Endometrial polyps
The endometrial polyps They are hyperplastic proliferations, or excessive growths, of the endometrial glands and tissue surrounding a blood vessel. They form projections that protrude from the surface of the endometrium, the inner layer of the uterine cavity responsible for housing the embryo and menstrual cycles during pregnancy.
Due to the advancement in the use of transvaginal ultrasound and diagnostic hysteroscopy, the diagnosis of this pathology is increasing. Polyps are the most frequently found pathology during diagnostic hysteroscopy and are the cause of most surgical hysteroscopies.
Endometrial polyps
Causes
Alteration in the balance of estrogen/progesterone levels: Hormones that regulate the proliferation and menstrual release of the endometrium. Higher levels of these receptors are found inside polyps than in the surrounding normal endometrium. Both contribute to this irregular growth of the endometrial glands and their vascularization, giving rise to polyps.
Symptom
Most polyps are asymptomatic. and are usually diagnosed during a routine gynecological examination.
If they ever become symptomatic, they usually produce symptoms in relation to abnormal uterine bleedingThis is the most common symptom and occurs in 64 to 88 percent of women with polyps. Intermenstrual bleeding is the most common symptom in premenopausal women with endometrial polyps. The amount of bleeding is usually small and may only involve spotting.
Rarely, an endometrial polyp is visible during speculum examination of the external cervical os. Prolapsed polyps may be symptomatic or asymptomatic.
It is also frequent postcoital bleeding and it is a common finding in asymptomatic patients who consult for infertility.
El postmenopausal bleeding is another common presentation. Some postmenopausal women with polyps experience breakthrough bleeding during hormone therapy.
Factors riesgo
They increase the frequency of appearance High blood pressure, Diabetes, Obesity and age From 40 years, with the highest prevalence between 45 and 50 years of age. In addition to certain medications such as tamoxifen, which is essential to prevent recurrences in patients diagnosed with some types of breast cancer.
Classification of Endometrial Polyps
We can divide polyps into:
- Functional or Typical (20%): with an appearance similar to normal endometrium
- Hyperplastic (35%): with changes that indicate accelerated growth.
- Atrophic (40%): with changes with a tendency toward delayed or regressive growth, these are the polyps that we usually find in menopausal patients.
- Evil (1-5%): with cancer cells in the polyp.
The concept of Pseudopolyp It refers to thickened endometrial areas with a polyp-like appearance, smaller than 1 cm and which disappear after menstruation since they do not have their own vessels.
As to risk of malignancy Approximately 95 percent of endometrial polyps are benign. A systematic review of 17 observational studies involving more than 10 women reported that the incidence of malignant or hyperplastic polyps was significantly higher in postmenopausal women compared with premenopausal women (000 versus 5,4 percent) and in those with bleeding compared with those without (1,7 versus 4.2 percent).
Diagnosis
Ultrasound can diagnose the existence of an endometrial polyp either by direct visualization of the polyp and its vascularization using color Doppler or indirectly by detecting an area of abnormal endometrial growth.
Other techniques that can help us with the diagnosis are: hysterosalpingography also known as tubal radiography and sonohysterography or ultrasound with fluid infusion into the uterus.
La experiment gold standard for the diagnosis of polyps is the hysteroscopy, as it allows to confirm and locate the lesion, evaluate the endometrium in detail, establish an anatomopathological diagnosis with biopsies of the polyp and the endometrium, presenting a sensitivity and specificity between 95-100%.
Thanks to this concomitant test, diseases such as endometrial hyperplasia or different types of endometrial carcinoma can be diagnosed early.
Techniques that preceded hysteroscopy, such as uterine curettage, left more than 10% of polyps undiagnosed.
There is strong evidence that in postmenopausal women with bleeding and thickened endometrium and a negative blind endometrial biopsy (without hysteroscopic view), showed that 3% of women had endometrial cancer undiagnosed and 3% had endometrial hyperplasia with atypia in polyps.
Indications for treatment of endometrial polyps
In general, removal of any polyp that is symptomatic, meaning that it causes bleeding or infertility, is indicated.
In premenopausal patients with completely asymptomatic polyps that appear functional and are smaller than 10 mm, it may be appropriate to simply maintain a wait-and-see attitude, with ultrasound monitoring every 6 months to assess their growth.
Post-surgical advice
Hysteroscopic polypectomy is a simple technique, which is usually performed on an outpatient basis or in a day hospital.
The patient may experience slight genital bleeding for a few days after the intervention, as well as mild discomfort that usually subsides with treatment with anti-inflammatory (NSAID).
Most patients return to their daily lives within a few days.
Article published by the Dr. Alfonso Duque Frischkorn.
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