endometrial polyps - a pathological benign (outgrowth) of the inner layer of the uterus.Endometrial polyps are solitary and multiple.
endometrial polyps occur in 5 - 25% of patients in all age groups, but most of the signs of endometrial polyps found in pre- and postmenopausal women.
Endometrial Polyps vary in size, shape and (to a lesser extent) structure.They have an irregular round or oblong-oval.Polyps are small there may be no symptoms.There may be situations of accidental diagnosis of small and / or polyps in asymptomatic patients, are examined for other gynecological pathology.
large polyps (more than 1-3 cm) almost never are asymptomatic.A distinctive feature of any foreign endometrial polyps is the presence of "body" and "legs", which can be wide, but the size is always less than the base.
According to its internal structure (cell structure) of endometrial polyps is not a great variety, as in all cases formed of the same fabric - lining of the uterus.
uterine wall consists of three main layers: the mucosa (the endometrium), a powerful muscle layer (myometrium) and the outermost, serosal layer (perimeter).Each has its own purpose.The endometrium is a two-layer structure and, in turn, is formed by the inner (basal) and external (functional) layers.
basal layer of dense structure and is characterized by quantitative and qualitative composition of the cell, his reaction to the hormonal exposure is minimal.In fact, the basal cell layer serves as a reserve and "support" for the overlying, functional, layer.
functional layer of the endometrium lining the uterus itself, contains a lot of full-fledged active vessels and glands.It has a pronounced response to the cyclic hormonal fluctuations, and its thickness changes significantly depending on the phase of the menstrual cycle reaches its maximum value on the eve of the next menstrual period.The outer layer of the endometrium is responsible for menstrual function due to its ability to rejection and recovery.
Cyclic structural changes in the endometrium occur symmetrically hormonal measurements in the body, namely fluctuations in the amount of estrogen.With an excess of estrogen (hyperestrogenism) develops hormonal dysfunction, and in the endometrium breaks down normal ratio of rejection and recovery processes.Excessive proliferation (proliferation) of the inner layer called the endometrium hyperplasia.
endometrial hyperplastic processes is not always just a diffuse character.In some cases, the endometrium is increased rapidly, but can not go beyond certain limits, however it starts to increase in height.Delimitation process of endometrial hyperplasia is a pathological focal proliferation and called endometrial polyps.
Polyps may develop in the intact mucosa, and may be part of an overall hyperplastic process when the patient at the same time there is a diffuse and focal hyperplasia of the endometrium.
leading role in the development of endometrial polyps plays a hormonal dysfunction of the ovaries.Severe overproduction of estrogen and progestogen deficiency provoke the development of endometrial hyperplasia.
Clinical signs of endometrial polyps may be minimal or absent altogether.Symptoms of endometrial polyps are similar to those in the endometrial hyperplastic processes, since it is a form of focal hyperplasia of the endometrium.
polyps Relapses are not uncommon and in most cases linked to the previous incorrect removal of a polyp (a small portion left leg).Most endometrial polyps are benign, but the risk of malignancy exists.All patients with endometrial polyps should undergo an adequate medical examination and treatment.
therapy endometrial polyps includes conservative and surgical methods.United regimen endometrial polyp does not exist, for each patient's therapy is selected individually.
reasons endometrial polyp
in the development of endometrial polyps dominant role for disruption of normal hormonal ovarian function.The appearance of endometrial hyperplastic processes contribute hyperestrogenia in combination with progesterone deficiency.
The reason given in the development of endometrial polyps are involved:
- functional or organic (tumor, trauma) violations in the "pituitary - hypothalamus," responsible for the hormonal ovarian function.
- Pathology of ovarian hormone producing tumors, polycystic ovary syndrome.
- Severe disorders of fat metabolism (the risk of endometrial hyperplasia in women with overweight increases tenfold).
- Disorders of the immune system.
- Long-term therapy with hormonal drugs or incorrect hormonal contraception.
- Complex operations on the ovaries.
- Diseases of the endocrine glands (adrenal glands, pancreas, thyroid gland) that violate the mechanism of normal steroidogenesis.
- Abuse of intrauterine devices, resulting in mucosal trauma and / or development of local inflammation.
- extragenital diseases (eg, hypertension).
- Psychological factors - severe stress, depression and others.
- Traumatic manipulation of the uterus: abortion, diagnostic curettage and others.
- inflammatory chronic diseases of the uterus and ovaries.
- spontaneous abortion or birth with incomplete removal of the placenta.In this case, blood clots are replaced by connective tissue with the subsequent formation of endometrial polyp.
Sometimes endometrial polyps found in infertile women, as anovulation accompanied giperestrogeniey and progesterone deficiency.However, if the infertility appeared after the formation of endometrial polyps, it should be considered a complication of the latter.
the disposal of excess estrogen is responsible liver.Diseases of the biliary tract and / or liver disease are diagnosed in one third of patients with endometrial hyperplasia.
often develop endometrial polyps in women whose mothers have diseases associated with giperestrogeniey (uterine fibroids, endometrial polyps, adenomyosis, and others), which gives reason to imply the relative genetic predisposition to endometrial hyperplasia.Most likely, these women inherit a defective hormonal regulation, which is implemented in the presence of adverse factors.
in pre- and postmenopausal women increases the activity of the adrenal cortex, responsible for the production of androgens, affect the endometrium and ovaries.This explains the increase in the number of cases of endometrial polyps in women of that period.
None of the above causes of endometrial polyps is not absolute, since they do not always lead to the appearance of the pathological process in the uterus.For example, women with diabetes, severe obesity or hypertension alone, there is much less chance of endometrial polyp than those of holders of these diseases simultaneously.
endometrial polyps symptoms
endometrial polyps are formed from the basal layer, but slightly different cell structure.Depending on what kind of structure is dominated by a part of the polyp release:
- Glandular endometrial polyp.It grows from the basal layer and is formed mainly by glandular component.It consists of stroma and large amounts of iron.Sometimes clearance forms glands expand the type of cysts, then talk about the glandular - cystic polyp, which is not a separate species of endometrial polyp.
- Fibrous endometrial polyp.Formed only by connective tissue, sometimes find it collagen fibers, virtually none glands.
- glandular - fibrous endometrial polyp.Apart from connective tissue contains a small amount of iron.
- adenomatous polyps of the endometrium.This glandular polyp, in which there are atypical (precancerous) cells.
glandular and fibrous glandular endometrial polyp differ in composition only quantitative content elements of the glandular tissue.
so-called functional endometrial polyp is diagnosed in patients of reproductive age, and preserved a two-phase cycle in its second phase.From other functional endometrial polyp is characterized in that the image of the functional layer, preserving its ability to cyclically vary with the surrounding mucosa.
symptoms of endometrial polyps are very diverse.Often uterine polyps (especially if they are small) does not manifest itself and detected during ultrasound accident.
are two clinical variants of endometrial polyps:
- hormone-dependent (first) version.It occurs in 60-70% of patients.Polyps (more glandular and glandular-cystic) are formed on the diffuse background of endometrial hyperplasia.Most often present in women with severe metabolic and endocrine disorders, accompanied by obesity, hyperglycemia (elevated levels of glucose in the blood) and hypertension.Patients in this group there are anovulatory uterine bleeding, infertility, uterine fibroids and polycystic ovaries.Polyps are often the first type are subject to other malignancy.
- Standalone (second) option.It occurs in 30-40% of patients.It is characterized by the development of polyps (less fibrous or glandular-fibrous) against the background of unchanged functioning endometrium in women without obvious endocrine disorders.
clinical picture of endometrial polyps is very diverse and depends on the patient's age, hormonal and reproductive function of the ovaries and the presence of background neginekologicheskoy pathology.
Women with polyps may complain of menstrual dysfunction, are different in nature and intensity of pain in the projection of the uterus, abnormal discharge (whites) and infertility.
menstrual disorders refers to the frequent and constant symptom of endometrial polyp.The nature of these disorders ranges from heavy intermenstrual bleeding in the reproductive period to the smearing of scarce bleeding in menopause.Blood loss depends on the degree of hormonal dysfunction, the condition and size of the endometrial polyp.
Pain is not a symptom of the leading endometrial polyps may be accompanied by a large (greater than 2 cm) polyps, or be a sign of endometrial polyps complicated.When torsion leg polyp in his body broken and blood supply to the developing necrosis.Status of women is deteriorating, there are intense pain.Complicated endometrial polyps require immediate surgical intervention.
in 24% of patients with infertility during the survey revealed endometrial polyps.Most often, this category of women polyps develop on the background of changes in the endometrium (hyperplasia) and hyperestrogenia progesterone deficiency and eliminate the chances of pregnancy.
If a polyp is developed autonomously in the background unaltered endometrium, pregnancy is possible, but it remains a possibility of premature termination.Preferably plan a pregnancy after removal of endometrial polyps and restore normal hormonal function.
Gynecological examination of patients with endometrial polyps is uninformative.Maybe it revealed a slight increase in the uterus and the presence of concomitant gynecological pathology.In cases when combined with endometrial polyps cervical polyps, the doctor can detect the presence of formation (polyp) into the cervical canal.
Laboratory research includes quantification of ovarian hormones (particularly estrogen and progesterone), thyroid gland (TSH, T4) and adrenal glands (androgens).
leading methods of diagnosis of endometrial polyps are ultrasound, hysteroscopy and subsequent histological examination of scrapings of the endometrium.
Diagnosis of uterine polyps using ultrasonography in most cases is not difficult, and the resulting study data 80% agree with the conclusion of histology.Ultrasound picture of endometrial polyps depends on the number, size and location, and a good specialist can determine their composition is more likely.Polyps in the uterus are visualized in the form of round or oval formations with clear smooth contours, towering above the surface of the expanded uterus.The hallmark ultrasound - a sign of small polyps is their inability to deform the shape of the uterus.Also, this method allows us to detect the presence of concomitant pathology of the endometrium - hyperplasia, inflammation and others.
Ultrasound study has several limitations that do not allow to use its data as a final diagnosis:
- Accuracy and reliability of ultrasound diagnosis depends largely on the skill of the doctor.
- polyps that are a part of the glandular tissue, may be poorly visualized as similar in structure to the endometrium.Also it is not always easy to detect polyps, having a flat shape.
- It is not always possible during the ultrasound to distinguish between endometrial polyp of uterine fibroids or adenomyosis, especially when they are combined.
- The biggest drawback is the inability to determine the nature of the polyp and exclude structural abnormalities or atypical endometrial changes.
To enable diagnostic difficulties and definitive diagnosis is the most reliable (97%) of the instrumental method of examination - hysteroscopy.The procedure allows to examine the entire uterus, including the hard to reach areas, assess the condition of the endometrium, to identify associated structural damage.Hysteroscopy allows you to pick up the material for subsequent histological examination.
final verdict belongs to the histological examination of endometrial polyp, the information content of which is close to 100%.
Glandular endometrial polyp
In women of reproductive age endometrial polyps usually have glandular structure.Glandular polyps differ predominance of stromal glandular component.The stroma of the polyp is presented loose connective tissue permeated mutated blood vessels (often have a twisted view of the glomeruli).The glands are arranged randomly within the polyp, are of different length and thickness.The structure of glandular polyp can be detected cysts formed during the expansion of the lumen of glands.
Glandular endometrial polyps develop mainly on the background of hormonal dysfunction, so along with glandular polyps in patients often identified other gormonozavicimye disease.
glandular polyp Symptoms depend on the specific clinical situation.If a polyp develops from endometrial unchanged, it does not provoke vivid symptoms.May include the scarce or spotting outside the state of menstruation.If a polyp has a medium to large size, the amount of lost blood during menstruation may increase.If women are hormonal disorders, the symptoms of glandular endometrial polyps may change due to availability.
Glandular endometrial polyps do not pose a threat to life of the patient, but deserve attention because of the potential unwanted transformation in adenomatous polyps, which are considered precancerous.Processes intensive proliferation (proliferation) of iron in the composition of the polyp give rise to cells with signs of atypia.These cells differ from other cells of the structure and the ability to multiply uncontrolled.If they become too much, endometrial polyp acquires the properties of malignancy.The probability of this negative scenario is small, but for the complete elimination of its development should be treated in time.