Endometrial polyps are soft tissue tumors of the endometrial cavity (uterus), ranging in size from a few millimeters to several centimeters, consisting of a body and a leg or a wide base. The presence of glandular structures of the stroma and blood vessels of the endometrial layer of the uterus in the polyps confirms their endometrial source. In practice, there are both polyps limited to the uterine cavity and polyps that sag to the cervix and even the vagina. Hypertension, obesity, the use of certain medications, and age may be risk factors for the development of polyps. Depending on the diagnostic methods and the patient groups studied, it is reported that approximately 7 to 35 percent of women suffer from this disease.
The most common complaint with polyps, whether during the childbearing period or after menopause, is bleeding. In the childbearing period, this manifests itself in the form of an increasing number of secretions and their duration, as well as the appearance of metrorrhagia (dysfunctional uterine bleeding). In patients who have gone through menopause, polyps are the cause of postmenopausal bleeding. Polyps rarely grow without causing complaints and are found by accident.
There is scientific evidence that polyps can cause infertility. Although it is not clear what mechanism causes infertility, according to some hypothesis, such deviation as a malfunction of the openings of the fallopian tubes (where the fallopian tube enters the uterus) that affect the promotion of sperm to the area, as well as problems with attachment of a fertilized egg to the endometrium or abnormal development of the resulting embryos can be the causes of infertility.
Most endometrial polyps are benign growths. However, depending on the study group, the probability of forming hyperplastic or malignant polyps varies between 0 and 12 percent. It is reported that the onset of menopause, hypertension, old age, the use of drugs like Tamoxifen, as well as the formation of larger polyps can cause the development of cancer.
Polyps are often diagnosed randomly during an ultrasound procedure of patients with irregular bleeding complaints. However, the sensitivity of diagnostic tests for the presence of polyps using ultrasound is not entirely accurate. Therefore, additional tests may be required to diagnose polyps. Saline infusion sonohysterography, performed by injecting a sterile saline solution into the uterine cavity and accompanying ultrasound, is an auxiliary diagnostic method that can be performed on an outpatient basis. If necessary, MRI can also be used for diagnostic purposes or differential diagnosis. The final diagnosis of endometrial polyps can be made using hysteroscopy. With the help of hysteroscopy, you can see the inside of the uterus and directly recognize existing pathologies using the camera.
Treatment of endometrial polyps is carried out by taking into account the characteristics of the patient and the polyp, not the general characteristics. The polyps, which are usually found by chance at childbearing age, can be less than one centimeter in size and cause no problems. There is a chance that this type of polyp may spontaneously disappear. Combined medications containing gonadotropin-releasing hormone analogs, estrogen and progesterone, as well as progesterone-only medications and progesterone-releasing intrauterine devices, also have a potentially reducing effect on polyps. Despite this, careful calculations of the safety, benefits, and harms of these treatments are always required at the beginning.
Hysteroscopy is a method of diagnosing and treating polyps. It helps to examine the inside of the uterus, as well as to treat polyps and other diseases. In addition to the polyp, other pathologies can also be recognized by hysteroscopy. To date, it is considered the most suitable option for the final diagnosis and treatment.