Endometrial Polyps of the uterus are a kind of local endometrium hyperplasia, characterized by an abnormal growth of the mucosa in the uterine cavity in the form of a single or multiple tumors having a broad base or a leg. Polyps of the uterus make themselves known by uterine bleeding, recurrent pain and infertility. Endometrial polyps are diagnosed in the course of a complex gynecological examination: visual examination, ultrasound diagnostics, hysteroscopy and histological test. Treatment for uterine polyps is surgical, including polypectomy and curettage (scraping) of the uterus, sometimes – supravaginal amputation or hysterectomy (full removal of the uterus).
- Endometrial polyps classification
- Reasons of the endometrial polyps development
- Symptoms of the endometrial polyps
- Diagnostics of the endometrial polyps
- Treatment of the endometrial polyps
- Prognosis and prophylaxis of the endometrial polyps
Polyps of the uterus, or endometrial polyps, are local benign outgrowths, protruding from the basal layer of endometrial cells, and towering above the endometrium as individual bumps. Endometrial polyps’ sizes vary widely – from several millimeters (like a sesame seed) to several centimeters (like a golf ball). Endometrial polyps can be both single and multiple, connected to the internal uterus wall by either a thin leg or a wide base. In the case there are multiple endometrial polyps, the condition is called an uterus polyposis.
Normally, endometrial polyps do not spread beyond the uterus, but in rare cases they might grow through the cervix into the vagina. Uterine polyps are found in patients of different age groups: young girls, middle-aged women and those, who have already began menopause. The frequency of this pathology occurrence ranges from 6 to 20%.
Endometrial Polyps Classification
The structure of the endometrial polyp consists of the three main components: endometrial glands, endometrial stroma (base layer of cells) and a central vascular channel. The polyp surface is covered by the epithelium (cover layer of cells of all body organs), it’s leg contains a fibrous stroma and thick-walled vessels. Endometrial polyps might get ulcers, become infected, necrotic or subjected to cell metaplasia.
According to the morphological structure, it is customary to distinguish glandular (having glands-like tissue), glandular-fibrous, fibrous (consisting of fibers) and adenomatous types of endometrial polyps.
Glandular type of endometrial polyps are formed by the endometrial tissue containing glands. It is most likely to develop at a young age. Glandular-fibrous polypous tumors are made of microscopic endometrial glands and connective tissue (stroma), they are found in older women. Endometrial polyps of the fibrous type are mostly formed by dense connective tissue, in which several single glands can be found. Such polyps are usually found in women older than 40 years. Adenomatous kind of the endometrial polyps is made up of a glandular epithelium with signs of proliferation (rapid growth) and change in glands structure. They can potentially transform into endometrial cancer and therefore require greater attention.
Among uterine polyps a separate place is taken by the kind of placental polyps. They are formed from fragments of placenta, which were not completely removed as a result of a complicated abortion, childbirth, spontaneous abortion or missed abortion. Placental polyps of the uterine are identifyed by long, heavy bleedings, which might eventually lead to infection and infertility.
Reasons Endometrial Polyps Develop
Endometrial polyps usually develop on the background of the ovaries hormonal dysfunction and excessive level of estrogen in the body, accompanied by the endometrial hyperplasia in the form of a polyp-like growth of the mucous lining. Other conditions caused by estrogen can be found in these patients along with the endometrial polyps. Among them are glandular hyperplasia of the endometrium, uterine fibroids, adenomyosis, mastopathy, polycystic ovaries, and so on.
Chronic gynecological infections and sexual inflammatory diseases of women (endometritis, adnexitis, oophoritis), surgical trauma of uterus during abortion, endometrial curettage, extended wear of the IUD(intrauterine device) contribute to the development of uterine polyps. Women with hypertension, obesity, thyroid gland disease, diabetes, immune disorders, neurological and psychological trauma are at risk of developing endometrial polyps.
Symptoms of Endometrial Polyps
Regardless of the structure, all endometrial polyps cause similar symptoms. After the asymptomatic period, dysfunctional uterine bleedings appear, which may be of a cyclic or an acyclic nature. Endometrial polyps cause menorrhagias – heavy periods, sanioserous premenstrual discharge, bloody smearings outside of the mensese and after a sexual intercourse, metrorrhagias, bleeding after the menopause. Constant blood loss often leads to significant anemia accompanied by the pale skin, dizziness and weakness.
For large uterine polyps typical symptoms are appearance of abnormal white mucous discharge, cramping pain in the abdomen, discomfort and pain during sexual intercourse. In women of reproductive age endometrial polyps often cause infertility, in pregnant women they increase the risk of a miscarriage and a premature birth.
Diagnostics of Endometrial Polyps
Examinations to diagnose uterine polyps include the collection of gynecological and reproductive medical history, vaginal examination, pelvic ultrasound, hysteroscopy and uterography, a separate diagnostic curettage with endometrial histological analysis.
During the gynecological examination mirrors can help to find the polyps of the cervix, while it is not usually possible to find the endometrial polyps through visualization and palpation.
During the pelvic ultrasound, the doctors check if the uterus is enlarged and if it has any thickened endometrial with distinctive growths of the mucous having a homogeneous structure.
Hysteroscopy is the standard examination performed to define the presence of endometrial polyps – it is an examination of the uterus done with the help of a flexible device equipped with a video camera, which is inserted through the cervical canal. If the polyps are present, the visualization would show single or multiple, round or oblong formations in the uterine cavity, the color of which can be pale pink, yellowish or dark purple.
Hysteroscopy allows to determine the number, size, location of the polyps as well as perform their simultaneous removal under the visual control with subsequent morphological verification of the diagnosis. To obtain tissue samples a diagnostic curettage of the endometrium is done.
During uterography — an X-ray of the uterus performed with the contrast medium, uneven contours of the uterus and the presence of polypoid outgrowths can be revealed.
Before planning the transcervical removal of the endometrial polyps it is necessary to check in case the woman has any infections (mycoplasmosis, chlamydia, gonorrhea, trichomoniasis, candidiasis), as well as perform a bacteriological, oncocytological and microscopic examination of smears from the genital tract.
Treatment of Endometrial Polyps
The best method of treatment for endometrial polyps is the endoscopic polypectomy — removal of the tumors during a hysteroscopy followed by endometrium curettage. If the polyp has a leg it is removed by “twisting it off”, the polyp bottom base is cauterized by an electrocoagulation or a cryogenic method to prevent the condition recurrence. In 3-4 days after the polypectomy and curettage a control gynecological ultrasound evaluation is performed.
Within 10 days after the hysteroscopic removal of the endometrial polyps you may experience smearing discharge from the genital tract and cramping pain. To prevent getting infection during this period sexual activity should be limited.
Further treatment strategy is depends on the histotype of the endometrial polyp, the patient’s age and the existing deviations in the menstrual cycle.
When the polyp has fibrous structure and no menstrual dysfunction was identified, the treatment is limited to the polypectomy with the curettage of the uterus.
For the normalization of the hormonal processes oral contraceptives are selected (Combined Oral Contraceptive Pills), installation of a hormonal intrauterine device, or treatment with progestins (Utrogestan, Norcolut, Duphaston).
The more radical treatment is required if adenomatous polyps are detected. In premenopausal and postmenopausal women the uterus is removed via the supravaginal amputation or extirpation. In case there is a risk of oncological disease or if any endocrine disorders are present, it is recommended to perform the panhysterectomy (resection of the uterus and it’s appendages).
Prognosis and Prophylaxis of Endometrial Polyps
Their tendency to relapse is a specific characteristic of the endometrial polyps’ condition. About 1.5% of the recurrent endometrial polyps are susceptible to malignant transformation, while the highest risk of the endometrial cancer is associated with the adenomatous polyps. Therefore, after completing the treatment of endometrial polyps, the patients remain under the gynecologist’s supervision.
If untreated, endometrial polyps lead to anemia and infertility.
The presence of the endometrial polyps increases the probability of a miscarriage and requires consideration of that factor during pregnancy follow-up.
Prophylaxis of the endometrial polyps is concluded in a timely and thorough treatment of the inflammatory diseases of the uterus and it’s appendages, correction of ovarian dysfunction, careful conduct of intrauterine manipulations.