therefore distinguish endometrial polyps and polyps of the cervical canal.This is due to the anatomical structure of the uterus, which distinguish the actual body and cervix (at its center passes the cervical canal, opening to the uterus).
they do not differ in histological structure.However, there are certain differences in tactics and diagnostic principles.
Types of polyps
From the point of view of the tissue structure of the polyps in the uterus may be the following types:
- 1) Glandular - dominated by glandular cells
- 2) glandulocystica - occurs gradually blockage excretory ducts of glands with the formation of cysts
- 3) fibrous - connective tissue predominates in these polyps.
Polyps may be either on a broad basis, or on a thin stem.The most common complications occur in the presence of polyps in the second type.
Causes of polyps in the uterus
reasons that lead to the appearance of polyps in the uterus may be different.But all of them are accompanied by state hyperestrogenemia, ie higher content of estrogen in the body.
This may be due to increased synthesis of these hormones in the background of normal progesterone (absolute hyperestrogenemia) or normal or even reduced the synthesis of estrogen, which is combined with a reduction in progesterone (relative hyperestrogenemia).
main causal factors, which are accompanied by a change in the hormonal balance are:
- hormonally active ovarian cysts
- neuro-endocrine and metabolic syndromes
- overweight and obesity, as is currently the adipose tissue is seen asendocrine organ that synthesizes estrone.
Symptoms of polyps in the uterus
Symptoms of polyps in the uterus may be different.In some cases, the disease process may be asymptomatic for a long time, and in the other - even in the presence of small polyps appear those sizes or other characteristics.
It depends on the following factors:
- polyp location - in a day, in the corners of the tube, in the cervical canal, etc.
- method of attaching a polyp - a thin knife or wide basis
- histological structure
- for signs of atypia
- polyp size.
However, there are certain symptoms that are suspicious of this pathology.These include:
- 1) Pain in the lower abdomen, which may be aching or cramping in nature.The latter type of pain occurs at birth or polyp infringement
- 2) Spotting of varying severity, which are observed in the interval between periods
- 3) Contact spotting caused by trauma to the polyp during intercourse.This symptom occurs when a polyp is a vaginal lumen (which may be as polyps of the cervical canal and polyps cavity larger uterus)
- 4) Heavy and prolonged menstruation, caused by the fact that the endometrium can not simultaneously detached andagainst this background, there is no compression 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 difficult to underestimate.The most informative in this regard is ultrasound, which efficiently complement Doppler.
This will make a differential diagnosis between polyps and submucous node uterine fibroids, as well as indirectly estimate the malignant or benign process, as in every case, there are certain characteristics of blood flow.
Ultrasound examination makes it possible to estimate the size of the polyp, place of attachment and the nature of the attachment, as well as to identify possible violations of the microcirculation.
cervical examination in the mirror is not always informative.Visualize a polyp in the cervical canal, which protrudes into the vaginal lumen, it is possible only with cervical polyp or polyps of the uterus, but large in size.However, to hold between them a face based on just this inspection is not possible.
the presence of a polyp of any location is shown holding a histological examination.It is included in the standard survey of women with endometrial hyperplastic processes, including endocervical.
With it, you can reliably determine:
- 1) The histological type of polyp
- 2) Availability of signs of malignant transformation.
In the case of delayed diagnosis and delayed treatment of this pathology of the inner layer of the uterus and cervix may develop certain complications.These include:
- uterine bleeding that leads to anemia of varying severity
- ischemic changes in organs that develop on the background of chronic post-hemorrhagic anemia, moderate and severe
- presence of comorbidity - uterine fibroids and endometrial polyps,that share a common pathogenesis
- violation polyp power as a result of clotting in blood vessels that feed it, and as a result of infringement of one of the tube angles or in the cervical canal
- birth polyp, especially if it is attached to the wall of the uterus thin leg
- the development of precancerous processes and cancer of the endometrium, which often predisposes the presence of adenomatous polyps (that is, against the background of atypia).
Treatment of polyps in the uterus
polyps in the uterus Treatment is carried out at the same time as surgical and conservative.The first involves the complete removal of them through either of the uterus and scraping the cervix or by hysteroscopy, combined with hysteroresectoscopy.
However, follow-up activities should be aimed at preventing the recurrence of hyperplastic process.
His choice depends on the following factors:
- 1) the presence of atypia polyp (estrogens stimulate oncologic process, so when adenomatous polyps are contraindicated)
- 2) age of women
- 3) the desire to realize the reproductive function.
- combined estrogen-progestin (appointed in juvenile and early and middle reproductive years)
- progestins (can be assigned at any age, andas are the means of choice in the treatment of late reproductive and perimenopausal age)
- preparations for hormone replacement therapy (used in perimenopausal age)
- GnRH agonists.
This is due to the fact that the persistent recurrence of the most suspicious of malignancy, which can not always be detected by histological examination.
Prevention Preventive measures that prevent the development of polyps in the uterus, address the possible risk factors.It is therefore recommended:
- normalize ovarian-menstrual cycle
- reduce body
- mass regularly visit a gynecologist for early detection of a disease
- minimize the incidence of intrauterine procedures, which include the introduction of an intrauterine device, abortion,uterine curettage.
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