Polyps in the uterus are formations from the endometrium that appear from the age of 9. Most often detected before menopause at 40 - 50 years. A polyp refers to benign neoplasms, but if no measures are taken to treat it, under certain conditions it can become malignant. The probability of such a rebirth is 1 - 2%.
Polyps are single on a broad base or on a stalk, and multiple (polyposis).
Polyps in the uterus are found in women in about 10% of cases. Among gynecological diseases account for 25% of cases, indicating a widespread problem.
Polyps in the uterus - causes
When studying this pathology, it turned out that polyps in the uterus, the causes of which in each individual case are different, arise against the background:
• hormonal disorders;
• reduced immunity;
• stress and prolonged nervous strain;
• changes caused by the age of the woman.
In addition, there is still a mass risk factors that provoke the development of polyps in the uterus:
1. Diseases of the genital organs in women (ovarian cysts, fibroids, endometriosis).
2. Mechanical damage to the cervix that occurs during instrumental gynecological examinations as a result of inflammatory diseases (endocervicitis), during labor or abortion.
3. Sexually transmitted infections (STIs), as well as against the background of a violation of the vaginal microflora. The most dangerous of them are: ureaplasmosis, herpes, toxoplasmosis, mycoplasmosis, candidiasis.
4. Genetic predisposition.
5. Hypodynamia.
6. Long-term treatment with Temoxifene, a drug used in the presence of tumors, in order to block hormone-sensitive receptors. As a result, endothelial cells grow intensively in some patients and polyps form.
Vascular growths: with the formation of the vasculature around it, active reproduction of epithelial cells begins.
The risk group includes women who have:
• obesity;
• hypertonic disease;
• endocrine pathology.
The mechanism of formation of polyps in the uterus
Due to hormonal failure, the normal functioning of the ovaries can be disrupted, and therefore a large amount of estrogen enters the bloodstream.
Normally, its production occurs within two weeks of the menstrual cycle. With hormonal disorders, it enters the bloodstream continuously. Under its influence, there is an increased proliferation of the endometrium.
During menstruation, the endometrium does not completely exfoliate; some part of it remains in the uterus. This process proceeds over several cycles and leads to the formation of formation at the site of endometrial accumulation.
In the future, there is a germination of blood vessels and fibers of the connective tissue - a polyp is formed.
Types of polyps in the uterus
Polyps, depending on the cells from which they are formed and their structures, emit:
1. Glandular polyps - formed at a young age, similar to fluid cysts.
2. Fibrous polyps are dense, because they are based on connective tissue, develop after the age of 40, before menopause and menopause.
3. Glandular - fibrous, formed, respectively, from gland cells and connective tissue.
4. Polyps - adenomas: atypical cells are found in their structure, therefore cancer can develop.
5. Placental polyps are formed from surviving particles of the placenta.
The sizes of polyps in the uterus vary from a few millimeters to 3.0 cm. Basically, polyps up to 1.0 cm are found.
Polyps in the uterus - the first symptoms
Polyps in the uterus can be asymptomatic. In such cases, they are a find when examined for another pathology, or when finding out the causes of infertility.
Upon reaching certain sizes of polyps in the uterus, the first symptoms appear:
• a variety of menstrual irregularities;
• uterine bleeding in between menstruation;
• bleeding during menopause;
• pain and discomfort during sex, and after it - spotting.
Also, a polyp can be detected if inflammation develops or an injury occurs. This leads, in addition to the above, to the manifestation following clinical symptoms:
• pulling pains that occur not only during sexual intercourse, but also shortly before the onset of menstruation;
• the presence of blood in the discharge, not associated with menstruation.
Polyps in the uterus - signs
As polyps grow in the uterus, their signs become more pronounced:
• anemia develops;
• persistent menstrual irregularities;
• miscarriage;
• fetal hypoxia;
• infertility;
• uterine cancer, which is the main danger of polyps.
Diagnosis of polyps in the uterus
Ultrasound of the uterus is the most accessible, informative and painless diagnostic method. During the procedure, the intravaginal probe produces the most accurate results.
For a detailed study, hysteroscopy is performed: the apparatus (a thin tube with a camera) is inserted into the uterine cavity. If necessary, a hysteroscope takes material for biopsy. Also, through the apparatus, a contrast agent can be introduced into the uterine cavity and an x-ray taken.
Treatment of polyps in the uterus
Treatment of polyps in the uterus is exclusively surgical. If a single polyp is found, it is cut out. With polyposis, the upper layer of the uterine mucosa is scraped out.
Indications for surgical treatment are:
• lack of effect of hormonal treatment;
• age over 40 years;
• the size of the formation is more than 1.0 cm;
• if atypical cells are found during histological examination.
Currently, the treatment of polyps in the uterus is carried out by hysteroscopic and laparoscopic methods.
The hysteroscopic method is considered a less traumatic procedure, is performed under mild anesthesia and lasts about 20 minutes.
The most suitable time for manipulation is 2 to 3 days after menstruation: the uterine mucosa is thin at this time, the polyp is easily determined, because it rises above it, you can remove it quickly. The method has several advantages:
• security;
• painlessness;
• lack of incisions and, accordingly, surgical sutures;
• The hysteroscope camera allows you to detect even small polyps and remove them.
Laparoscopy is performed under the control of a laparoscope through an opening (0.5 - 1.5 cm) in the lower abdomen. The method is very effective in the presence of malignancy. If atypical cells are found in the polyp, which indicates a high risk of a tumor, the uterus is removed using this method.
The advantages of laparoscopy are:
• postoperative pain is rare;
• there are practically no complications;
• lack of scars;
• quick recovery of the body.
Treatment of polyps in the uterus
Treatment of polyps in the uterus in certain cases is carried out without surgery. This is possible in some cases:
• in nulliparous women, because surgical intervention leads to problems with conception;
• in patients of a young age (cases are described when polyps were found in girls in adolescence)
• if there is one small polyp, taking certain drugs can reduce it and achieve complete disappearance.
Given that a polyp is formed in the uterine cavity under the influence of a high level of estrogen, hormonal drugs are prescribed that reduce the amount of estrogen and help increase progesterone levels. They eliminate the etiological factor (estrogens), resulting in a significant decrease in the polyp, it dries up and leaves the uterus during menstruation.
Preparations for the treatment of polyps are prescribed taking into account age:
• up to 35 years old - estrogen - progestogen contraceptives (Regulon, Janine, Yarina);
• after 35 years - gestagens (Duphaston, Utrozhestan, Norkolut);
• after 40 years and with the onset of menopause - gonadotropin releasing hormone antagonists (Zoladex, Diferelin) - they protect against the effects of estrogen causing changes in the uterus;
• antibiotics are prescribed at any age - they are necessary in cases where the formation of polyps has occurred in connection with the inflammatory process in the uterus (Zitrolide, Monomycin, etc.).
All drugs are prescribed by a gynecologist in a certain phase of the cycle and according to a special scheme.
Prevention of polyps in the uterus
Prevention of uterine polyps is associated with ovarian dysfunction, which produces a large number of estrogens. Therefore, preventive measures include:
• regular visits to the gynecologist to exclude pathology and the correct selection of contraceptives;
• active physical activity, the fight against physical inactivity eliminate blood stasis in the small pelvis;
• eliminate promiscuous sexual intercourse;
• do not eat meat products containing hormones;
• Avoid sudden hypothermia.
It is always necessary to be attentive to your body and, at the slightest malfunction, consult with a specialist on time in order to avoid unpleasant complications.
