Uterus polyps – the focal giperplaziya of endometrium which is characterized by pathological growth of a mucous cavity of a uterus in the form of single or multiple new growths on the wide basis or a leg. Polyps of a uterus are shown by uterine bleedings, periodic pains, infertility. Polyps of a uterus are diagnosed during comprehensive gynecologic examination – survey, ultrasonography, hysteroscopy, a histologic research. Treatment of polyps of a uterus surgical, including a polipektomiya and a curettage of a cavity of a uterus, sometimes – nadvlagalishchny amputation or an extirpation of a uterus.
Uterus polyps, or endometrium polyps, are the local good-quality outgrowths from a basal layer of endometrioidny cages towering over mucous a uterus in the form of separate hillocks. The size of polyps of a uterus varies over a wide range - from several millimeters (size of a sesame sunflower seed) to several centimeters (a ball for golf). Polyps of endometrium can be both single, and multiple, tied with a uterus wall a thin leg or the wide basis. In case of multiple polyps of endometrium speak about a uterus polypose.
Usually endometrioidny polyps do not extend for a uterus cavity, but in rare instances can sprout via the tservikalny channel in a vagina. Polyps of a uterus come to light at patients of various age groups – young girls, women of middle and climacteric age; frequency of pathology fluctuates from 6 to 20%. Polyps of endometrium are quite often combined with polyps of the tservikalny channel. Uterus polyps in gynecology are regarded as a precancer state and are subject to obligatory removal.
Classification of polyps of a uterus
The structure of a polyp of a uterus is presented by three main components: endometrialny glands, endometrialny stromy and central vascular channel. The surface of a polyp is covered with an epithelium, the leg includes fibrous to Strom and thick-walled vessels. Polyps of a uterus can , be infected, nekrotizirovatsya, be exposed to a cellular metaplaziya.
On morphological structure it is accepted to allocate polyps of a uterus of ferruterous, ferruterous and fibrous, fibrous and adenomatozny type. Polyps of a uterus of ferruterous type are formed by the fabric of endometrium containing glands; develop at young age more often. Ferruterous and fibrous polipozny educations are microscopically presented by glands of endometrium and connecting fabric (stromy); occur at women of mature age. Polyps of a uterus of fibrous type are formed by mainly dense connecting fabric at which there are single glands; such polyps are usually diagnosed for women 40 years are more senior. Adenomatozny polyps of a uterus consist of a ferruterous epithelium with signs of proliferation, restructuring of glands; have prerequisites to transition to endometrial cancer therefore require to themselves special attention.
Among uterus polyps separately distinguish the placentary polyps which are formed of fragments of a placenta unextracted completely owing to the complicated abortion, childbirth, spontaneous termination of pregnancy, the stood pregnancy. Placentary polyps of a uterus are shown by long, plentiful bleedings that can lead further to infection and infertility.
Reasons of development of polyps of a uterus
In genesis of polyps of a uterus the leading role is assigned to neurohormonal influence and inflammatory changes of endometrium. Uterus polyps, as a rule, develop against the background of hormonal dysfunction of ovaries and a giperestrogeniya which are followed by a focal giperplaziya of endometrium in the form of polipovidny growths of mucous. Along with uterus polyps other diseases caused by an estrogeniya - a ferruterous giperplaziya of endometrium, uterus fibroma, , mastopathy, polycystous ovaries etc. also can occur at such patients.
Emergence of polyps of a uterus is promoted by chronic sexually transmitted infections and female inflammatory diseases (the endometritis, adneksit, ooforit), a uterus travmatization surgical abortions, endometrium vyskablivaniye, long carrying Naval Forces. Women with arterial hypertension, obesity, diseases of a thyroid gland, diabetes, immune violations, psychological injuries treat risk group on development of polyps of endometrium.
Symptoms of polyps of a uterus
Irrespective of a structure of polyps of a uterus, all of them cause similar symptomatology. After the period of an asymptomatic current there are dysfunctional uterine bleedings which can have cyclic or acyclic character. At polyps of a uterus menorragiya – the plentiful monthly, sanious premenstrual allocations smearing blood allocations out of periods and after sexual intercourse, a metrorragiya, bleeding in a menopause are noted. Constant blood losses often lead to the considerable anemization which is followed by pallor of integuments, dizziness, weakness.
Emergence of pathological mucous is typical for polyps of a uterus of the big sizes is more white, skhvatkoobrazny pains in the bottom of a stomach, discomfort and pains during sexual intercourse. Endometrium polyps often cause infertility in women of reproductive age, at pregnant women - increase risks of an abortion and premature birth.
Diagnostics of polyps of a uterus
Inspection concerning polyps of a uterus includes collecting the gynecologic and reproductive anamnesis, carrying out vaginal survey, ultrasonography of a small pelvis, hysteroscopy and metrografiya, separate diagnostic scraping with a histologic research of endometrium.
At gynecologic survey in mirrors it is possible to find uterus neck polyps while polyps of endometrium are usually inaccessible to visualization and a palpation. When performing ultrasonography of a small pelvis existence of an expanded cavity of a uterus, reinforced endometrium with accurate growths of mucous uniform structure pays attention.
The standard of inspection at polyps of a uterus is carrying out hysteroscopy – survey of a cavity of a uterus the flexible device with the video camera entered via the tservikalny channel. At the same time visually in a cavity of a uterus single or multiple, roundish or oblong educations which color can be light pink, yellowish or dark-purple are defined. By means of hysteroscopy the quantity, the sizes, a location of polyps is defined, and also their one-stage removal under visual control from the subsequent morphological verification of the diagnosis is made.
For receiving samples of fabrics the diagnostic scraping of endometrium is also carried out. In the course of a metrografiya – a uterus cavity X-ray analysis with contrast substance uneven outlines of a cavity of a uterus and existence in them of polipovidny outgrowths come to light. Before planning of transtservikalny removal of polyps of a uterus inspection of the woman on infections (mycoplasmosis, clamidiosis, gonorrhea, trichomoniasis, candidiasis), a bacteriological, onkotsitologichesky and microscopic research of dabs from a genital tract is required.
Treatment of polyps of a uterus
As optimum method of treatment of polyps of a uterus serves the endoscopic polipektomiya - removal of educations during hysteroscopy with the subsequent scraping of endometrium. Polyps on a leg delete by means of "untwisting", cauterize a bed of a polyp electrothermic coagulation or by a cryogenic method for an exception of a recurrence. After a polipektomiya and a scraping for 3-4 days control gynecologic ultrasonography is carried out.
After a gisterorezektoskopiya of polyps of a uterus within 10 days the bloody smearing allocations from a genital tract, spasmodic pains can be noted. For prevention of an infection for this period sexual activity is limited. Further medical tactics is defined gistotipy a uterus polyp, age of the patient and the available violations of a menstrual cycle.
At fibrous structure of a polyp of a uterus and absence of menstrual dysfunction treatment is limited to a polipektomiya with a uterus curettage. Ferruterous or ferruterous and fibrous polyps of a uterus after their removal at any age demand additional hormonal treatment. Selection of oral contraception (the COOK - an ethenylestradiol in a combination with diyenogesty or dezogestrely), installation of hormonal intrauterine means of Mirren, treatment of a gestagenama is made for normalization of hormonal processes (progesterone, , ).
In case of identification of adenomatozny polyps of a uterus more radical treatment is required. To women of premenopauzalny and post-menopausal age removal of a uterus – nadvlagalishchny amputation or a hysterectomy is made. At an onkonastorozhennost or existence of endocrine violations performance of a pan-hysterectomy - removal of a uterus with an adneksektomiya is shown.
Forecast and prevention of polyps of a uterus
As feature of a current of polyps of a uterus serves their bent to a recurrence. Recidivous polyps of a uterus in 1,5% of cases are subject to malignant transformation; the greatest risk of development of endometrial cancer is accompanied by adenomatozny polyps. Therefore after the end of treatment concerning polyps of a uterus of the patient remain under observation of the gynecologist. In the absence of treatment of polyps of a uterus anemia, infertility develops. Existence of polyps of endometrium increases probability of an abortion and demands the accounting of this factor during conducting pregnancy.
Prevention of polyps of endometrium consists in a timely and careful prolechivaniye of inflammatory diseases of a uterus and appendages, correction of dysfunction of ovaries, careful carrying out intrauterine manipulations.