Polyp in the uterus: removal, treatment, reviews

A polyp in the uterus is a benign formation inside the uterus formed from overgrown endometrial cells. In size, they are more often diagnosed from 1–2 mm, but they also occur up to 2–3 cm. These outgrowths lead to menstrual irregularities, pain, infertility, miscarriages, iron deficiency anemia, and cancer of the genital organs. Therefore, it is necessary to treat the pathology immediately after detection. Eliminating the polyp and preventing recurrence can be a combination of surgical and drug therapy.

What are polyps, and why do they appear

Uterine polyps (endometrial polyps) are benign growths. They arise from the endometrium: the mucous membrane that lines the uterine cavity. It consists of inner basal and outer functional layers with glandular structures. With excessive growth (hyperplasia) of the mucosa, growths quickly form. Polyps of the uterus grow on a thin stalk or a wide base. Their size varies from millimeters to several centimeters.

Polyps are a common pathology of the endometrium in gynecology. A polyp in the uterus in women occurs from 6% to 20%. It is often found in patients of reproductive age and 40-50 years.

There are many reasons why polyps grow in the uterus, and not all are fully understood. The following factors play a key role in their appearance:

1. Hormonal failures of the female body. With high estrogen levels and low progesterone levels in the blood, endometrial tissue overgrows. An imbalance leads to the formation of an endometrial polyp. For the same reason, polycystic, endometrioid cysts on the ovary, fibroma, endometrial hyperplasia, and adenomyosis may occur.
2. Blockage and proliferation of blood vessels in the uterine cavity. This leads to excessive reproduction of epithelial (functional) cells.
3. Inflammatory diseases of the female pelvic organs: ovaries, uterine mucosa, fallopian tubes, appendages (adnexitis, endocervicitis, endometritis). To suppress the infection, the body produces white blood cells that eliminate inflammation, but at the same time, they accelerate the growth of endometrial cells.
4. Gynecological interventions: abortions, curettage. Complications of procedures can damage the inner layer and its growth, erosion, and inflammation.
5. Heredity. Pathology is often diagnosed in members of the same family.

In gynecology, doctors identify additional causes of polyps in the uterus. At risk are women who:

• irregular and rare periods: up to 4 times a year;
• there is no ovulation;
• obesity;
• diabetes;
• regularly increased pressure;
• chronic pathologies of the endocrine system, thyroid gland;
• sedentary lifestyle;
• menstruation began before age 12;
• late menopause after 55 years;
• diagnosed with polycystic, myoma, and fibroma;
• For a long time, an intrauterine device has been installed.

Symptoms of polyps in the uterus

With a small polyp in the uterus, there may be no symptoms. And the outgrowth is discovered by chance on ultrasound. Usually, the first manifestations of an endometrial polyp occur when the formation reaches 1 cm or more in diameter.

Typical symptoms of polyps in the uterus:

• irregular, prolonged, and profuse menstruation, leucorrhoea;
• copious blood or spotting between periods: this symptom occurs with ulceration of endometrial polyps;
• pain syndrome and uterine bleeding during intercourse: noted if uterine polyps are in the cervix and go into the vagina;
• pulling, cramping pains in the lower back or lower abdomen.

What does a polyp look like

Polyposis formations in the uterus look like mushrooms or papillomas. Usually, they are pale or burgundy in color with a purple or yellowish tint. Innovations consist of:

• central vessel;
• endometrial gland;
• endometrial stroma;
• epithelium on the surface of the growth;
• fibrous stroma: a polyp stem grows from it.

A polyp on ultrasound or x-ray photos looks like an oval or rounded process protruding above the mucosa. During the diagnosis, echo signs are detected: thickening of the endometrium and its uneven structure.

How and why polyps form

In the mechanism of development of polyps in the uterus, several factors play a key role:

1. Female hormonal disorders. The endometrium, from which polyps grow in the uterus, is a hormone-sensitive tissue. With abnormal production of hormones in the ovaries, its functional (less often basal) layer grows excessively and unevenly, and as a result of excess, growths form.
2. Changing the function of “immune surveillance.” Normally, the body distinguishes ordinary cells from atypical ones and destroys the latter. If this mechanism fails, the immune system does not recognize foreign cells, and they increase.
3. Decreased apoptosis processes. Apoptosis is programmed cell death. When it is violated, cells do not die at the end of their life cycle, from which they transform, and polyps appear inside the uterus.
4. Genetic factor. Often in women with polyps, abnormalities in the chromosomes that are responsible for the occurrence of tumors are detected. These changes are inherited.

Classification and varieties of polyps

Uterine polyps are classified according to three key features: location, number, and structure.

Location of polyps in the uterus

There are two types of endometrial polyps by location. Often they are found together:

Polyp of the uterine body (endometrial with endometriosis) – This polyp is located in the uterine cavity: on the anterior, posterior, or lateral wall. In most cases, it does not go beyond the cervical canal, but occasionally it can grow through it and hang down into the vagina.

Polyp of the cervix (cervical) – grows from the mucous membrane of the cervix (endocervix).

Sometimes on ultrasound, the doctor says that polyps are found on the ovaries. However, these organs do not have a mucous membrane, so growths on the gonads cannot appear. This term refers to processes that are fixed in the fallopian tubes. When growing, they go beyond the tubes and can be visualized as outgrowths on the appendages.

Quantity

Endometrial polyps are classified by number as follows:

1. Single – find 1-2 separately located outgrowths.
2. Multiple polyps on the endometrium – 3 or more pieces grow. In this case, they talk about uterine polyposis.

Structure

The most difficult classification is related to the morphological structure of the polyp in the uterus. According to this criterion, five types are distinguished:

1. Glandular polyp (mucous type) – consists of endometrial glands (mucosal cells) and rarely grows more than 1.5 cm. Glandular polyps especially often occur in adolescents and young women.

2. Fibrous polyp – is formed from connective tissue (fibrous) type. It is most often diagnosed in patients older than 40 years.

3. Glandular-fibrous polyps of the uterus – At the same time contain endometrial and mucous elements. The diameter is at most 2.5 cm. Usually found in mature women during menopause.

4. Adenomatous polyp of the endometrium (atypical appearance) – the adenomatous appearance consists of atypical glandular cells. Grows up to 4 cm or more.

5. Placental polyps – The placental type is formed from particles of the placenta if it has not been completely removed during childbirth, abortion, or miscarriage.

Impact on pregnancy

Polyps of the cervix and uterine body negatively affect the possibility of conception due to two factors:

1. Closing the lumen of the uterus and preventing the penetration of sperm into the egg reduces the chances of becoming pregnant.
2. Often, neoplasms form when the estrogen level is high, and progesterone (responsible for maintaining the fetus) is low. Therefore, doctors say that the occurrence of pregnancy with polyps is unlikely.

Also, uterine polyps affect the course of pregnancy. If conception does occur, it does not allow the placenta to fit snugly against the uterine wall. This disrupts the flow of blood and oxygen, resulting in the fetus not receiving adequate nutrition.

Polyps in the uterine cavity in pregnant women can lead to:

• bloody and bloody discharge;
• fetal hypoxia;
• miscarriages;
• Developmental delay in the child.

The growth should be removed after childbirth if a pregnant woman has polyposis. And during the gestation of the fetus, the goal of the treatment process is to stabilize and improve the child’s condition.

What is the danger of polyposis?

Polyps of the uterus are dangerous for the following consequences:

• irregular, painful, and heavy periods;
• infertility;
• miscarriage;
• decrease in sexual desire;
• cancer of the body or cervix;
• Iron deficiency anemia.

The most common condition for which polyps inside the uterus are dangerous is anemia. It occurs due to regular blood loss.

Normally, the iron level falls during menstruation, but it is quickly restored. In patients with hyperplasia, blood loss is higher than usual due to frequent and heavy menstruation and bleeding in the middle of the cycle.

As a result, the body does not have time to restore normal iron levels, and anemia develops. Weakness, hair, and nails accompany it, such as skin deterioration, decreased immunity, and psycho-emotional disorders.

Diagnosis of polyposis in the uterus

To identify a polyp in a woman and prescribe treatment, a series of examinations are carried out for diagnosis in gynecology:

• Collection of anamnesis: they find out complaints and information about previous diseases in the patient herself and her close relatives;
• Bimanual examination on a gynecological chair in the mirrors: during such a diagnosis, growths in the cervical canal can be detected, but polyps in the uterine cavity are not visible;
• colposcopy: a visual examination of the cervix using a special device;
• Ultrasound diagnostics: detect polyps and echo signs of pathological changes in the uterus;
• Hydrosonography: ultrasound with contrast, such a diagnosis better reveals the echo signs of an anomaly; at the time of the study, a photo is taken describing the location, size, and number of outgrowths;
• Hysteroscopy: the uterus is examined from the inside with a special device equipped with a video camera; during the diagnostic process, a piece of tissue can be taken for histology;
• metrography: x-ray photos of the uterus with contrast.

If, after diagnosis, polyposis is confirmed, treatment and surgery are prescribed. Before it, additional diagnostic studies are required:

• a smear for flora from the cervical canal;
• PCR diagnostics;
• blood test for tumor markers;
• general analysis of blood and urine;
• examination for the diagnosis of sexually transmitted diseases;
• histology of fragments of hyperplastic tissue.

How often does a uterine polyp turn into cancer?

The detection of endometrial polyps in the uterine cavity and dysplasia is regarded in the diagnosis as a precancerous condition. The formations themselves are benign but dangerous because, without treatment, they can become malignant or cause processes that provoke the growth of tumors.

The risk of rebirth is low: 1–2%. It depends on the location and nature of the morphological structure, which is determined during the histological examination:

• polyps in the cervical canal cause cervical cancer in 1.5% of cases;
• for glandular polyps in the uterus, malignant degeneration is atypical. Usually, they act only as a provoking factor;
• fibrous and placental polyps inside the uterus cause processes that lead to the occurrence of cancerous tumors;
• adenomatous growths are the most formidable: they malign quickly and often;
• Multiple and recurrent growths are reborn more often than others.

The likelihood of developing cancer varies from person to person. Among the increased risk of the patient:

• during menopause;
• with obesity;
• with diabetes mellitus and other diseases of the endocrine system;
• with liver pathologies;
• living in ecologically unfavorable areas.

Can polyps resolve on their own?

Some believe certain drugs or folk remedies will cause uterine polyps to peel off and come out during menstruation. However, this is not so: all scientific articles on reliable medical sites refute this opinion.

The growths are firmly connected to the inner shell with a leg or a wide base. You can get rid of them only if you carry out treatment, perform an operation and remove them. However, hormonal drugs during treatment normalize the level of hormones in the blood and can slow down the growth of formations in the uterus. This approach is useful when it is impossible to remove the processes due to the patient’s serious condition or pregnancy.

It is not worth hoping for a spontaneous recovery without treatment. When the first symptoms of polyps appear in the uterus, treatment by a specialist is necessary. Make an appointment with a gynecologist as soon as possible in any convenient way – by phone or online.

How to treat polyps

The tactics for treating polyps in the uterus include surgical and medical approaches. Complex treatment is considered necessary; they are used sequentially. Surgery for polyps in the uterus is needed to remove excess tissue, and drugs are required to normalize hormone levels, eliminate infections, and prevent relapses after treatment.

The surgical method of treatment

Surgical treatment of endometrial polyps in the uterus is used if:

• the growth has grown over 1 cm;
• it is impossible to cure polyposis or stop its development by therapeutic methods;
• age over 40;
• when diagnosed in polyps in the uterus, atypical cells were found that can degenerate into malignant ones;
• high risk of complications.

After removing endometrial polyps from the uterus, the doctor sends their fragments for histology. After treatment, for successful rehabilitation, it is recommended to limit physical and sexual activity for 10–14 days and pay special attention to intimate hygiene.

Conservative treatment of polyps in the uterus

The doctor mainly uses medical and physiotherapeutic methods before or after surgical treatment. In the first case, the gynecologist prescribes non-surgical treatment for:

• polyps in young women who have not given birth;
• during pregnancy;
• small sizes of formations: up to 1 cm;
• The presence of infectious and inflammatory processes.

Patients are interested in why conservative treatment to remove polyps in the uterus is required after surgery. It is necessary to be treated with medications to normalize the hormonal background and prevent the re-development of polyps.

Non-surgical medical treatments should include:

• the appointment of hormonal preparations by a gynecologist: combined oral contraceptives, gestagens;
• installation of an intrauterine hormonal coil;
• taking antibiotics and non-steroidal anti-inflammatory drugs if there is an infection;
• the use of multivitamin complexes: they remove nutritional deficiencies during treatment;
• physiotherapy treatments: magnetotherapy, ultrasound and laser therapy, electrophoresis.

Forecast and prevention of polyps in the uterus

The success of combined therapy for endometrial polyps in the uterus reaches 80-100%. If the patient underwent a polypectomy and subsequent medical treatment, the risk of recurrence does not exceed 10-15%.

It should be understood that one operation for effective treatment is not enough. After surgery, hormonal treatment is mandatory. Without it, polyps recur in every second woman within six months.

To prevent the formation of a uterine polyp, it is recommended to adhere to the following treatment and preventive rules:

• Timely eliminate hormonal disorders;
• timely treatment of inflammatory and infectious diseases of the genital organs;
• Try not to do traumatic manipulations in a feminine way since the appearance of polyps is often associated with damage to the genital organs;
• At least once a year, it is imperative to undergo a medical examination by a gynecologist and do an ultrasound scan since polyposis is often asymptomatic;
• Maintain optimal body weight through exercise and proper nutrition;
• Do not eat the meat of animals grown on hormones.

Polyps in the uterus are common, benign neoplasms that occur in every fifth woman. This disease is harmful to health and can lead to serious consequences. If not detected and properly treated, tissue hyperplasia can degenerate into cancer. But with timely therapy using surgical and medical methods, the pathology is completely curable, and the risk of relapse is minimal.