Causes of the polyp of the endometrium.
The exact causes of the formation of endometrial polyps are not known. It is believed that a certain role is played by hormonal factors, because endometrial polyps respond to stimulation with estrogens, as well as the inner layer of the uterus. Unlike hyperplasia of the endometrium, polyps are excess tissue growth in only one place. On this basis, the formation of endometrial polyps does not exclude the role of infection (inflammation of the inner layer of the uterus – endometritis) and mechanical damage to the endometrium (abortion). Another theory of polyp formation is increased vascular growth in the uterus.
How the endometrial polyp is manifested.
With the polyps, the endometrium can not exist at all. In such cases, the polyp of the endometrium is an accidental finding either with a planned ultrasound, or in the examination of infertility.
With a polyp, the endometrium can be.
Scant blood allocation before or after menstruation.
Bleeding in the middle of the menstrual cycle.
Bloody discharge after a few months or years after menopause.
Infertility, failure of IVF.
Whether the endometrial polyps lead to infertility is a controversial issue. Nevertheless, the tactics of gynecologists all over the world are the same: when infertility and the detection of the polyp of the endometrium, it is necessary to perform hysteroscopy and remove the polyp. It is proved that in women with infertility, after removal of the endometrial polyp, the probability of pregnancy is significantly increased. Polyps of the endometrium may increase the risk of miscarriage after IVF. Therefore, the endometrial polyp is always removed before IVF. Endometrial polyps have one unpleasant property – they can arise repeatedly, which is due to the presence of a vascular pedicle. After reliable targeting of this leg, the risk of re-growth of the endometrial polyp is very low.
Endometrial polyps do not respond to hormonal treatment. The only way to get rid of the endometrial polyp is through surgical removal with hysteroscopy. In young women it is very important to remove the polyp of the endometrium and its pedicle without injuring the uterus. Therefore, the preferred method of removing polyps in young women is targeted removal of the polyp under the control of hysteroscopy, and not scraping the uterus blindly. It is after curettage blindly that the endometrial polyps resurface repeatedly, since the polyp stalk can not be removed completely. In women during the menopause, endometrial polyps often combine with endometrial hyperplasia, so it is mandatory to scrape the uterus.
After removal of the endometrial polyp, hormonal treatment may be required, especially if the polyp occurs repeatedly and there is a disturbance in the cycle. The choice of hormonal therapy in such cases is carried out individually, on the basis of concomitant diseases and pregnancy plans. Treatment after detection of an adenomatous polyp of the endometrium or polyp with the presence of atypical cells is carried out together with a gynecologist-oncologist. Pregnancy after such treatment is possible, both alone and after IVF. If the endometrial polyps are repeatedly formed in women during menopause, it is possible to perform a procedure to remove the entire inner layer of the uterus (this is called ablation of the endometrium). The question of the removal of the uterus is solved individually, taking into account the concomitant diseases. Removal of the uterus (hysterectomy) is carried out if cancer cells are detected in the endometrial polyp.