Two to three polyps
Multiple polyps often indicate a hormonal cause (excess estrogen, taking tamoxifen, obesity) or are combined with endometrial hyperplasia, therefore, together with a polypectomy, the doctor evaluates the entire endometrium and, if necessary, takes a biopsy or performs resection of hyperplastic areas. All polyps are removed sequentially with coagulation of the bases; tissue is marked by location for histology. Based on the result, treatment for the cause is prescribed - gestagens, IUDs with levonorgestrel, or correction of therapy, which reduces relapses; Ultrasound control after 3–6 months.
Indications
- endometrial polyps of any size according to ultrasound/hysteroscopy - mandatory removal with histology, especially in menopause;
- abnormal uterine bleeding, intermenstrual discharge, postmenopausal bleeding;
- polyps in case of infertility, miscarriage, before IVF;
- recurrent and multiple polyps, polyps in combination with hyperplasia.
Why resectoscopy and not curettage?
Curettage “blindly” leaves a stalk of the polyp in 30–50% of cases, which leads to relapse and injures the healthy endometrium; hysteroresectoscopy removes the polyp under visual control exactly at the base along with the stalk and preserves the rest of the endometrium - relapses are reduced to 5-10%, and in case of infertility, the implantation rate increases. Each polyp is examined histologically: in 1–3% (in menopause - up to 5–10%), atypia or cancer is found in them, so removal is indicated for everyone, including asymptomatic people. The price depends on the number of polyps.
