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  • Polyps in the uterus: causes, symptoms and treatment, photo

    Polyps in the uterus are a manifestation of the hyperplastic processes of the endometrium and endocervix.

    Therefore, distinguish polyps of the endometrium and polyps of the cervical canal. This is due to the anatomical structure of the uterus, in which the body and the cervix are distinguished( there is a cervical canal opening into the uterine cavity in its center).

    They do not differ in histological structure. However, there are certain differences in the tactics of reference and the principles of diagnosis.

    Types of polyps


    In terms of tissue structure, polyps in the uterus can be of the following types:

    1. 1) Glandular - glandular cells predominate
    2. 2) Glandular-cystic - the occlusion ducts of the glands gradually form to form cysts
    3. 3) Fibrous - in such polyps predominatesconnective tissue.
    It is also important to distinguish polyps with atypia and polyps without cellular and tissue atypia. The first is still called adenomatous. They require more active interventions from the physician.


    Polyps can be either on a wide base or on a thin stem. Most often the development of complications occurs in the presence of polyps of the second type.

    Reasons for the formation of polyps in the uterus


    The causes that lead to the formation of polyps in the uterus can be different. But they are all accompanied by a state of hyperestrogenemia, that is, an increased content of estrogens in the body.

    This may be due to increased synthesis of these hormones against the background of normal progesterone content( absolute hyperestrogenemia) or normal or even reduced estrogen synthesis, which is combined with a decrease in progesterone production( relative hyperestrogenemia).

    The main causative factors that are accompanied by a change in the hormonal balance are:

    • hormone-active ovarian cysts
    • neuroendocrine-exchange syndromes
    • excess body weight and obesity, since at present fatty tissue is considered as an endocrine organ that synthesizes estrone.
    This is the least active fraction of estrogens, which very often leads to hyperplasia of the inner layer of the uterus and the cervical canal.

    Symptoms of polyps in the uterus


    Symptoms of polyps in the uterus can be different. In some cases, this pathological process can be asymptomatic for a long time, while in others - even in the presence of small-sized polyps, manifest by some or other signs.

    This depends on the following factors:

    • location of the polyp - in the bottom, in the area of ​​the tube corners, in the cervical channel, etc.
    • of the polyp attachment method - on a thin knife or a wide base
    • of the histological structure
    • of the presence of signs of atypia
    • of polyp sizes.
    Therefore, focusing only on the presence of a clinical picture in the establishment of this diagnosis is not rational. In such cases, additional research methods are required that can identify asymptomatic cases of polyps in the uterus.

    However, there are certain symptoms that are suspicious of this pathology. These include:

    1. 1) Pain in the lower abdomen, which can be aching or cramping. The last kind of pain syndrome is observed at the birth of a polyp or its infringement of
    2. . 2) Bloody discharges of varying severity that are observed in the interval between menstruations
    3. . 3) Contact bleeding due to trauma to the polyp during sexual intercourse. This symptom occurs if the polyp is in the lumen of the vagina( this can be both cervical canal polyps and large uterine cavity polyps)
    4. 4) Abundant and prolonged menstruation due to the fact that the endometrium can not simultaneously tear itself away and against this backgroundthere is no clamping of the spiral arteries of the uterus.

    Diagnosis of polyps in the uterus


    Given the fact that polyps can be asymptomatic, the importance of additional research methods is difficult to underestimate. The most informative in this regard is ultrasound, which is rationally supplemented with Doppler.

    This will allow for differential diagnosis between the polyp and the submucous node of the uterine myoma, and also indirectly assess the malignancy or goodness of the process, since in each case there are certain features of the blood flow.

    Ultrasound examination provides an opportunity to assess the size of the polyp, the location of its attachment and the nature of this attachment, as well as to identify possible violations of microcirculation.

    Inspection of the cervix in the mirrors is not always informative. Visualize the polyp in the cervical canal, which bulges into the lumen of the vagina, can only be done with a cervical polyp or ileal cavity polyp, but of a large size. However, it is not possible to draw a line between them on the basis of this inspection alone.

    If there is a polyp of any localization, a histological examination is performed. It is included in the standard of examination of women with hyperplastic processes of the endometrium, including endocervix.

    It can reliably determine:

    1. 1) Histological type of polyp
    2. 2) The presence of signs of malignant degeneration.

    Complications of


    In the case of delayed diagnosis and late treatment of this pathology of the inner layer of the uterus and the cervical can develop certain complications. These include:

    • uterine bleeding that leads to the development of anemia of varying severity
    • ischemic changes in organs developing against a background of chronic posthemorrhagic anemia of moderate to severe
    • the presence of a combined pathology - uterine fibroids and endometrial polyps that have a common pathogenesis
    • disruption of nutritionpolyp as a result of thrombosis of the vessel feeding it, and also as a result of infringement in one of the tube corners or in the cervical channel
    • the birth of a polyp, especially if it is crepetsya to the wall of the uterus thin legs
    • the development of precancerous processes and endometrial cancer, which often predisposes the presence of adenomatous polyps( that is, against the background of atypia).
    Due to the seriousness of possible complications, it is necessary to diagnose in a timely manner the presence of polyps in the uterine cavity and cervical canal. And after a careful morphological study to conduct their treatment.

    Treatment of polyps in the uterus


    Treatment of polyps in the uterus is carried out simultaneously both surgical and conservative. The first implies their complete removal with the help of either curettage of the uterine cavity and cervical canal, or with the help of hysteroscopy combined with hysteroresectoscopy.

    However, follow-up activities should be aimed at preventing recurrences of the hyperplastic process.

    Therefore, the second stage is to conduct conservative therapy, which consists in the appointment of the most optimal hormone drug.

    Its choice depends on the following factors:

    1. 1) The presence of atypia of the polyp( estrogens stimulate the oncological process, therefore, when they are adenomatous polyps they are contraindicated)
    2. 2) The age of the woman
    3. 3) Desires to realize the reproductive function.
    The main groups of drugs that are used to normalize the hormonal balance are the following:

    • combined estrogen-progestational( prescribed in the juvenile and early and middle reproductive years)
    • gestagens( can be prescribed at any age, and also are the means of choosing treatment inlate reproductive and perimenopausal age)
    • preparations for hormone replacement therapy( used at the age of perimenopause)
    • antigonadotropins
    • agogonadoliberines surfers.
    In the case where, despite ongoing conservative therapy, the recurrence of the hyperplastic process occurs, removal of the uterus is indicated if the woman does not plan any more pregnancy.

    This is due to the fact that persistent relapses are most suspicious of a malignant process, which can not always be detected by histological examination.

    Prevention


    Preventive measures that prevent the development of polyps in the uterus are aimed at eliminating possible risk factors. Therefore it is recommended:

    • to normalize the ovarian-menstrual cycle
    • to reduce the body weight
    • to regularly visit the gynecologist for the timely detection of a particular pathology
    • to minimize the frequency of intra-uterine interventions, such as intrauterine device introduction, abortion, uterine scraping.


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