What is a polyp and why is it formed?
A polyp is a local growth of the endometrium on a stalk or broad base. Unlike the rest of the endometrium, the polyp is not completely shed during menstruation, so it persists and can grow larger over time.
The polyp of the cervical canal and cervix is isolated separately - it is visible during a routine examination in the speculum and is removed on an outpatient basis.
- Hormonal disorders, primarily excess estrogen with a relative deficiency of progesterone
- Age: frequency increases after 40 years and in perimenopause
- Obesity - adipose tissue produces additional estrogens
- Chronic endometritis
- Taking tamoxifen
- Arterial hypertension and diabetes mellitus
- History of intrauterine interventions
- Absence of childbirth
Symptoms
- Bloody discharge between periods
- Spotting before and after menstruation
- Heavy and prolonged menstruation
- Bloody discharge after sexual intercourse
- Any bleeding after menopause
- Nagging pain in the lower abdomen with large polyps
- Difficulties in achieving pregnancy and implantation failure during IVF
- Often - complete absence of symptoms; polyp is found on ultrasound
Diagnostics
- Transvaginal ultrasound, optimally immediately after menstruation - at this time the endometrium is thin and the polyp is best visible
- Ultrasound with Dopplerography - a feeding vessel in the leg of a polyp is a characteristic sign
- Hysterosonography with contrast - increases accuracy
- Hysteroscopy - direct examination of the uterine cavity; gold standard for diagnosis
- Pipelle biopsy of the endometrium - assessment of the condition of the mucosa
- Histological examination of the removed polyp is mandatory
- Speculum examination to identify cervical polyps
The timing of the ultrasound is of practical importance: in the second phase of the cycle, the endometrium is thickened, and a small polyp is easy to miss. Therefore, the study is prescribed for the first days after the end of menstruation.
Treatment
- Hysteroresectoscopy - removal of a polyp under visual control with targeted excision of the pedicle; modern standard
- Removal of single or multiple polyps depending on the finding
- Cervical polyp removal - outpatient procedure
- Mandatory histological examination of the removed material
- Hormonal therapy after removal - for hormonal disorders and to prevent relapse
- Intrauterine hormonal system - considered if there is a tendency to relapse
- Treatment of chronic endometritis when detected
- Weight loss in obesity
- Observation with control ultrasound
Polyp and pregnancy
- The polyp can mechanically interfere with the attachment of the embryo
- It maintains local inflammation in the uterine cavity, worsening the conditions for implantation
- In case of infertility and repeated IVF failures, polyp removal is included in the standard of preparation
- After removal, the likelihood of pregnancy increases
- Pregnancy can usually be planned after just one or two cycles - the doctor will tell you the exact date
- A polyp identified during pregnancy is most often observed rather than removed
Should you worry about cancer?
The vast majority of endometrial polyps are benign. However, a small proportion may contain atypical changes or, less commonly, malignant cells.
- The risk is higher in postmenopausal women than in younger women
- Large size, rapid growth and bleeding are alarming
- Taking tamoxifen increases the risk of changes in the endometrium
- Obesity, diabetes and hypertension increase the risk
- That is why histological examination of the removed polyp is mandatory in all cases.
This is the main argument in favor of removal rather than observation, especially in menopausal women: only histology gives an accurate answer about the nature of the formation.
Where is treatment in Tashkent
We need high-quality ultrasound in the correct phase of the cycle, a hysteroscopic stand for targeted removal and a histological laboratory.
In Tashkent, hysteroscopy, hysteroresectoscopy and removal of cervical polyps are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
When planning an operation, check whether the removal will be performed under the control of a hysteroscope: targeted excision of the pedicle significantly reduces the risk of relapse compared to conventional curettage. Clinic contacts are below.
