Endometrial polyps are the cause of the problem

  Endometrial polyps are single or multiple nodular masses protruding from the uterine cavity, which consist of endometrial glands and interstitium containing small blood vessels, and are a hyperproliferative disease of the endometrial basal layer. It is now mostly believed that its pathogenesis is the proliferation of the basal layer of the endometrium due to the long-term influence of a single estrogen. Because of the small size of the lesion, it is often missed and patients are not treated in a timely manner. Therefore, it is essential to know the common treatment methods.  The first symptoms of endometrial polyps are diverse and usually manifest as the following: 1. Irregular vaginal bleeding: Among the cases of abnormal uterine bleeding, those caused by endometrial polyps take the second place, second only to endometrial hyperplasia. It is only because the polyp tissue grows asynchronously with the endometrial tissue, the polyp is not easily shed, and there are dilated blood vessels under the epithelium on its surface, and the rupture of these microvessels causes spot bleeding in the middle of menstruation and postmenopausal bleeding. Usually patients visit the clinic because of abnormal vaginal bleeding, intermenstrual bleeding, postmenopausal abnormal bleeding, the amount of blood is sometimes more and sometimes less, and the dripping is not clean.  2.Menstrual flow: There are two reasons for this performance, one is that the endometrial polyp tissue increases the area of the uterine cavity, especially multiple polyps; the second is that the endometrial polyp lesions fill the uterine cavity, so that the uterus contraction is abnormal, so that the menstrual flow is high. Patients are mostly seen with increased menstrual flow secondary to previous menstrual flow.  3, color Doppler ultrasound diagnosis: ultrasound can diagnose more than half of the endometrial polyps, mostly selected in the proliferative phase, because the endometrium is thinner at this time, and the endometrial hypoechogenicity is easily distinguished from polyps with high echogenicity. However, it should be noted that there are limitations in relying on ultrasound to diagnose endometrial polyps, which are not easily detected by ultrasound for smaller polyps. When the patient has typical clinical manifestations, the uterine cavity should be fully examined under direct hysteroscopic view.  4, infertility: endometrial polyp itself is a foreign body to the uterine cavity, which prevents the fertilized egg from making contact with the endometrium. Endometrial polyp affects the local endometrial blood supply and interferes with the fertilized egg’s implantation and development, and located at the mouth of the fallopian tube can affect the fertilized egg’s entry into the uterine cavity. The polyp causes irregular bleeding in the endometrium, inflammatory reaction in the endometrium, and changes in the intrauterine environment, which is not conducive to sperm survival and fertilized egg implantation. Patients often come to the clinic with unexplained infertility, so polyp removal can improve the conception rate in women with no other cause of infertility.  These four conditions are the most common clinical manifestations of endometrial polyps. So how should they be treated?  Three methods can be used to treat endometrial polyps: the first is diagnostic scraping, but this method is based on the operator’s experience and sensory blind scraping, so it is easy to miss the diagnosis, and the positive rate of detection is low. The second method is endometrial resection, in which the basal layer of the endometrium is removed, but this method is not commonly used because of the large invasion and the tendency to cause uterine cavity adhesions. The third is hysteroscopic endometrial polypectomy, which can clarify the location and size of the polyps, with small invasion and easy recovery, so this method is mostly used in clinical treatment. After the surgery, the patient is advised to take oral mafron once a day for 21 days to prevent and control uterine adhesions and to antagonize the endometrial influence of a single estrogen. Later, progesterone therapy is given for half a cycle after menstruation for 3 cycles, with regular review.