progestogen - levonorgestrel into the uterine cavity.Suitable menstruating women are not planning a pregnancy in the coming years, as well as those who have endometrial polyps combined with uterine fibroids and adenomyosis.Spiral tied for 5 years.
Identification adenomatous polyp forms require a more "aggressive" approach to treatment.If the woman is premenopausal (45 years before menopause) or postmenopausal (after menopause), hysterectomies shown.In oncological alertness and exchange-endocrine disorders - removes the uterus with appendages.If a woman of reproductive age, with no metabolic disorders, possibly temporary appointment of hormones after curettage, but later in life, the question of surgical treatment should be reviewed.
postoperative period usually runs smoothly.After hysteroscopy to 10 days can be confusing for smearing blood from the genital tract.For the prevention of inflammatory complications the doctor prescribes
antibiotics (Cefazolin, Ceftriaxone).
Within 10 days after curettage is a low-fat diet and lack of sexual relations.
Folk remedies for the treatment of endometrial polyps
Folk remedies have rather low efficacy for the treatment of endometrial polyposis.It extends the application of garlic - one clove of garlic is softened - put in cheesecloth and tie the thread so that took the form of a gauze swab.The tampon inserted into the vagina daily at night for a month.So you can only burn the mucous membrane of the vagina, but not cured polyps.
Complications of Endometrial polyposis:
- menstrual disorders - with heavy bleeding hemoglobin level drops, which leads to anemia;
- relapse after scraping;
- polyp degeneration into a malignant tumor-endometrial cancer, especially when adenomatous polyps.In other forms of polyposis rebirth unlikely.
prevention of endometrial polyposis:
dynamical observation by a gynecologist;
- weight-control obesity prevention;
- the rejection of abortion;
- timely treatment of inflammatory diseases of the uterus and appendages;
-Application of hormonal contraceptives.
FAQ obstetrician on endometrial polyps.
1. Can I put "MIRENA" without scraping polyp?
No, Mirena is indicated for the treatment of menstrual disorders and for the prevention of recurrence of endometrial polyps -stavit it is possible only after scraping.
2. How fast can zaberemenenet after polyp removal?
immediately, but it is advisable to plan a pregnancy after a course of hormonal therapy.
3. Can I have sex with endometrial polyps?
4. Can be a pain after a hysteroscopy?
Not if Bolivia has likely occurred spasm of the cervical canal, you must consult your doctor immediately.
5. Scraping is performed under general anesthesia?
6. Can be used to treat polyposis Chinese fitotampony?
Yes, it is possible, only after scraping.
7. Can I endometrial polyps go to the bath?
No, if polyposis - all thermal procedures are contraindicated.
8. I found a small endometrial polyp during pregnancy.As polyps affect the fetus?Can I get rid of it during pregnancy?
endometrial polyps has no negative effects on the fetus.With treatment polyposis need to wait until delivery.
9. whether hysteroscopy Do in clinics, or only in hospitals?
hysteroscopy can be done on an outpatient basis in a hospital.It is important that the doctor was competent and had proper examination, before taking you to the scraping.
10. whether endometrial polyps in virgins happens?
Yes, the presence or absence of sexual activity has no relation to the disease.
Obstetrician-gynecologist, Ph.D.Christina Frambos.