Endometrial polyp
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An endometrial polyp or uterine polyp is a polyp or lesion in the lining of the uterus (endometrium) that takes up space within the uterine cavity. Commonly occurring, they are experienced by up to 10% of women.[1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).[1][2] Pedunculated polyps are more common that sessile ones.[3] They range in size from a few millimeters to several centimeters.[2] If pedunculated, they can protrude through the cervix into the vagina.[1][4] Small blood vessels may be present in polyps, particularly large ones.[1]
Cause and symptoms
No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.[2] They often cause no symptoms.[3] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.[2][5] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between mentstrual periods, or after menopause.[6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[4]
Diagnosis
Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.[2] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).[1] Larger polyps may be missied by curettage.[7]
Endometrial polyp with feeding vessel on power doppler image
Treatment
Polyps can be surgically removed using curettage or hysterescopy.[8] When curettage is performed, polyps may be missed. To reduce this risk, the uterues can be first explored using grasping forceps at the beginning of the curettage procedure.[6] During hysterescopy, the polyp can be visualized and removed through the cervix. If it is a large polyp, it can be cut into sections before each section is removed.[6] If cancerous cells are discovered, a hysterectomy may be performed.[2] A hysterectomy would usually not be cconsidered if cancer has been ruled out.[6] Whichever method is used, polyps are usually treated under general anesthetic.[7]
Prognosis and complications
Endometrial polyps are usually benign although some may be precancerous or cancerous.[2] About 0.5% of endometrial polyps contain adenocarcinoma cells.[9] Polyps can increase the risk of miscarriage in women undergoing IVF treatment.[2] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.[2] Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[6]
Risk factors and epidemiology
Endometrial polyps usually occur in women in their 40s and 50s.[2] Risk factors include obesity, high blood pressure, a history of cervical polyps.[2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.[2][10] Endometrial polyps occur in up to 10% of women.[1] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.[10]
Structure
Endometrial polyps can be solitary or occur with others.[11] They are round or oval and measure between a few millimeters to several centimeters in diameter.[11][6] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.[6] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.[6] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.[11] Pedunculated polyps are more common than sessile ones.[3]
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Bates, Jane (2007). Practical Gynaecological Ultrasound. Cambridge University Press. p. 65. ISBN 1900151510.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 "Uterine polyps". MayoClinic.com. 2006-04-27. Retrieved 2007-10-20.
- ↑ 3.0 3.1 3.2 Sternberg, Stephen S. (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0781740517. Unknown parameter
|coauthors=ignored (help) - ↑ 4.0 4.1 "Dysmenorrhea: Menstrual abnormalities". Merck Manual of Diagnosis and Therapy. 2005. Retrieved 2007-10-20.
- ↑ "Endometrial Polyp". GPnotebook. Retrieved 2007-10-20.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 DeCherney, Alan H. (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0838514014. Unknown parameter
|coauthors=ignored (help) - ↑ 7.0 7.1 Macnair, Trisha. "Ask the doctor - Uterine polyps". BBC Health. Retrieved 2007-10-21.
- ↑ "Uterine bleeding - Signs and Symptoms". UCSF Medical Center. 2007-05-08. Retrieved 2007-10-20.
- ↑ Rubin, Raphael (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 806. ISBN 0781795168. Unknown parameter
|coauthors=ignored (help) - ↑ 10.0 10.1 Edmonds, D. Keith (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing. p. 637. ISBN 1405156678. Unknown parameter
|coauthors=ignored (help) - ↑ 11.0 11.1 11.2 Bajo Arenas, José M. (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 184214331X. Unknown parameter
|coauthors=ignored (help)