To make it easier to understand this topic, let’s remember how the uterus works. The uterus resembles a pear in shape, it has a cavity inside it – this is the place where the seeds of the pear are located. From the inside, the uterine cavity is lined with a mucous membrane called the endometrium. This shell has two layers: basal and functional. From the basal layer during each menstrual cycle, a new layer grows, which is called the functional layer. If there is no pregnancy, it is rejected during menstruation.
Polyps are outgrowths from this mucous membrane and have a rounded or oblong shape of various sizes, but most often they are no more than 1-2 cm. a Polyp can grow not only from the basal layer, but also from the functional one, and this is important. Polyps of the functional layer are rejected during menstruation and do not require any treatment, while polyps from the basal layer themselves can not be rejected and require removal.
Polyps most often manifest themselves as intermenstrual bloody secretions, profuse prolonged menstruation, bloody secretions before menstruation, during ovulation, as well as after sexual intercourse or during physical activity. Some of the polyps are asymptomatic, that is, they are detected accidentally during ultrasound. Polyps can also interfere with pregnancy, you have to be a cause of infertility.
ABOUT THE DIAGNOSIS OF POLYPS
Diagnosis of polyps is quite simple, they are easy to see during a normal ultrasound. After the initial diagnosis, it is necessary to repeat the ultrasound after menstruation to make sure what kind of polyp it is: if it is functional, it will disappear, and if the polyp is from the basal layer, it will remain. In some cases, you may be prescribed a drug for the second phase of the cycle to “improve” the rejection of the endometrium during menstruation.
If a polyp is detected on ultrasound, the procedure should be repeated after the next menstruation for 5-7 days.
In doubtful cases, ultrasound is supplemented with the introduction of a small amount of saline into the uterine cavity. This allows you to expand the uterine cavity and examine the presence of polyps in more detail.
Polyps in the vast majority of cases are benign, but they still require mandatory histological examination after removal. Often there is a situation when the endometrial polyp is not visible during ultrasound, but its signs are detected in the results of an aspiration biopsy of the endometrium and after that, scraping is prescribed. This is not entirely true. Aspiration biopsy most often shows the presence of functional polyps, which, as I wrote above, do not require removal.
Polyps growing from the basal layer require only removal, and medications do not have any effect on them. They are removed by hysteroresectoscopy. The procedure is outpatient, takes 10-15 minutes and requires no more than 2-3 hours in the clinic.
ABOUT TREATMENT OF ENDOMETRIAL POLYPS
Under intravenous anesthesia (in fact, medical sleep), a thin tube with a camera at the end is inserted into the uterine cavity through the vagina and the cervical canal. Inside this tube there is a channel for the introduction of tools. Under the control of vision, the polyp is cut off at the base, and the polyp bed is cauterized. That’s the whole procedure. The removed polyp is sent for histological examination.
There is no link between polyps and hormonal disorders.
Why polyps grow, no one knows, there is no connection between polyps and “hormonal disorders”. There are no ways to prevent polyps. Contraceptives are often prescribed after removal of polyps, but there are no reliable studies showing that this reduces the likelihood of relapse. You can get pregnant after removing an endometrial polyp by skipping one menstrual cycle. Thus, if a polyp is diagnosed, it just needs to be removed – and that’s all, no additional actions are required after that. Polyp removal is not a traumatic operation, it has minimal risks and is quite easy to perform. It is important to remove the polyp under the control of vision and be sure to cauterize its bed. Until now, in a number of clinics, the endometrial polyp is removed blindly, by scraping the walls of the uterus with a curette. In this case, only the protruding part of the polyp can be cut off, and this subsequently leads to a relapse. In fact, the most common cause of relapse of this disease is insufficient quality removal of this formation.
Polyps can recur. And most often this happens due to poor-quality removal of this education by a doctor.
ABOUT ENDOMETRIAL HYPERPLASIA
Endometrial hyperplasia-unlike a polyp, this is already a complete thickening of the entire uterine mucosa. There are two types of hyperplasia: simple and complex. Simple hyperplasia is a problem of one particular menstrual cycle. Endometrial growth is triggered by estrogens produced by the ovaries during the first phase of the menstrual cycle. They increase the thickness of the mucous membrane. This process should stop as soon as ovulation occurs, then progesterone – the second female hormone that stops the growth of the endometrium in thickness and begins its preparation for the beginning of pregnancy-comes to replace estrogen. Thus, if ovulation does not occur, the endometrium continues to grow further, as a rule, while a follicular cyst is formed in the ovary from the dominant follicle that has not burst. Clinically, this is manifested by delayed menstruation. Most often, this situation can be found after a change of climate or in women on the eve of menopause, when the regulation of the menstrual cycle begins to fail.
Simple endometrial hyperplasia also occurs in polycystic ovary syndrome. In this case, the follicles do not Mature, but there are quite a lot of them, and they collectively produce a lot of estrogens that grow the endometrium. Since ovulation does not occur in this syndrome, the yellow body is not formed, respectively, progesterone is not produced, and, in fact, there is no one to stop the growth of the mucous membrane. These patients also have periods with long delays.
Endometrial hyperplasia is a complete thickening of the entire uterine mucosa, often combined with the presence of a functional cyst in the ovary or with a polycystic ovarian structure.
When simple hyperplasia occurs, the endometrium looks thickened on ultrasound, and this is most often combined with the presence of a functional cyst in the ovary or with a polycystic ovarian structure. Since simple endometrial hyperplasia is an error of one particular cycle, this condition is not dangerous. In the presence of such hyperplasia, scraping of the uterine cavity is not required. A special drug is prescribed for 10 days (such treatment is also called “hormonal curettage”), after which an independent menstruation (usually quite abundant) takes place, and the thickness of the endometrium is evaluated again. In the vast majority of cases, it is thin and not changed. That’s all, the treatment of this disease ends, while the functional cyst disappears too. If endometrial hyperplasia was caused by polycystic ovary syndrome, treatment is prescribed for this particular disease.
ABOUT COMPLEX ENDOMETRIAL HYPERPLASIA
Complex endometrial hyperplasia is already a serious condition that has the risk of developing into cancer. Most likely, the formation of this disease is based on a breakdown in the sprouting layer of the endometrium. Most often, thickening of the endometrium in “complex” hyperplasia is not accompanied by a functional cyst or polycystic ovary, that is, there is not always a cause-and-effect relationship, although it is not excluded. Most often, complex hyperplasia occurs closer to or after menopause. Overweight, diabetes, irregular menstrual cycles, and age over 35 are also risk factors for developing complex hyperplasia.
Complex endometrial hyperplasia can go into Oncology.
With ultrasound, you can only suspect the presence of complex hyperplasia, in particular, the endometrium will be thickened immediately after menstruation. This hyperplasia does not respond to “hormonal curettage”, that is, it is not completely rejected after taking gestagenic drugs. The” gold standard ” for diagnosing endometrial hyperplasia is the histological method. Previously, the doctor can take a biopsy of your endometrium, in which atypical cells can be detected, but the final diagnosis is made only after scraping. This scraping is also called therapeutic and diagnostic, since it removes the entire modified endometrium, after which it is subjected to histological examination.
ABOUT TREATMENT OF ENDOMETRIAL HYPERPLASIA
Several approaches are used to treat complex endometrial hyperplasia. The doctor may prescribe injections of a special drug (gestagen) that causes temporary endometrial atrophy; this treatment takes about six months. For the same purpose, drugs that cause artificial menopause can be used. The effectiveness of this treatment is quite high, moreover, the patient may even become pregnant later, that is, the endometrium is restored completely, preserving all its functions. To prevent relapses after the main stage of treatment, a special hormone-containing spiral “Mirena”is often installed in the uterine cavity. In certain types of complex hyperplasia and when combined with other concomitant diseases, preference is given to removing the uterus, since complex hyperplasia can develop into endometrial cancer.
Complex endometrial hyperplasia can be treated with medication.
The diagnosis of “endometrial hyperplasia” in most cases is not dangerous, the main thing is not to miss the presence of “complex hyperplasia”, but, fortunately, this condition is much less common. I hope it has become clear that these two types of hyperplasia are different from each other, so it is important that the histological report should indicate which type of hyperplasia you have detected. Often, histologists do not use such a classification or misinterpret the histological picture, putting “complex hyperplasia” where it does not exist. Tip: if you have received a conclusion that you have signs of complex hyperplasia, then take the glasses of the drug and get a consultation on them again in a leading cancer clinic. Based on my practice, I can say that quite often this unpleasant diagnosis is removed, and it turns out that there is not even a simple hyperplasia.
The development of hyperplasia is influenced by excessive production of estrogens. It can be caused by the presence of a cyst or polycystic ovaries. Immediate treatment is required.
If you are diagnosed with simple hyperplasia, it is important to understand what led to excessive production of estrogens: a cyst, polycystic ovaries – and eliminate the cause. Thus, in the presence of simple hyperplasia, the endometrium is not treated, but the conditions that led to its appearance. A functional cyst is an error of one cycle, so there is no need for treatment, but the polycystic ovary syndrome requires correction.