What Are Endometrial Polyps?

Endometrial polyps are a common disease in gynecology. They are caused by local hyperplasia of the endometrium. They appear as single or multiple smooth masses protruding from the uterine cavity. Can cause irregular vaginal bleeding and infertility. Women from child-bearing age to post-menopausal women are at high risk of endometrial polyps. At present, the etiology is unknown, and it is believed to be related to endocrine disorders. Ultrasound is the main diagnosis. The sensitivity of intrauterine acoustic imaging is higher. Hysteroscopy is the gold standard for diagnosing endometrial polyps. Hysteroscopic polypectomy is endometrium Polyps are the preferred treatment, but polyps are prone to relapse. Endometrial polyps are occasionally malignant, especially in postmenopausal vaginal bleeding, when polyps are atypical hyperplasia, they should be treated as precancerous lesions.

Basic Information

English name: endometrial polyps
Visiting department: Obstetrics and Gynecology
Multiple groups: Women of childbearing age and postmenopausal

Common causes: Unknown, thought to be related to endocrine disorders
Common symptoms: Irregular uterine bleeding, abdominal pain, leucorrhea abnormalities, infertility, etc.
Contagious: no

Causes of endometrial polyps

Endocrine factors

Because estrogen can promote endometrial hyperplasia and menstruation, the formation of endometrial polyps is closely related to excessive estrogen levels. Perimenopausal and postmenopausal hormone replacement therapy, regular consumption of some hormonal health products will increase women's estrogen levels.

2. Inflammatory factors

Long-term gynecological inflammation stimulation, intrauterine foreign body (such as contraceptive ring) stimulation, delivery, abortion, puerperal infection, surgical operation or mechanical stimulation may cause the occurrence of endometrial polyps, and long-term inflammation stimulation will make polyps Big.

3. Other

Increasing age, hypertension, obesity, diabetes, and long-term use of tamoxifen after breast cancer are all factors that cause high incidence of endometrial polyps.

Clinical manifestations of endometrial polyps

The disease can occur at any age after puberty, but it is common in women over 35 years of age. Smaller endometrial polyps are usually asymptomatic and are often found during gross examination of the uterus for other diseases, or when diagnosed with curettage. Some patients can see more menstruation and prolonged menstruation, which is related to the increase in endometrial area and endometrial hyperplasia. Large polyps or polyps that protrude into the neck can cause secondary infections and necrosis, and cause irregular bleeding and foul bloody secretions.

Irregular uterine bleeding

More menstruation and prolonged menstruation or abnormal menstrual bleeding before menopause, but the severity of the symptoms has nothing to do with the number, diameter and location of polyps.

Abdominal pain

It usually starts in the second half of menstruation and progresses progressively. It gradually disappears with clean menstruation. Mainly due to the obstruction of endometrial polyps, resulting in poor drainage of menstrual blood.

3. Leucorrhea is abnormal

A small number of patients with large polyps may have leucorrhea or bloodshot blood in the leucorrhea. It may also be contact bleeding, especially after intercourse and when squatting and hard stools.

4. Infertility

If the endometrial polyps grow in the cervical canal, they may prevent sperm from entering the uterine cavity; if they grow in the uterine cavity, they may prevent the implantation of fertilized eggs or affect the development of embryos, leading to infertility.

Endometrial polyp examination

Gynecological examination

The uterus is slightly larger, such as those with endometrial polyp pedicles, and neoplasms can be seen or touched at the cervix.

2. Ultrasound

Transvaginal ultrasound examination shows a conventional hyperechoic lesion in the uterine cavity, which is surrounded by a weak strong echo halo. The results of inspection during the menstrual cycle proliferative period are more reliable. Repeated ultrasonography after the menstrual period is clean can help distinguish "polyp-like endometrium" from endometrial polyps. Intrauterine acoustic imaging is more sensitive and specific.

3. Hysteroscopy

Hysteroscopy can not only observe the situation in the uterine cavity under direct vision, it is intuitive and clear, and it can remove tissue for pathological examination, which is an important method for diagnosing endometrial polyps.

4. Pathological examination

The most common types are localized endometrial masses protruding from the uterine cavity, singly or in multiples, with diameters ranging from a few millimeters to several centimeters, with thick, slender, and short pedicles. Hemorrhage and necrosis often occur on the surface of polyps, and infection can also occur. If the pedicle is twisted, hemorrhagic infarction occurs.

Pathological examination showed that the endometrial polyps consist of endometrium, and the surface is covered with a layer of cubic epithelium or low columnar epithelium. The middle part of the polyp forms a fibrous longitudinal axis, which contains blood vessels.

Endometrial polyps diagnosis

Based on the patient's symptoms, gynecological examination and ultrasound examination, a preliminary diagnosis can be made. The diagnosis can be confirmed by taking pathological examination of the diseased tissue under the guidance of hysteroscopy. Pay attention to the identification with submucosal fibroids and endometrial cancer.

Endometrial polyps treatment

Conservative treatment

For small, asymptomatic polyps, temporary intervention is not necessary, and some polyps can resolve spontaneously. Drug treatment of polyps is not recommended.

2. hysteroscopic resection

For patients with obvious clinical symptoms, B-ultrasound finds that there are neoplasms in the uterine cavity, or patients with intrauterine neoplasms that cannot completely eliminate the possibility of malignancy, surgery is recommended; in addition, patients with fertility requirements find that endometrial polyps may be It is also recommended to try pregnancy again after surgery. Hysteroscopic polypectomy is the most important treatment method, and the related risks are low. All the resected tissues are sent for pathological examination.

(1) Generally, surgery is performed 3 to 7 days after menstruation is clean; sexual life is prohibited for 3 days before surgery; urine can be properly held before surgery to facilitate B-ultrasound monitoring during surgery.

(2) Rest for at least 1 week after operation. Sexual life and tub bath are prohibited within 1 month after operation.

(3) Pay attention to changes in the condition. There may be a small amount of vaginal bleeding within 2 months after hysteroscopic resection. If there is more bleeding, see a doctor in time. Normal menstruation can be restored in the third month.

3. radical surgery

For patients over 40 years of age, if the bleeding symptoms are obvious, the above treatment cannot be eradicated or those who often relapse, you can consider total hysterectomy.

Prognosis of endometrial polyps

25% of endometrial polyps (especially less than 1cm in diameter) can resolve on their own; 75% to 100% of cases can improve the symptoms of abnormal uterine bleeding through hysteroscopic polypectomy; removal of endometrial polyps in patients with infertility can improve Fertility. The disease is prone to recurrence. It should be reviewed regularly after surgery and every 3 months, but asymptomatic patients do not need to undergo repeated surgical treatment.