Endometrial polyp
| Endometrial polyp | |
|---|---|
| File:Polyp.Uterus.jpg
Endometrial polyp, viewed by sonography.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | N84.0 |
| ICD-9-CM | 621 |
| Patient UK | Endometrial polyp |
An endometrial polyp or uterine polyp is a mass in the inner lining of the uterus.[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 than 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, particularly in large polyps.[1]
Contents
Signs and symptoms
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 menstrual periods, or after menopause.[6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[4]
Cause
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] Risk factors include obesity, high blood pressure and a history of cervical polyps.[2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.[2][7] The use of an IntraUterine System containing levonorgestrel in women taking tamoxifen may reduce the incidence of polyps.[8]
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 missed by curettage.[9]
Endometrial polyps can be solitary or occur with others.[10] They are round or oval and measure between a few millimeters and several centimeters in diameter.[6][10] 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.[10] Pedunculated polyps are more common than sessile ones.[3]
Treatment
Polyps can be surgically removed using curettage with or without hysteroscopy.[11] When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.[6] Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted 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 (surgical removal of the uterus) may be performed.[2] A hysterectomy would usually not be considered if cancer has been ruled out.[6] Whichever method is used, polyps are usually treated under general anesthetic.[9]
It is unclear if removing polyps affects fertility as it has not been studied.[12]
Prognosis
Endometrial polyps are usually benign although some may be precancerous or cancerous.[2] About 0.5% of endometrial polyps contain adenocarcinoma cells.[13] 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 hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[6] Untreated, small polyps may regress on their own.[14]
Epidemiology
Endometrial polyps usually occur in women in their 40s and 50s.[2] 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.[7]
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 3.0 3.1 3.2 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 4.0 4.1 Dysmenorrhea: Menstrual abnormalities at Merck Manual of Diagnosis and Therapy Professional Edition
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 7.0 7.1 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 9.0 9.1 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ 10.0 10.1 10.2 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
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- ↑ Lua error in package.lua at line 80: module 'strict' not found.
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